hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|AR,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",general_contract_provisions,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Baptist Health Medical Center - Hot Spring County,1/1/2025,2.0.0,Baptist Health Medical Center - Hot Spring County,1001 Schneider Drive Malvern AR 72104,AR5048,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,standard_charge|min,standard_charge|max,additional_generic_notes,standard_charge|Aetna|all|negotiated_dollar,standard_charge|Aetna|all|negotiated_percentage,standard_charge|Aetna|all|negotiated_algorithm,estimated_amount|Aetna|all,standard_charge|Aetna|all|methodology,additional_payer_notes|Aetna|all,standard_charge|Blue Cross Blue Shield|all|negotiated_dollar,standard_charge|Blue Cross Blue Shield|all|negotiated_percentage,standard_charge|Blue Cross Blue Shield|all|negotiated_algorithm,estimated_amount|Blue Cross Blue Shield|all,standard_charge|Blue Cross Blue Shield|all|methodology,additional_payer_notes|Blue Cross Blue Shield|all,standard_charge|Cigna|all|negotiated_dollar,standard_charge|Cigna|all|negotiated_percentage,standard_charge|Cigna|all|negotiated_algorithm,estimated_amount|Cigna|all,standard_charge|Cigna|all|methodology,additional_payer_notes|Cigna|all,standard_charge|EHN|all|negotiated_dollar,standard_charge|EHN|all|negotiated_percentage,standard_charge|EHN|all|negotiated_algorithm,estimated_amount|EHN|all,standard_charge|EHN|all|methodology,additional_payer_notes|EHN|all,standard_charge|First Health|all|negotiated_dollar,standard_charge|First Health|all|negotiated_percentage,standard_charge|First Health|all|negotiated_algorithm,estimated_amount|First Health|all,standard_charge|First Health|all|methodology,additional_payer_notes|First Health|all,standard_charge|Health Advantage|all|negotiated_dollar,standard_charge|Health Advantage|all|negotiated_percentage,standard_charge|Health Advantage|all|negotiated_algorithm,estimated_amount|Health Advantage|all,standard_charge|Health Advantage|all|methodology,additional_payer_notes|Health Advantage|all,standard_charge|HealthLink|all|negotiated_dollar,standard_charge|HealthLink|all|negotiated_percentage,standard_charge|HealthLink|all|negotiated_algorithm,estimated_amount|HealthLink|all,standard_charge|HealthLink|all|methodology,additional_payer_notes|HealthLink|all,standard_charge|Multiplan|all|negotiated_dollar,standard_charge|Multiplan|all|negotiated_percentage,standard_charge|Multiplan|all|negotiated_algorithm,estimated_amount|Multiplan|all,standard_charge|Multiplan|all|methodology,additional_payer_notes|Multiplan|all,standard_charge|Municipal Health|all|negotiated_dollar,standard_charge|Municipal Health|all|negotiated_percentage,standard_charge|Municipal Health|all|negotiated_algorithm,estimated_amount|Municipal Health|all,standard_charge|Municipal Health|all|methodology,additional_payer_notes|Municipal Health|all,standard_charge|Qualchoice|all|negotiated_dollar,standard_charge|Qualchoice|all|negotiated_percentage,standard_charge|Qualchoice|all|negotiated_algorithm,estimated_amount|Qualchoice|all,standard_charge|Qualchoice|all|methodology,additional_payer_notes|Qualchoice|all,standard_charge|United HealthCare|all|negotiated_dollar,standard_charge|United HealthCare|all|negotiated_percentage,standard_charge|United HealthCare|all|negotiated_algorithm,estimated_amount|United HealthCare|all,standard_charge|United HealthCare|all|methodology,additional_payer_notes|United HealthCare|all,standard_charge|United Behavioral Health|all|negotiated_dollar,standard_charge|United Behavioral Health|all|negotiated_percentage,standard_charge|United Behavioral Health|all|negotiated_algorithm,estimated_amount|United Behavioral Health|all,standard_charge|United Behavioral Health|all|methodology,additional_payer_notes|United Behavioral Health|all,standard_charge|Vantos|all|negotiated_dollar,standard_charge|Vantos|all|negotiated_percentage,standard_charge|Vantos|all|negotiated_algorithm,estimated_amount|Vantos|all,standard_charge|Vantos|all|methodology,additional_payer_notes|Vantos|all,standard_charge|Zelis|all|negotiated_dollar,standard_charge|Zelis|all|negotiated_percentage,standard_charge|Zelis|all|negotiated_algorithm,estimated_amount|Zelis|all,standard_charge|Zelis|all|methodology,additional_payer_notes|Zelis|all,standard_charge|Ambetter|all|negotiated_dollar,standard_charge|Ambetter|all|negotiated_percentage,standard_charge|Ambetter|all|negotiated_algorithm,estimated_amount|Ambetter|all,standard_charge|Ambetter|all|methodology,additional_payer_notes|Ambetter|all,standard_charge|BCBS Exchange|all|negotiated_dollar,standard_charge|BCBS Exchange|all|negotiated_percentage,standard_charge|BCBS Exchange|all|negotiated_algorithm,estimated_amount|BCBS Exchange|all,standard_charge|BCBS Exchange|all|methodology,additional_payer_notes|BCBS Exchange|all,standard_charge|Aetna MA|all|negotiated_dollar,standard_charge|Aetna MA|all|negotiated_percentage,standard_charge|Aetna MA|all|negotiated_algorithm,estimated_amount|Aetna MA|all,standard_charge|Aetna MA|all|methodology,additional_payer_notes|Aetna MA|all,standard_charge|AR Superior Select MA|all|negotiated_dollar,standard_charge|AR Superior Select MA|all|negotiated_percentage,standard_charge|AR Superior Select MA|all|negotiated_algorithm,estimated_amount|AR Superior Select MA|all,standard_charge|AR Superior Select MA|all|methodology,additional_payer_notes|AR Superior Select MA|all,standard_charge|BCBS and Health Advantage MA|all|negotiated_dollar,standard_charge|BCBS and Health Advantage MA|all|negotiated_percentage,standard_charge|BCBS and Health Advantage MA|all|negotiated_algorithm,estimated_amount|BCBS and Health Advantage MA|all,standard_charge|BCBS and Health Advantage MA|all|methodology,additional_payer_notes|BCBS and Health Advantage MA|all,standard_charge|Essence MA|all|negotiated_dollar,standard_charge|Essence MA|all|negotiated_percentage,standard_charge|Essence MA|all|negotiated_algorithm,estimated_amount|Essence MA|all,standard_charge|Essence MA|all|methodology,additional_payer_notes|Essence MA|all,standard_charge|Humana MA|all|negotiated_dollar,standard_charge|Humana MA|all|negotiated_percentage,standard_charge|Humana MA|all|negotiated_algorithm,estimated_amount|Humana MA|all,standard_charge|Humana MA|all|methodology,additional_payer_notes|Humana MA|all,standard_charge|UHC MA|all|negotiated_dollar,standard_charge|UHC MA|all|negotiated_percentage,standard_charge|UHC MA|all|negotiated_algorithm,estimated_amount|UHC MA|all,standard_charge|UHC MA|all|methodology,additional_payer_notes|UHC MA|all,standard_charge|Wellcare and Wellcare by Allwell|all|negotiated_dollar,standard_charge|Wellcare and Wellcare by Allwell|all|negotiated_percentage,standard_charge|Wellcare and Wellcare by Allwell|all|negotiated_algorithm,estimated_amount|Wellcare and Wellcare by Allwell|all,standard_charge|Wellcare and Wellcare by Allwell|all|methodology,additional_payer_notes|Wellcare and Wellcare by Allwell|all,standard_charge|Empower (PASSE)|all|negotiated_dollar,standard_charge|Empower (PASSE)|all|negotiated_percentage,standard_charge|Empower (PASSE)|all|negotiated_algorithm,estimated_amount|Empower (PASSE)|all,standard_charge|Empower (PASSE)|all|methodology,additional_payer_notes|Empower (PASSE)|all,standard_charge|Summit Care (PASSE)|all|negotiated_dollar,standard_charge|Summit Care (PASSE)|all|negotiated_percentage,standard_charge|Summit Care (PASSE)|all|negotiated_algorithm,estimated_amount|Summit Care (PASSE)|all,standard_charge|Summit Care (PASSE)|all|methodology,additional_payer_notes|Summit Care (PASSE)|all,standard_charge|AR Total Care (PASSE)|all|negotiated_dollar,standard_charge|AR Total Care (PASSE)|all|negotiated_percentage,standard_charge|AR Total Care (PASSE)|all|negotiated_algorithm,estimated_amount|AR Total Care (PASSE)|all,standard_charge|AR Total Care (PASSE)|all|methodology,additional_payer_notes|AR Total Care (PASSE)|all,standard_charge|CareSource (PASSE)|all|negotiated_dollar,standard_charge|CareSource (PASSE)|all|negotiated_percentage,standard_charge|CareSource (PASSE)|all|negotiated_algorithm,estimated_amount|CareSource (PASSE)|all,standard_charge|CareSource (PASSE)|all|methodology,additional_payer_notes|CareSource (PASSE)|all
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,DRG,,,,Inpatient,,,1655060.97,413765.2425,48370,1406801.825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,1117578.509,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,923874.167,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,1049288.349,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,458551.7557,Other,CMS Methodology,,65.6,,1085719.996,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,923874.167,Other,"DRG Weight, with Charge Based Outlier",,70,,1158542.679,Percent of Total Billed Charges,,,85,,1406801.825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,444890.1302,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,1125441.46,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,437031.6397,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",579271.3395,Other,"DRG Weight, with Charge Based Outlier",,65,,1075789.631,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",414127,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,699044.011,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",278778,Other,CMS Methodology,,,"104.5% of Medicare, less IME",281472,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",272045,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",274738,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",274738,Other,CMS Methodology,,,"103% of Medicare, less IME",277432,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",282145,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,48370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,50537.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,49645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,48370,Other,AR Medicaid Methodology
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,DRG,,,,Inpatient,,,605245.26,151311.315,27120,557556.7614,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,557556.7614,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,415495.012,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,490478.8886,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,348885.0164,Other,CMS Methodology,,65.6,,397040.8906,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,415495.012,Other,"DRG Weight, with Charge Based Outlier",,70,,423671.682,Percent of Total Billed Charges,,,85,,514458.471,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,338490.6904,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,411566.7768,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,294877.3844,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",211835.841,Other,"DRG Weight, with Charge Based Outlier",,65,,393409.419,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",315085,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,301920.2744,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",212106,Other,CMS Methodology,,,"104.5% of Medicare, less IME",214155,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",206983,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",209032,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",209032,Other,CMS Methodology,,,"103% of Medicare, less IME",211081,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",214668,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,27120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,28225,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,27770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,27120,Other,AR Medicaid Methodology
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,DRG,,,,Inpatient,,,499128.92,124782.23,31370,424259.582,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,376679.681,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,277178.468,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,335677.288,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,230022.27,Other,CMS Methodology,,65.6,,327428.5715,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,277178.468,Other,"DRG Weight, with Charge Based Outlier",,70,,349390.244,Percent of Total Billed Charges,,,85,,424259.582,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,223169.22,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,339407.6656,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,194414.67,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",174695.122,Other,"DRG Weight, with Charge Based Outlier",,65,,324433.798,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",207738,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,201649.9144,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",139843,Other,CMS Methodology,,,"104.5% of Medicare, less IME",141194,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",136465,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",137816,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",137816,Other,CMS Methodology,,,"103% of Medicare, less IME",139167,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",141532,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,31370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,32687.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,32145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,31370,Other,AR Medicaid Methodology
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,DRG,,,,Inpatient,,,204055.92,51013.98,10120,173447.532,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,101281.043,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,70848.167,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,80129.115,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,87839.8561,Other,CMS Methodology,,65.6,,133860.6835,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,70848.167,Other,"DRG Weight, with Charge Based Outlier",,70,,142839.144,Percent of Total Billed Charges,,,85,,173447.532,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,85222.8446,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,138758.0256,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,74242.1881,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",71419.572,Other,"DRG Weight, with Charge Based Outlier",,65,,132636.348,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",79330,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,49005.5638,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",53403,Other,CMS Methodology,,,"104.5% of Medicare, less IME",53919,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",52113,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",52629,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",52629,Other,CMS Methodology,,,"103% of Medicare, less IME",53145,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",54048,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,DRG,,,,Inpatient,,,99419.94,24854.985,8420,84506.949,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,77026.449,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53881.581,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,60939.945,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,66804.1323,Other,CMS Methodology,,65.6,,65219.48064,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53881.581,Other,"DRG Weight, with Charge Based Outlier",,70,,69593.958,Percent of Total Billed Charges,,,85,,84506.949,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,64813.8378,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,67605.5592,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,56462.8083,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",51907.7013,Other,"DRG Weight, with Charge Based Outlier",,65,,64622.961,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",60332,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,37269.8034,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",40614,Other,CMS Methodology,,,"104.5% of Medicare, less IME",41006,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",39633,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",40025,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",40025,Other,CMS Methodology,,,"103% of Medicare, less IME",40418,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",41104,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,DRG,,,,Inpatient,,,370026.9,92506.725,22870,314522.865,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,209447.2937,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,145853.003,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,189136.5403,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,131226.6469,Other,CMS Methodology,,65.6,,242737.6464,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,145853.003,Other,"DRG Weight, with Charge Based Outlier",,70,,259018.83,Percent of Total Billed Charges,,,85,,314522.865,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,127317.0134,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,251618.292,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,138392.6749,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",129509.415,Other,"DRG Weight, with Charge Based Outlier",,65,,240517.485,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",118513,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,105219.5182,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",79780,Other,CMS Methodology,,,"104.5% of Medicare, less IME",80551,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",77853,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",78624,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",78624,Other,CMS Methodology,,,"103% of Medicare, less IME",79394,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",80743,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,22870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,23762.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,23395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,22870,Other,AR Medicaid Methodology
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,DRG,,,,Inpatient,,,88935.06,22233.765,5870,75594.801,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,51842.74,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,36265.06,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,41015.7,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,44962.598,Other,CMS Methodology,,65.6,,58341.39936,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,36265.06,Other,"DRG Weight, with Charge Based Outlier",,70,,62254.542,Percent of Total Billed Charges,,,85,,75594.801,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,43623.028,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,60475.8408,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,38002.358,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",34936.538,Other,"DRG Weight, with Charge Based Outlier",,65,,57807.789,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",40607,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,25084.484,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",27335,Other,CMS Methodology,,,"104.5% of Medicare, less IME",27599,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",26675,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",26939,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",26939,Other,CMS Methodology,,,"103% of Medicare, less IME",27203,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",27665,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,DRG,,,,Inpatient,,,189203.88,47300.97,16070,160823.298,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,107084.727,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,74907.963,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,84720.735,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,92873.3229,Other,CMS Methodology,,65.6,,124117.7453,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,74907.963,Other,"DRG Weight, with Charge Based Outlier",,70,,132442.716,Percent of Total Billed Charges,,,85,,160823.298,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,90106.3494,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,128658.6384,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,78496.4709,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",66221.358,Other,"DRG Weight, with Charge Based Outlier",,65,,122982.522,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",83876,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,51813.7182,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",56463,Other,CMS Methodology,,,"104.5% of Medicare, less IME",57008,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",55099,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",55644,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",55644,Other,CMS Methodology,,,"103% of Medicare, less IME",56190,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",57145,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,16622.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,16395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,DRG,,,,Inpatient,,,101734.78,25433.695,9270,86474.563,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,71357.909,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,49916.321,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,56455.245,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,61887.8743,Other,CMS Methodology,,65.6,,66738.01568,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,49916.321,Other,"DRG Weight, with Charge Based Outlier",,70,,71214.346,Percent of Total Billed Charges,,,85,,86474.563,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,60044.0498,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,69179.6504,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,52307.5903,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",48087.7033,Other,"DRG Weight, with Charge Based Outlier",,65,,66127.607,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",55892,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,34527.0394,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",37625,Other,CMS Methodology,,,"104.5% of Medicare, less IME",37989,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",36716,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",37080,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",37080,Other,CMS Methodology,,,"103% of Medicare, less IME",37443,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",38079,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,DRG,,,,Inpatient,,,147214.79,36803.6975,11820,125132.5715,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,83945.071,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,58721.299,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,66413.655,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,72804.5717,Other,CMS Methodology,,65.6,,96572.90224,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,58721.299,Other,"DRG Weight, with Charge Based Outlier",,70,,103050.353,Percent of Total Billed Charges,,,85,,125132.5715,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,70635.5062,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,100106.0572,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,61534.3757,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",56570.1227,Other,"DRG Weight, with Charge Based Outlier",,65,,95689.6135,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",65751,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,40617.4286,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",44262,Other,CMS Methodology,,,"104.5% of Medicare, less IME",44690,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",43193,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",43620,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",43620,Other,CMS Methodology,,,"103% of Medicare, less IME",44048,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",44796,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,DRG,,,,Inpatient,,,121728.86,30432.215,9270,103469.531,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,57409.922,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40159.418,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,45420.21,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,49790.9494,Other,CMS Methodology,,65.6,,79854.13216,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40159.418,Other,"DRG Weight, with Charge Based Outlier",,70,,85210.202,Percent of Total Billed Charges,,,85,,103469.531,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,48307.5284,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,82775.6248,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,42083.2774,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",38688.2314,Other,"DRG Weight, with Charge Based Outlier",,65,,79123.759,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",44967,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,27778.2052,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",30271,Other,CMS Methodology,,,"104.5% of Medicare, less IME",30563,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",29539,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",29832,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",29832,Other,CMS Methodology,,,"103% of Medicare, less IME",30124,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",30636,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,DRG,,,,Inpatient,,,90260.19,22565.0475,6720,76721.1615,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,46320.606,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32402.214,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,36646.83,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,40173.3162,Other,CMS Methodology,,65.6,,59210.68464,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32402.214,Other,"DRG Weight, with Charge Based Outlier",,70,,63182.133,Percent of Total Billed Charges,,,85,,76721.1615,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,38976.4332,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,61376.9292,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,33954.4602,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",31215.2022,Other,"DRG Weight, with Charge Based Outlier",,65,,58669.1235,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",36281,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22412.5596,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",24424,Other,CMS Methodology,,,"104.5% of Medicare, less IME",24660,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23834,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24070,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24070,Other,CMS Methodology,,,"103% of Medicare, less IME",24306,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24719,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
SPINAL PROCEDURES WITH MCC,28,DRG,,,,Inpatient,,,198557.92,49639.48,16070,168774.232,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,114112.215,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,79823.835,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,90280.575,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,98968.1805,Other,CMS Methodology,,65.6,,130253.9955,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,79823.835,Other,"DRG Weight, with Charge Based Outlier",,70,,138990.544,Percent of Total Billed Charges,,,85,,168774.232,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,96019.623,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,135019.3856,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,83647.8405,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",69495.272,Other,"DRG Weight, with Charge Based Outlier",,65,,129062.648,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",89380,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,55214.019,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",60168,Other,CMS Methodology,,,"104.5% of Medicare, less IME",60749,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",58715,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",59296,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",59296,Other,CMS Methodology,,,"103% of Medicare, less IME",59877,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",60895,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,16622.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,16395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,DRG,,,,Inpatient,,,103705.91,25926.4775,10970,88150.0235,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,63005.259,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,44073.471,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,49846.995,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,54643.7193,Other,CMS Methodology,,65.6,,68031.07696,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,44073.471,Other,"DRG Weight, with Charge Based Outlier",,70,,72594.137,Percent of Total Billed Charges,,,85,,88150.0235,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,53015.7198,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,70520.0188,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,46184.8353,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",42458.8983,Other,"DRG Weight, with Charge Based Outlier",,65,,67408.8415,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",49350,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,30485.5494,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",33221,Other,CMS Methodology,,,"104.5% of Medicare, less IME",33542,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",32418,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",32739,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",32739,Other,CMS Methodology,,,"103% of Medicare, less IME",33060,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",33622,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
SPINAL PROCEDURES WITHOUT CC/MCC,30,DRG,,,,Inpatient,,,62363.96,15590.99,7570,53009.366,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,41770.758,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29219.502,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33047.19,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36227.2866,Other,CMS Methodology,,65.6,,40910.75776,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29219.502,Other,"DRG Weight, with Charge Based Outlier",,70,,43654.772,Percent of Total Billed Charges,,,85,,53009.366,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35147.9676,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42407.4928,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30619.2786,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28149.0846,Other,"DRG Weight, with Charge Based Outlier",,65,,40536.574,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",32718,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20211.0828,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22025,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22237,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21493,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21705,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21705,Other,CMS Methodology,,,"103% of Medicare, less IME",21918,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22291,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,DRG,,,,Inpatient,,,110546.64,27636.66,10120,93964.644,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,78657.562,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,55022.578,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,62230.41,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,68218.7774,Other,CMS Methodology,,65.6,,72518.59584,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,55022.578,Other,"DRG Weight, with Charge Based Outlier",,70,,77382.648,Percent of Total Billed Charges,,,85,,93964.644,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,66186.3364,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,75171.7152,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,57658.4654,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",53006.8994,Other,"DRG Weight, with Charge Based Outlier",,65,,71855.316,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",61610,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,38059.0292,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",41474,Other,CMS Methodology,,,"104.5% of Medicare, less IME",41875,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",40472,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",40873,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",40873,Other,CMS Methodology,,,"103% of Medicare, less IME",41274,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",41975,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
VENTRICULAR SHUNT PROCEDURES WITH CC,32,DRG,,,,Inpatient,,,86907.12,21726.78,8420,73871.052,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40085.212,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28040.428,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31713.66,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34765.4324,Other,CMS Methodology,,65.6,,57011.07072,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28040.428,Other,"DRG Weight, with Charge Based Outlier",,70,,60834.984,Percent of Total Billed Charges,,,85,,73871.052,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33729.6664,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,59096.8416,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29383.7204,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27013.2044,Other,"DRG Weight, with Charge Based Outlier",,65,,56489.628,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31397,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19395.5192,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21136,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21340,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20625,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20829,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20829,Other,CMS Methodology,,,"103% of Medicare, less IME",21034,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21391,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,DRG,,,,Inpatient,,,39637.74,9909.435,5870,33692.079,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29947.535,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20948.915,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23693.175,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25973.1445,Other,CMS Methodology,,65.6,,26002.35744,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20948.915,Other,"DRG Weight, with Charge Based Outlier",,70,,27746.418,Percent of Total Billed Charges,,,85,,33692.079,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25199.327,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26953.6632,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21952.4845,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20181.4795,Other,"DRG Weight, with Charge Based Outlier",,65,,25764.531,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23457,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14490.331,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15790,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15943,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15409,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15562,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15562,Other,CMS Methodology,,,"103% of Medicare, less IME",15714,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15981,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,DRG,,,,Inpatient,,,95142.34,23785.585,8420,80870.989,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,72990.899,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51058.631,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,57747.195,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,63304.1473,Other,CMS Methodology,,65.6,,62413.37504,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51058.631,Other,"DRG Weight, with Charge Based Outlier",,70,,66599.638,Percent of Total Billed Charges,,,85,,80870.989,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,61418.1278,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,64696.7912,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,53504.6233,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",49188.1663,Other,"DRG Weight, with Charge Based Outlier",,65,,61842.521,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",57171,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,35317.1734,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",38486,Other,CMS Methodology,,,"104.5% of Medicare, less IME",38858,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",37556,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",37928,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",37928,Other,CMS Methodology,,,"103% of Medicare, less IME",38300,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",38951,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
CAROTID ARTERY STENT PROCEDURES WITH CC,35,DRG,,,,Inpatient,,,60816.05,15204.0125,6720,51693.6425,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42697.996,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29868.124,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33780.78,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,37031.4692,Other,CMS Methodology,,65.6,,39895.3288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29868.124,Other,"DRG Weight, with Charge Based Outlier",,70,,42571.235,Percent of Total Billed Charges,,,85,,51693.6425,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35928.1912,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41354.914,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31298.9732,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28773.9452,Other,"DRG Weight, with Charge Based Outlier",,65,,39530.4325,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33444,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20659.7336,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22513,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22731,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21970,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22187,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22187,Other,CMS Methodology,,,"103% of Medicare, less IME",22405,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22785,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,DRG,,,,Inpatient,,,48755.52,12188.88,5870,41442.192,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34407.287,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24068.603,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27221.535,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29841.0349,Other,CMS Methodology,,65.6,,31983.62112,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24068.603,Other,"DRG Weight, with Charge Based Outlier",,70,,34128.864,Percent of Total Billed Charges,,,85,,41442.192,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28951.9814,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33153.7536,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25221.6229,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23186.8819,Other,"DRG Weight, with Charge Based Outlier",,65,,31691.088,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26950,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16648.2142,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18142,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18317,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17704,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17879,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17879,Other,CMS Methodology,,,"103% of Medicare, less IME",18054,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18361,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
EXTRACRANIAL PROCEDURES WITH MCC,37,DRG,,,,Inpatient,,,126905.5,31726.375,10120,107869.675,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,62333.293,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,43603.417,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,49315.365,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,54060.9311,Other,CMS Methodology,,65.6,,83250.008,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,43603.417,Other,"DRG Weight, with Charge Based Outlier",,70,,88833.85,Percent of Total Billed Charges,,,85,,107869.675,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,52450.2946,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,86295.74,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,45692.2631,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",42006.0641,Other,"DRG Weight, with Charge Based Outlier",,65,,82488.575,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",48824,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,30160.4138,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",32867,Other,CMS Methodology,,,"104.5% of Medicare, less IME",33184,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",32073,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",32390,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",32390,Other,CMS Methodology,,,"103% of Medicare, less IME",32708,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",33264,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
EXTRACRANIAL PROCEDURES WITH CC,38,DRG,,,,Inpatient,,,78230.18,19557.545,7570,66495.653,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30244.101,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21156.369,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23927.805,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26230.3527,Other,CMS Methodology,,65.6,,51318.99808,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21156.369,Other,"DRG Weight, with Charge Based Outlier",,70,,54761.126,Percent of Total Billed Charges,,,85,,66495.653,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25448.8722,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,53196.5224,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22169.8767,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20381.3337,Other,"DRG Weight, with Charge Based Outlier",,65,,50849.617,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23689,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14633.8266,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15947,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16101,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15562,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15716,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15716,Other,CMS Methodology,,,"103% of Medicare, less IME",15870,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16139,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,DRG,,,,Inpatient,,,56541.89,14135.4725,5870,48060.6065,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21364.014,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14944.566,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16902.27,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18528.7578,Other,CMS Methodology,,65.6,,37091.47984,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14944.566,Other,"DRG Weight, with Charge Based Outlier",,70,,39579.323,Percent of Total Billed Charges,,,85,,48060.6065,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17976.7308,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38448.4852,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15660.4938,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14397.0918,Other,"DRG Weight, with Charge Based Outlier",,65,,36752.2285,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16734,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10337.1324,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11265,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11373,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10993,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11101,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11101,Other,CMS Methodology,,,"103% of Medicare, less IME",11210,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11401,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,DRG,,,,Inpatient,,,144015.38,36003.845,12670,122413.073,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,70802.317,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,49527.673,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,56015.685,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,61406.0159,Other,CMS Methodology,,65.6,,94474.08928,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,49527.673,Other,"DRG Weight, with Charge Based Outlier",,70,,100810.766,Percent of Total Billed Charges,,,85,,122413.073,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,59576.5474,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,97930.4584,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,51900.3239,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",47713.2929,Other,"DRG Weight, with Charge Based Outlier",,65,,93609.997,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",55457,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,34258.2122,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",37332,Other,CMS Methodology,,,"104.5% of Medicare, less IME",37693,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",36430,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",36791,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",36791,Other,CMS Methodology,,,"103% of Medicare, less IME",37152,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",37783,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,DRG,,,,Inpatient,,,97879.88,24469.97,10120,83197.898,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42386.414,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29650.166,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33534.27,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36761.2378,Other,CMS Methodology,,65.6,,64209.20128,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29650.166,Other,"DRG Weight, with Charge Based Outlier",,70,,68515.916,Percent of Total Billed Charges,,,85,,83197.898,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35666.0108,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,66558.3184,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31070.5738,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28563.9718,Other,"DRG Weight, with Charge Based Outlier",,65,,63621.922,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33200,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20508.9724,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22349,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22565,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21809,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22025,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22025,Other,CMS Methodology,,,"103% of Medicare, less IME",22241,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22619,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,DRG,,,,Inpatient,,,44972.27,11243.0675,6720,38226.4295,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32990.152,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23077.288,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26100.36,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28611.9704,Other,CMS Methodology,,65.6,,29501.80912,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23077.288,Other,"DRG Weight, with Charge Based Outlier",,70,,31480.589,Percent of Total Billed Charges,,,85,,38226.4295,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27759.5344,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30581.1436,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24182.8184,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22231.8824,Other,"DRG Weight, with Charge Based Outlier",,65,,29231.9755,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25840,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15962.5232,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17395,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17563,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16975,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17143,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17143,Other,CMS Methodology,,,"103% of Medicare, less IME",17311,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17605,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,DRG,,,,Inpatient,,,50040.3,12510.075,9270,42534.255,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37774.625,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26424.125,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29885.625,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32761.4875,Other,CMS Methodology,,65.6,,32826.4368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26424.125,Other,"DRG Weight, with Charge Based Outlier",,70,,35028.21,Percent of Total Billed Charges,,,85,,42534.255,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31785.425,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34027.404,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27689.9875,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25456.1125,Other,"DRG Weight, with Charge Based Outlier",,65,,32526.195,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29588,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18277.525,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19917,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20110,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19436,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19629,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19629,Other,CMS Methodology,,,"103% of Medicare, less IME",19821,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20158,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,DRG,,,,Inpatient,,,44340.88,11085.22,8368.1548,37689.748,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17294.678,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12097.982,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13682.79,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14999.4706,Other,CMS Methodology,,65.6,,29087.61728,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12097.982,Other,"DRG Weight, with Charge Based Outlier",,70,,31038.616,Percent of Total Billed Charges,,,85,,37689.748,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14552.5916,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30151.7984,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12677.5426,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11654.7886,Other,"DRG Weight, with Charge Based Outlier",,65,,28821.572,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13546,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8368.1548,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9119,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9207,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8899,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8987,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8987,Other,CMS Methodology,,,"103% of Medicare, less IME",9075,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9229,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,DRG,,,,Inpatient,,,47429.24,11857.31,8420,40314.854,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28138.107,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19683.183,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22261.635,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24403.8489,Other,CMS Methodology,,65.6,,31113.58144,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19683.183,Other,"DRG Weight, with Charge Based Outlier",,70,,33200.468,Percent of Total Billed Charges,,,85,,40314.854,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23676.7854,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,32251.8832,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20626.1169,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18962.1159,Other,"DRG Weight, with Charge Based Outlier",,65,,30829.006,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22040,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13614.8262,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14836,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14980,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14478,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14621,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14621,Other,CMS Methodology,,,"103% of Medicare, less IME",14765,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15016,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,DRG,,,,Inpatient,,,35259.03,8814.7575,7570,29970.1755,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20478.07,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14324.83,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16201.35,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17760.389,Other,CMS Methodology,,65.6,,23129.92368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14324.83,Other,"DRG Weight, with Charge Based Outlier",,70,,24681.321,Percent of Total Billed Charges,,,85,,29970.1755,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17231.254,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23976.1404,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15011.069,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13800.059,Other,"DRG Weight, with Charge Based Outlier",,65,,22918.3695,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16040,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9908.462,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10798,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10902,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10537,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10641,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10641,Other,CMS Methodology,,,"103% of Medicare, less IME",10745,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10928,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,DRG,,,,Inpatient,,,76676.5,19169.125,14370,65175.025,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,47001.957,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32878.833,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,37185.885,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,40764.2439,Other,CMS Methodology,,65.6,,50299.784,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32878.833,Other,"DRG Weight, with Charge Based Outlier",,70,,53673.55,Percent of Total Billed Charges,,,85,,65175.025,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,39549.7554,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52140.02,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,34453.9119,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",31674.3609,Other,"DRG Weight, with Charge Based Outlier",,65,,49839.725,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",36815,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22742.2362,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",24783,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25022,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",24184,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24424,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24424,Other,CMS Methodology,,,"103% of Medicare, less IME",24663,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25082,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,DRG,,,,Inpatient,,,69115.32,17278.83,12119.0208,58748.022,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25046.688,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17520.672,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19815.84,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21722.6976,Other,CMS Methodology,,65.6,,45339.64992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17520.672,Other,"DRG Weight, with Charge Based Outlier",,70,,48380.724,Percent of Total Billed Charges,,,85,,58748.022,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21075.5136,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,46998.4176,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29352.0096,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16878.8256,Other,"DRG Weight, with Charge Based Outlier",,65,,44924.958,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19618,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12119.0208,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13206,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13334,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12887,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13015,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13015,Other,CMS Methodology,,,"103% of Medicare, less IME",13143,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13366,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,DRG,,,,Inpatient,,,63186.07,15796.5175,11820,53708.1595,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34647.543,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24236.667,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27411.615,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30049.4061,Other,CMS Methodology,,65.6,,41450.06192,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24236.667,Other,"DRG Weight, with Charge Based Outlier",,70,,44230.249,Percent of Total Billed Charges,,,85,,53708.1595,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29154.1446,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42966.5276,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25397.7381,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23348.7891,Other,"DRG Weight, with Charge Based Outlier",,65,,41070.9455,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27138,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16764.4638,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18269,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18445,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17827,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18004,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18004,Other,CMS Methodology,,,"103% of Medicare, less IME",18180,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18489,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,DRG,,,,Inpatient,,,42445.13,10611.2825,8420,36078.3605,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22966.972,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16065.868,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18170.46,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19918.9844,Other,CMS Methodology,,65.6,,27844.00528,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16065.868,Other,"DRG Weight, with Charge Based Outlier",,70,,29711.591,Percent of Total Billed Charges,,,85,,36078.3605,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19325.5384,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28862.6884,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16835.5124,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15477.3164,Other,"DRG Weight, with Charge Based Outlier",,65,,27589.3345,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17989,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11112.7352,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12110,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12227,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11817,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11934,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11934,Other,CMS Methodology,,,"103% of Medicare, less IME",12051,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12256,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,DRG,,,,Inpatient,,,37758.23,9439.5575,8104.7768,32094.4955,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16750.348,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11717.212,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13252.14,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14527.3796,Other,CMS Methodology,,65.6,,24769.39888,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11717.212,Other,"DRG Weight, with Charge Based Outlier",,70,,26430.761,Percent of Total Billed Charges,,,85,,32094.4955,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14094.5656,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25675.5964,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12278.5316,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11287.9676,Other,"DRG Weight, with Charge Based Outlier",,65,,24542.8495,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13120,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8104.7768,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8832,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8917,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8619,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8704,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8704,Other,CMS Methodology,,,"103% of Medicare, less IME",8789,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8939,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,DRG,,,,Inpatient,,,96205.42,24051.355,9270,81774.607,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,50742.818,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35495.642,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,40145.49,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,44008.6486,Other,CMS Methodology,,65.6,,63110.75552,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35495.642,Other,"DRG Weight, with Charge Based Outlier",,70,,67343.794,Percent of Total Billed Charges,,,85,,81774.607,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,42697.4996,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,65419.6856,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,37196.0806,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",34195.3066,Other,"DRG Weight, with Charge Based Outlier",,65,,62533.523,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",39745,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24552.2788,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",26755,Other,CMS Methodology,,,"104.5% of Medicare, less IME",27014,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",26109,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",26367,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",26367,Other,CMS Methodology,,,"103% of Medicare, less IME",26626,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",27078,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,DRG,,,,Inpatient,,,61601.82,15400.455,7570,52361.547,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33427.493,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23383.217,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26446.365,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28991.2711,Other,CMS Methodology,,65.6,,40410.79392,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23383.217,Other,"DRG Weight, with Charge Based Outlier",,70,,43121.274,Percent of Total Billed Charges,,,85,,52361.547,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28127.5346,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41889.2376,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24503.4031,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22526.6041,Other,"DRG Weight, with Charge Based Outlier",,65,,40041.183,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26183,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16174.1338,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17625,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17796,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17200,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17370,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17370,Other,CMS Methodology,,,"103% of Medicare, less IME",17540,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17838,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,DRG,,,,Inpatient,,,53468.61,13367.1525,6720,45448.3185,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26368.096,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18445.024,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20861.28,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22868.7392,Other,CMS Methodology,,65.6,,35075.40816,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18445.024,Other,"DRG Weight, with Charge Based Outlier",,70,,37428.027,Percent of Total Billed Charges,,,85,,45448.3185,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22187.4112,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36358.6548,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19328.6432,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17769.3152,Other,"DRG Weight, with Charge Based Outlier",,65,,34754.5965,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20653,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12758.3936,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13903,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14037,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13567,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13702,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13702,Other,CMS Methodology,,,"103% of Medicare, less IME",13836,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14071,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,DRG,,,,Inpatient,,,76752.44,19188.11,10120,65239.574,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37337.284,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26118.196,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29539.62,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32382.1868,Other,CMS Methodology,,65.6,,50349.60064,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26118.196,Other,"DRG Weight, with Charge Based Outlier",,70,,53726.708,Percent of Total Billed Charges,,,85,,65239.574,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31417.4248,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52191.6592,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27369.4028,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25161.3908,Other,"DRG Weight, with Charge Based Outlier",,65,,49889.086,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29245,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18065.9144,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19687,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19877,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19211,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19402,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19402,Other,CMS Methodology,,,"103% of Medicare, less IME",19592,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19925,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,DRG,,,,Inpatient,,,40503.62,10125.905,7570,34428.077,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19087.213,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13351.897,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15100.965,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16554.1151,Other,CMS Methodology,,65.6,,26570.37472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13351.897,Other,"DRG Weight, with Charge Based Outlier",,70,,28352.534,Percent of Total Billed Charges,,,85,,34428.077,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16060.9186,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27542.4616,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13991.5271,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12862.7681,Other,"DRG Weight, with Charge Based Outlier",,65,,26327.353,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14950,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9235.4858,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10064,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10161,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9821,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9918,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9918,Other,CMS Methodology,,,"103% of Medicare, less IME",10016,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10186,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,DRG,,,,Inpatient,,,32712.31,8178.0775,6251.1406,27805.4635,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12919.391,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9037.379,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10221.255,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11204.8357,Other,CMS Methodology,,65.6,,21459.27536,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9037.379,Other,"DRG Weight, with Charge Based Outlier",,70,,22898.617,Percent of Total Billed Charges,,,85,,27805.4635,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10871.0102,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22244.3708,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9470.3197,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8706.3067,Other,"DRG Weight, with Charge Based Outlier",,65,,21263.0015,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10119,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6251.1406,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6812,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6878,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6647,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6713,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6713,Other,CMS Methodology,,,"103% of Medicare, less IME",6779,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6894,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,DRG,,,,Inpatient,,,58117.59,14529.3975,8420,49399.9515,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27308.473,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19102.837,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21605.265,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23684.3171,Other,CMS Methodology,,65.6,,38125.13904,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19102.837,Other,"DRG Weight, with Charge Based Outlier",,70,,40682.313,Percent of Total Billed Charges,,,85,,49399.9515,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22978.6906,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,39519.9612,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20017.9691,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18403.0301,Other,"DRG Weight, with Charge Based Outlier",,65,,37776.4335,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21390,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13213.4018,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14399,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14538,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14051,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14190,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14190,Other,CMS Methodology,,,"103% of Medicare, less IME",14329,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14573,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,DRG,,,,Inpatient,,,38765.15,9691.2875,6720,32950.3775,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16545.755,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11574.095,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13090.275,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14349.9385,Other,CMS Methodology,,65.6,,25429.9384,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11574.095,Other,"DRG Weight, with Charge Based Outlier",,70,,27135.605,Percent of Total Billed Charges,,,85,,32950.3775,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13922.411,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26360.302,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12128.5585,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11150.0935,Other,"DRG Weight, with Charge Based Outlier",,65,,25197.3475,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12960,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8005.783,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8724,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8808,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8513,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8598,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8598,Other,CMS Methodology,,,"103% of Medicare, less IME",8682,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8829,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,DRG,,,,Inpatient,,,36223.78,9055.945,6720,30790.213,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15017.877,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10505.313,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11881.485,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13024.8279,Other,CMS Methodology,,65.6,,23762.79968,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10505.313,Other,"DRG Weight, with Charge Based Outlier",,70,,25356.646,Percent of Total Billed Charges,,,85,,30790.213,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12636.7794,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24632.1704,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11008.5759,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10120.4649,Other,"DRG Weight, with Charge Based Outlier",,65,,23545.457,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11763,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7266.5082,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7918,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7995,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7727,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7804,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7804,Other,CMS Methodology,,,"103% of Medicare, less IME",7880,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8014,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,70,DRG,,,,Inpatient,,,62229.1,15557.275,10970,52894.735,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32637.276,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22830.444,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25821.18,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28305.9252,Other,CMS Methodology,,65.6,,40822.2896,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22830.444,Other,"DRG Weight, with Charge Based Outlier",,70,,43560.37,Percent of Total Billed Charges,,,85,,52894.735,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27462.6072,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42315.788,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23924.1492,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21994.0812,Other,"DRG Weight, with Charge Based Outlier",,65,,40448.915,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25564,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15791.7816,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17209,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17375,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16793,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16959,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16959,Other,CMS Methodology,,,"103% of Medicare, less IME",17126,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17417,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,71,DRG,,,,Inpatient,,,52556.77,13139.1925,9571.5198,44673.2545,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19781.703,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13837.707,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15650.415,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17156.4381,Other,CMS Methodology,,65.6,,34477.24112,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13837.707,Other,"DRG Weight, with Charge Based Outlier",,70,,36789.739,Percent of Total Billed Charges,,,85,,44673.2545,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16645.2966,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35738.6036,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14500.6101,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13330.7811,Other,"DRG Weight, with Charge Based Outlier",,65,,34161.9005,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15494,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9571.5198,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10430,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10531,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10178,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10279,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10279,Other,CMS Methodology,,,"103% of Medicare, less IME",10380,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10556,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,DRG,,,,Inpatient,,,40315.1,10078.775,6813.3164,34267.835,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14081.254,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9850.126,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11140.47,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12212.5058,Other,CMS Methodology,,65.6,,26446.7056,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9850.126,Other,"DRG Weight, with Charge Based Outlier",,70,,28220.57,Percent of Total Billed Charges,,,85,,34267.835,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11848.6588,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27414.268,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10322.0018,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9489.2798,Other,"DRG Weight, with Charge Based Outlier",,65,,26204.815,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11029,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6813.3164,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7425,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7496,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7245,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7317,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7317,Other,CMS Methodology,,,"103% of Medicare, less IME",7389,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7514,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,DRG,,,,Inpatient,,,46133.83,11533.4575,8420,39213.7555,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29010.912,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20293.728,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22952.16,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25160.8224,Other,CMS Methodology,,65.6,,30263.79248,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20293.728,Other,"DRG Weight, with Charge Based Outlier",,70,,32293.681,Percent of Total Billed Charges,,,85,,39213.7555,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24411.2064,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31371.0044,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21265.9104,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19550.2944,Other,"DRG Weight, with Charge Based Outlier",,65,,29986.9895,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22723,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14037.1392,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15297,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15444,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14927,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15075,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15075,Other,CMS Methodology,,,"103% of Medicare, less IME",15223,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15481,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,DRG,,,,Inpatient,,,40377.8,10094.45,7570,34321.13,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19565.848,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13686.712,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15479.64,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16969.2296,Other,CMS Methodology,,65.6,,26487.8368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13686.712,Other,"DRG Weight, with Charge Based Outlier",,70,,28264.46,Percent of Total Billed Charges,,,85,,34321.13,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16463.6656,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27456.904,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14342.3816,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13185.3176,Other,"DRG Weight, with Charge Based Outlier",,65,,26245.57,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15325,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9467.0768,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10317,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10416,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10067,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10167,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10167,Other,CMS Methodology,,,"103% of Medicare, less IME",10267,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10441,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
VIRAL MENINGITIS WITH CC/MCC,75,DRG,,,,Inpatient,,,44900.93,11225.2325,8420,38165.7905,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31199.494,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21824.686,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24683.67,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27058.9538,Other,CMS Methodology,,65.6,,29455.01008,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21824.686,Other,"DRG Weight, with Charge Based Outlier",,70,,31430.651,Percent of Total Billed Charges,,,85,,38165.7905,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26252.7868,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30532.6324,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22870.2098,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21025.1678,Other,"DRG Weight, with Charge Based Outlier",,65,,29185.6045,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24437,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15096.1004,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16451,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16610,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16053,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16212,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16212,Other,CMS Methodology,,,"103% of Medicare, less IME",16371,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16649,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
VIRAL MENINGITIS WITHOUT CC/MCC,76,DRG,,,,Inpatient,,,22083.45,5520.8625,6720,18770.9325,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17210.213,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12038.897,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13615.965,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14926.2151,Other,CMS Methodology,,65.6,,14486.7432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12038.897,Other,"DRG Weight, with Charge Based Outlier",,70,,15458.415,Percent of Total Billed Charges,,,85,,18770.9325,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14481.5186,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,15016.746,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12615.6271,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11597.8681,Other,"DRG Weight, with Charge Based Outlier",,65,,14354.2425,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13480,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8327.2858,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9074,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9162,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8855,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8943,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8943,Other,CMS Methodology,,,"103% of Medicare, less IME",9031,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9184,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
HYPERTENSIVE ENCEPHALOPATHY WITH MCC,77,DRG,,,,Inpatient,,,56502.43,14125.6075,8420,48027.0655,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29024.051,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20302.919,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22962.555,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25172.2177,Other,CMS Methodology,,65.6,,37065.59408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20302.919,Other,"DRG Weight, with Charge Based Outlier",,70,,39551.701,Percent of Total Billed Charges,,,85,,48027.0655,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24422.2622,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38421.6524,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21275.5417,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19559.1487,Other,"DRG Weight, with Charge Based Outlier",,65,,36726.5795,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22734,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14043.4966,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15304,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15451,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14934,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15082,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15082,Other,CMS Methodology,,,"103% of Medicare, less IME",15230,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15488,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
HYPERTENSIVE ENCEPHALOPATHY WITH CC,78,DRG,,,,Inpatient,,,42334.93,10583.7325,7570,35984.6905,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18730.583,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13102.427,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14818.815,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16244.8141,Other,CMS Methodology,,65.6,,27771.71408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13102.427,Other,"DRG Weight, with Charge Based Outlier",,70,,29634.451,Percent of Total Billed Charges,,,85,,35984.6905,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15760.8326,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28787.7524,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13730.1061,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12622.4371,Other,"DRG Weight, with Charge Based Outlier",,65,,27517.7045,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14671,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9062.9278,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9876,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9972,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9638,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9733,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9733,Other,CMS Methodology,,,"103% of Medicare, less IME",9828,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9995,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,79,DRG,,,,Inpatient,,,40690.15,10172.5375,5870,34586.6275,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12418.232,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8686.808,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9824.76,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10770.1864,Other,CMS Methodology,,65.6,,26692.7384,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8686.808,Other,"DRG Weight, with Charge Based Outlier",,70,,28483.105,Percent of Total Billed Charges,,,85,,34586.6275,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10449.3104,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27669.302,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9102.9544,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8368.5784,Other,"DRG Weight, with Charge Based Outlier",,65,,26448.5975,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9727,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6008.6512,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6548,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6611,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6390,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6453,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6453,Other,CMS Methodology,,,"103% of Medicare, less IME",6516,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6627,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,DRG,,,,Inpatient,,,39709.3,9927.325,7570,36958.13,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36958.13,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25852.97,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29239.65,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32053.351,Other,CMS Methodology,,65.6,,26049.3008,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25852.97,Other,"DRG Weight, with Charge Based Outlier",,70,,27796.51,Percent of Total Billed Charges,,,85,,33752.905,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31098.386,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27002.324,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27091.471,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24905.881,Other,"DRG Weight, with Charge Based Outlier",,65,,25811.045,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28948,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17882.458,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19487,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19675,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19016,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19205,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19205,Other,CMS Methodology,,,"103% of Medicare, less IME",19393,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19722,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,DRG,,,,Inpatient,,,46468.2,11617.05,7570,39497.97,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16983.096,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11880.024,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13436.28,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14729.2392,Other,CMS Methodology,,65.6,,30483.1392,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11880.024,Other,"DRG Weight, with Charge Based Outlier",,70,,32527.74,Percent of Total Billed Charges,,,85,,39497.97,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14290.4112,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31598.376,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12449.1432,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11444.8152,Other,"DRG Weight, with Charge Based Outlier",,65,,30204.33,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13302,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8217.3936,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8955,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9041,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8738,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8825,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8825,Other,CMS Methodology,,,"103% of Medicare, less IME",8911,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9063,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,DRG,,,,Inpatient,,,90913.72,22728.43,10970,77276.662,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,43550.154,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30464.226,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,34454.97,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,37770.5358,Other,CMS Methodology,,65.6,,59639.40032,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30464.226,Other,"DRG Weight, with Charge Based Outlier",,70,,63639.604,Percent of Total Billed Charges,,,85,,77276.662,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,36645.2388,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,61821.3296,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31923.6318,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",29348.2098,Other,"DRG Weight, with Charge Based Outlier",,65,,59093.918,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",34111,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21072.0564,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22963,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23185,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22408,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22630,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22630,Other,CMS Methodology,,,"103% of Medicare, less IME",22852,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",23240,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,DRG,,,,Inpatient,,,52150.96,13037.74,8420,44328.316,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26097.808,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18255.952,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20647.44,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22634.3216,Other,CMS Methodology,,65.6,,34211.02976,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18255.952,Other,"DRG Weight, with Charge Based Outlier",,70,,36505.672,Percent of Total Billed Charges,,,85,,44328.316,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21959.9776,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35462.6528,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19130.5136,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17587.1696,Other,"DRG Weight, with Charge Based Outlier",,65,,33898.124,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20442,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12627.6128,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13761,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13894,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13428,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13561,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13561,Other,CMS Methodology,,,"103% of Medicare, less IME",13694,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13927,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,DRG,,,,Inpatient,,,38912.09,9728.0225,7570,33075.2765,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17945.997,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12553.593,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14198.085,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15564.3519,Other,CMS Methodology,,65.6,,25526.33104,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12553.593,Other,"DRG Weight, with Charge Based Outlier",,70,,27238.463,Percent of Total Billed Charges,,,85,,33075.2765,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15100.6434,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26460.2212,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13154.9799,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12093.7089,Other,"DRG Weight, with Charge Based Outlier",,65,,25292.8585,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14056,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8683.3002,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9462,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9554,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9234,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9325,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9325,Other,CMS Methodology,,,"103% of Medicare, less IME",9417,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9577,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,DRG,,,,Inpatient,,,78205.44,19551.36,10120,66474.624,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42532.82,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29752.58,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33650.1,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36888.214,Other,CMS Methodology,,65.6,,51302.76864,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29752.58,Other,"DRG Weight, with Charge Based Outlier",,70,,54743.808,Percent of Total Billed Charges,,,85,,66474.624,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35789.204,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,53179.6992,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31177.894,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28662.634,Other,"DRG Weight, with Charge Based Outlier",,65,,50833.536,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33315,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20579.812,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22426,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22643,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21885,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22101,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22101,Other,CMS Methodology,,,"103% of Medicare, less IME",22318,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22697,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,DRG,,,,Inpatient,,,48710.65,12177.6625,7570,41404.0525,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24618.732,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17221.308,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19477.26,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21351.5364,Other,CMS Methodology,,65.6,,31954.1864,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17221.308,Other,"DRG Weight, with Charge Based Outlier",,70,,34097.455,Percent of Total Billed Charges,,,85,,41404.0525,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20715.4104,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33123.242,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18046.3044,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16590.4284,Other,"DRG Weight, with Charge Based Outlier",,65,,31661.9225,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19283,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11911.9512,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12981,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13106,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12667,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12793,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12793,Other,CMS Methodology,,,"103% of Medicare, less IME",12918,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13138,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,DRG,,,,Inpatient,,,29947.12,7486.78,6720,25455.052,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16592.68,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11606.92,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13127.4,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14390.636,Other,CMS Methodology,,65.6,,19645.31072,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11606.92,Other,"DRG Weight, with Charge Based Outlier",,70,,20962.984,Percent of Total Billed Charges,,,85,,25455.052,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13961.896,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20364.0416,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12162.956,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11181.716,Other,"DRG Weight, with Charge Based Outlier",,65,,19465.628,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12996,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8028.488,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8749,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8833,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8538,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8622,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8622,Other,CMS Methodology,,,"103% of Medicare, less IME",8707,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8855,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CONCUSSION WITH MCC,88,DRG,,,,Inpatient,,,78645.04,19661.26,7570,66848.284,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26478.839,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18522.491,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20948.895,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22964.7853,Other,CMS Methodology,,65.6,,51591.14624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18522.491,Other,"DRG Weight, with Charge Based Outlier",,70,,55051.528,Percent of Total Billed Charges,,,85,,66848.284,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22280.5958,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,53478.6272,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19409.8213,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17843.9443,Other,"DRG Weight, with Charge Based Outlier",,65,,51119.276,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20740,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12811.9774,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13962,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14096,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13624,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13759,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13759,Other,CMS Methodology,,,"103% of Medicare, less IME",13894,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14130,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
CONCUSSION WITH CC,89,DRG,,,,Inpatient,,,33536.96,8384.24,5870,28506.416,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20123.317,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14076.673,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15920.685,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17452.7159,Other,CMS Methodology,,65.6,,22000.24576,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14076.673,Other,"DRG Weight, with Charge Based Outlier",,70,,23475.872,Percent of Total Billed Charges,,,85,,28506.416,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16932.7474,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22805.1328,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14751.0239,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13560.9929,Other,"DRG Weight, with Charge Based Outlier",,65,,21799.024,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15762,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9736.8122,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10610,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10713,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10354,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10457,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10457,Other,CMS Methodology,,,"103% of Medicare, less IME",10559,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10739,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
CONCUSSION WITHOUT CC/MCC,90,DRG,,,,Inpatient,,,38815.9,9703.975,5870,32993.515,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16091.521,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11256.349,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12730.905,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13955.9867,Other,CMS Methodology,,65.6,,25463.2304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11256.349,Other,"DRG Weight, with Charge Based Outlier",,70,,27171.13,Percent of Total Billed Charges,,,85,,32993.515,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13540.1962,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26394.812,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11795.5907,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10843.9877,Other,"DRG Weight, with Charge Based Outlier",,65,,25230.335,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12604,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7785.9986,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8485,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8567,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8280,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8362,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8362,Other,CMS Methodology,,,"103% of Medicare, less IME",8444,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8587,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,DRG,,,,Inpatient,,,59755.99,14938.9975,11820,50792.5915,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34215.833,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23934.677,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27070.065,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29674.9891,Other,CMS Methodology,,65.6,,39199.92944,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23934.677,Other,"DRG Weight, with Charge Based Outlier",,70,,41829.193,Percent of Total Billed Charges,,,85,,50792.5915,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28790.8826,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40634.0732,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25081.2811,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23057.8621,Other,"DRG Weight, with Charge Based Outlier",,65,,38841.3935,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26800,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16555.5778,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18041,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18215,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17605,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17780,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17780,Other,CMS Methodology,,,"103% of Medicare, less IME",17954,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18259,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,DRG,,,,Inpatient,,,46277.23,11569.3075,9270,39335.6455,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19871.799,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13900.731,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15721.695,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17234.5773,Other,CMS Methodology,,65.6,,30357.86288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13900.731,Other,"DRG Weight, with Charge Based Outlier",,70,,32394.061,Percent of Total Billed Charges,,,85,,39335.6455,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16721.1078,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31468.5164,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14566.6533,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13391.4963,Other,"DRG Weight, with Charge Based Outlier",,65,,30080.1995,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15565,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9615.1134,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10478,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10579,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10225,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10326,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10326,Other,CMS Methodology,,,"103% of Medicare, less IME",10427,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10604,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,DRG,,,,Inpatient,,,38128.39,9532.0975,7168.4226,32409.1315,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14815.161,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10363.509,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11721.105,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12849.0147,Other,CMS Methodology,,65.6,,25012.22384,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10363.509,Other,"DRG Weight, with Charge Based Outlier",,70,,26689.873,Percent of Total Billed Charges,,,85,,32409.1315,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12466.2042,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25927.3052,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10859.9787,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9983.8557,Other,"DRG Weight, with Charge Based Outlier",,65,,24783.4535,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11604,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7168.4226,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7812,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7887,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7623,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7698,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7698,Other,CMS Methodology,,,"103% of Medicare, less IME",7774,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7906,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,DRG,,,,Inpatient,,,219189.16,54797.29,16920,186310.786,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,68486.099,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47907.431,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,57696.30792,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,59397.1873,Other,CMS Methodology,,65.6,,143788.089,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47907.431,Other,"DRG Weight, with Charge Based Outlier",,70,,153432.412,Percent of Total Billed Charges,,,85,,186310.786,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,57627.5678,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,149048.6288,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,50202.4633,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",76716.206,Other,"DRG Weight, with Charge Based Outlier",,65,,142472.954,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",53643,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,33137.4934,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",36111,Other,CMS Methodology,,,"104.5% of Medicare, less IME",36460,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",35239,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",35587,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",35587,Other,CMS Methodology,,,"103% of Medicare, less IME",35936,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",36547,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,17515,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,17270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,DRG,,,,Inpatient,,,103651.11,25912.7775,9270,88103.4435,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,44995.444,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31475.236,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,35598.42,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,39024.0188,Other,CMS Methodology,,65.6,,67995.12816,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31475.236,Other,"DRG Weight, with Charge Based Outlier",,70,,72555.777,Percent of Total Billed Charges,,,85,,88103.4435,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,37861.3768,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,70482.7548,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,32983.0748,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",30322.1828,Other,"DRG Weight, with Charge Based Outlier",,65,,67373.2215,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",35243,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21771.3704,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23725,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23954,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23152,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23381,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23381,Other,CMS Methodology,,,"103% of Medicare, less IME",23610,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24011,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,DRG,,,,Inpatient,,,88951.49,22237.8725,10970,75608.7665,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,44995.444,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31475.236,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,35598.42,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,39024.0188,Other,CMS Methodology,,65.6,,58352.17744,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31475.236,Other,"DRG Weight, with Charge Based Outlier",,70,,62266.043,Percent of Total Billed Charges,,,85,,75608.7665,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,37861.3768,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,60487.0132,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,32983.0748,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",30322.1828,Other,"DRG Weight, with Charge Based Outlier",,65,,57818.4685,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",35243,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21771.3704,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23725,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23954,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23152,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23381,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23381,Other,CMS Methodology,,,"103% of Medicare, less IME",23610,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24011,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,DRG,,,,Inpatient,,,139104.06,34776.015,14370,118238.451,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,67282.942,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47065.798,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,53231.31,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,58353.7034,Other,CMS Methodology,,65.6,,91252.26336,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47065.798,Other,"DRG Weight, with Charge Based Outlier",,70,,97372.842,Percent of Total Billed Charges,,,85,,118238.451,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,56615.1724,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,94590.7608,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,49320.5114,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",45341.6054,Other,"DRG Weight, with Charge Based Outlier",,65,,90417.639,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",52700,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,32555.3372,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",35476,Other,CMS Methodology,,,"104.5% of Medicare, less IME",35819,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",34619,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34962,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34962,Other,CMS Methodology,,,"103% of Medicare, less IME",35305,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35905,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,DRG,,,,Inpatient,,,54913.65,13728.4125,9270,46676.6025,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40717.761,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28482.909,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,32214.105,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,35314.0347,Other,CMS Methodology,,65.6,,36023.3544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28482.909,Other,"DRG Weight, with Charge Based Outlier",,70,,38439.555,Percent of Total Billed Charges,,,85,,46676.6025,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,34261.9242,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37341.282,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29847.3987,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27439.4757,Other,"DRG Weight, with Charge Based Outlier",,65,,35693.8725,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31893,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19701.5826,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21469,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21677,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20951,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21158,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21158,Other,CMS Methodology,,,"103% of Medicare, less IME",21366,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21729,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,DRG,,,,Inpatient,,,62038.9,15509.725,10970,52733.065,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26152.241,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18294.029,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20690.505,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22681.5307,Other,CMS Methodology,,65.6,,40697.5184,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18294.029,Other,"DRG Weight, with Charge Based Outlier",,70,,43427.23,Percent of Total Billed Charges,,,85,,52733.065,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22005.7802,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42186.452,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19170.4147,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17623.8517,Other,"DRG Weight, with Charge Based Outlier",,65,,40325.285,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20484,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12653.9506,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13789,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13923,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13456,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13589,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13589,Other,CMS Methodology,,,"103% of Medicare, less IME",13723,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13956,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
SEIZURES WITH MCC,100,DRG,,,,Inpatient,,,71942.4,17985.6,9270,61151.04,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37264.081,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26066.989,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29481.705,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32318.6987,Other,CMS Methodology,,65.6,,47194.2144,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26066.989,Other,"DRG Weight, with Charge Based Outlier",,70,,50359.68,Percent of Total Billed Charges,,,85,,61151.04,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31355.8282,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48920.832,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27315.7427,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25112.0597,Other,"DRG Weight, with Charge Based Outlier",,65,,46762.56,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29188,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18030.4946,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19648,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19838,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19174,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19364,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19364,Other,CMS Methodology,,,"103% of Medicare, less IME",19553,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19886,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
SEIZURES WITHOUT MCC,101,DRG,,,,Inpatient,,,32868.75,8217.1875,7570,27938.4375,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17300.309,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12101.921,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13687.245,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15004.3543,Other,CMS Methodology,,65.6,,21561.9,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12101.921,Other,"DRG Weight, with Charge Based Outlier",,70,,23008.125,Percent of Total Billed Charges,,,85,,27938.4375,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14557.3298,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22350.75,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12681.6703,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11658.5833,Other,"DRG Weight, with Charge Based Outlier",,65,,21364.6875,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13551,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8370.8794,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9122,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9210,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8902,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8990,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8990,Other,CMS Methodology,,,"103% of Medicare, less IME",9078,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9232,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
HEADACHES WITH MCC,102,DRG,,,,Inpatient,,,73357.39,18339.3475,10530.579,62353.7815,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21763.815,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15224.235,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17218.575,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18875.5005,Other,CMS Methodology,,65.6,,48122.44784,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15224.235,Other,"DRG Weight, with Charge Based Outlier",,70,,51350.173,Percent of Total Billed Charges,,,85,,62353.7815,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22616.143,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,49883.0252,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26945.5605,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14666.5155,Other,"DRG Weight, with Charge Based Outlier",,65,,47682.3035,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17047,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10530.579,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11475,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11586,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11198,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11309,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11309,Other,CMS Methodology,,,"103% of Medicare, less IME",11420,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11614,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
HEADACHES WITHOUT MCC,103,DRG,,,,Inpatient,,,35120.07,8780.0175,6720,29852.0595,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15958.254,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11163.126,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12625.47,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13840.4058,Other,CMS Methodology,,65.6,,23038.76592,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11163.126,Other,"DRG Weight, with Charge Based Outlier",,70,,24584.049,Percent of Total Billed Charges,,,85,,29852.0595,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13428.0588,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23881.6476,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11697.9018,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10754.1798,Other,"DRG Weight, with Charge Based Outlier",,65,,22828.0455,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12500,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7721.5164,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8414,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8496,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8211,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8292,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8292,Other,CMS Methodology,,,"103% of Medicare, less IME",8374,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8516,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
ORBITAL PROCEDURES WITHOUT CC/MCC,114,DRG,,,,Inpatient,,,43441.93,10860.4825,7570,36925.6405,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22188.017,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15520.973,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17554.185,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19243.4059,Other,CMS Methodology,,65.6,,28497.90608,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15520.973,Other,"DRG Weight, with Charge Based Outlier",,70,,30409.351,Percent of Total Billed Charges,,,85,,36925.6405,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18670.0874,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29540.5124,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16264.5139,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14952.3829,Other,"DRG Weight, with Charge Based Outlier",,65,,28237.2545,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17379,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10735.8322,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11699,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11812,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11417,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11530,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11530,Other,CMS Methodology,,,"103% of Medicare, less IME",11643,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11840,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,DRG,,,,Inpatient,,,49447.72,12361.93,6720,42030.562,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28736.87,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20102.03,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22735.35,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24923.149,Other,CMS Methodology,,65.6,,32437.70432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20102.03,Other,"DRG Weight, with Charge Based Outlier",,70,,34613.404,Percent of Total Billed Charges,,,85,,42030.562,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24180.614,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33624.4496,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21065.029,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19365.619,Other,"DRG Weight, with Charge Based Outlier",,65,,32141.018,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22509,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13904.542,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15152,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15299,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14786,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14933,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14933,Other,CMS Methodology,,,"103% of Medicare, less IME",15079,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15335,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
INTRAOCULAR PROCEDURES WITH CC/MCC,116,DRG,,,,Inpatient,,,52249.12,13062.28,9270,44411.752,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31319.622,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21908.718,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24778.71,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27163.1394,Other,CMS Methodology,,65.6,,34275.42272,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21908.718,Other,"DRG Weight, with Charge Based Outlier",,70,,36574.384,Percent of Total Billed Charges,,,85,,44411.752,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26353.8684,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35529.4016,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22958.2674,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21106.1214,Other,"DRG Weight, with Charge Based Outlier",,65,,33961.928,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24532,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15154.2252,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16514,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16674,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16115,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16275,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16275,Other,CMS Methodology,,,"103% of Medicare, less IME",16434,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16713,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,DRG,,,,Inpatient,,,42662.61,10665.6525,8420,36263.2185,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18998.994,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13290.186,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15031.17,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16477.6038,Other,CMS Methodology,,65.6,,27986.67216,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13290.186,Other,"DRG Weight, with Charge Based Outlier",,70,,29863.827,Percent of Total Billed Charges,,,85,,36263.2185,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15986.6868,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29010.5748,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13926.8598,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12803.3178,Other,"DRG Weight, with Charge Based Outlier",,65,,27730.6965,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14881,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9192.8004,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10018,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10114,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9776,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9872,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9872,Other,CMS Methodology,,,"103% of Medicare, less IME",9969,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10139,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,DRG,,,,Inpatient,,,32774.03,8193.5075,8420,27857.9255,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21833.264,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15272.816,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17273.52,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18935.7328,Other,CMS Methodology,,65.6,,21499.76368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15272.816,Other,"DRG Weight, with Charge Based Outlier",,70,,22941.821,Percent of Total Billed Charges,,,85,,27857.9255,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18371.5808,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22286.3404,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16004.4688,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14713.3168,Other,"DRG Weight, with Charge Based Outlier",,65,,21303.1195,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17101,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10564.1824,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11512,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11623,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11234,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11345,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11345,Other,CMS Methodology,,,"103% of Medicare, less IME",11456,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11651,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,DRG,,,,Inpatient,,,20567.45,5141.8625,6160.3206,17482.3325,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12731.691,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8906.079,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10072.755,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11042.0457,Other,CMS Methodology,,65.6,,13492.2472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8906.079,Other,"DRG Weight, with Charge Based Outlier",,70,,14397.215,Percent of Total Billed Charges,,,85,,17482.3325,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10713.0702,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,13985.866,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9332.7297,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8579.8167,Other,"DRG Weight, with Charge Based Outlier",,65,,13368.8425,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9972,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6160.3206,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6713,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6778,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6551,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6616,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6616,Other,CMS Methodology,,,"103% of Medicare, less IME",6681,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6794,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
NEUROLOGICAL EYE DISORDERS,123,DRG,,,,Inpatient,,,33079.64,8269.91,6720,28117.694,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15076.064,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10546.016,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11927.52,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13075.2928,Other,CMS Methodology,,65.6,,21700.24384,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10546.016,Other,"DRG Weight, with Charge Based Outlier",,70,,23155.748,Percent of Total Billed Charges,,,85,,28117.694,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12685.7408,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22494.1552,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11051.2288,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10159.6768,Other,"DRG Weight, with Charge Based Outlier",,65,,21501.766,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11809,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7294.6624,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7949,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8026,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7757,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7834,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7834,Other,CMS Methodology,,,"103% of Medicare, less IME",7911,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8045,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,DRG,,,,Inpatient,,,41246.69,10311.6725,7570,35059.6865,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24474.203,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17120.207,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19362.915,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21226.1881,Other,CMS Methodology,,65.6,,27057.82864,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17120.207,Other,"DRG Weight, with Charge Based Outlier",,70,,28872.683,Percent of Total Billed Charges,,,85,,35059.6865,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20593.7966,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28047.7492,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17940.3601,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16493.0311,Other,"DRG Weight, with Charge Based Outlier",,65,,26810.3485,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19170,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11842.0198,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12905,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13029,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12593,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12718,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12718,Other,CMS Methodology,,,"103% of Medicare, less IME",12842,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13060,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,DRG,,,,Inpatient,,,28930.03,7232.5075,6720,24590.5255,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15498.389,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10841.441,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12261.645,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13441.5703,Other,CMS Methodology,,65.6,,18978.09968,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10841.441,Other,"DRG Weight, with Charge Based Outlier",,70,,20251.021,Percent of Total Billed Charges,,,85,,24590.5255,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13041.1058,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19672.4204,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11360.8063,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10444.2793,Other,"DRG Weight, with Charge Based Outlier",,65,,18804.5195,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12139,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7499.0074,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8172,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8251,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7974,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8053,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8053,Other,CMS Methodology,,,"103% of Medicare, less IME",8132,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8271,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,DRG,,,,Inpatient,,,62553.7,15638.425,5870,53170.645,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,45256.347,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31657.743,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,35804.835,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,39250.2969,Other,CMS Methodology,,65.6,,41035.2272,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31657.743,Other,"DRG Weight, with Charge Based Outlier",,70,,43787.59,Percent of Total Billed Charges,,,85,,53170.645,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,38080.9134,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42536.516,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,33174.3249,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",30498.0039,Other,"DRG Weight, with Charge Based Outlier",,65,,40659.905,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",35448,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21897.6102,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23862,Other,CMS Methodology,,,"104.5% of Medicare, less IME",24093,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23286,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23517,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23517,Other,CMS Methodology,,,"103% of Medicare, less IME",23747,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24151,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
MOUTH PROCEDURES WITHOUT CC/MCC,138,DRG,,,,Inpatient,,,19058.05,4764.5125,5020,16199.3425,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15269.395,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10681.255,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12080.475,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13242.9665,Other,CMS Methodology,,65.6,,12502.0808,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10681.255,Other,"DRG Weight, with Charge Based Outlier",,70,,13340.635,Percent of Total Billed Charges,,,85,,16199.3425,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12848.419,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,12959.474,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11192.9465,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10289.9615,Other,"DRG Weight, with Charge Based Outlier",,65,,12387.7325,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11960,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7388.207,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8051,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8129,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7857,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7934,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7934,Other,CMS Methodology,,,"103% of Medicare, less IME",8012,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8148,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,DRG,,,,Inpatient,,,145455.34,36363.835,8420,123637.039,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,79382.084,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,55529.396,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,62803.62,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,68847.1468,Other,CMS Methodology,,65.6,,95418.70304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,55529.396,Other,"DRG Weight, with Charge Based Outlier",,70,,101818.738,Percent of Total Billed Charges,,,85,,123637.039,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,66795.9848,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,98909.6312,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,58189.5628,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",53495.1508,Other,"DRG Weight, with Charge Based Outlier",,65,,94545.971,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",62177,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,38409.5944,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",41856,Other,CMS Methodology,,,"104.5% of Medicare, less IME",42260,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",40845,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",41249,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",41249,Other,CMS Methodology,,,"103% of Medicare, less IME",41654,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",42361,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,DRG,,,,Inpatient,,,75308.63,18827.1575,6720,64012.3355,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40327.345,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28209.805,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31905.225,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34975.4315,Other,CMS Methodology,,65.6,,49402.46128,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28209.805,Other,"DRG Weight, with Charge Based Outlier",,70,,52716.041,Percent of Total Billed Charges,,,85,,64012.3355,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33933.409,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,51209.8684,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29561.2115,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27176.3765,Other,"DRG Weight, with Charge Based Outlier",,65,,48950.6095,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31587,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19512.677,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21263,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21469,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20750,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20955,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20955,Other,CMS Methodology,,,"103% of Medicare, less IME",21161,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21520,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,DRG,,,,Inpatient,,,50304.83,12576.2075,5870,42759.1055,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29513.948,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20645.612,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23350.14,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25597.0996,Other,CMS Methodology,,65.6,,32999.96848,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20645.612,Other,"DRG Weight, with Charge Based Outlier",,70,,35213.381,Percent of Total Billed Charges,,,85,,42759.1055,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24834.4856,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34207.2844,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21634.6516,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19889.2876,Other,"DRG Weight, with Charge Based Outlier",,65,,32698.1395,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23117,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14280.5368,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15562,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15712,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15186,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15336,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15336,Other,CMS Methodology,,,"103% of Medicare, less IME",15487,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15750,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,DRG,,,,Inpatient,,,123585.76,30896.44,14370,105047.896,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,61976.663,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,43353.947,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,49033.215,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,53751.6301,Other,CMS Methodology,,65.6,,81072.25856,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,43353.947,Other,"DRG Weight, with Charge Based Outlier",,70,,86510.032,Percent of Total Billed Charges,,,85,,105047.896,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,52150.2086,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,84038.3168,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,45430.8421,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",41765.7331,Other,"DRG Weight, with Charge Based Outlier",,65,,80330.744,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",48544,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,29987.8558,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",32679,Other,CMS Methodology,,,"104.5% of Medicare, less IME",32994,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",31889,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",32205,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",32205,Other,CMS Methodology,,,"103% of Medicare, less IME",32521,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",33073,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,DRG,,,,Inpatient,,,46469.72,11617.43,6720,39499.262,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32973.259,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23065.471,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26086.995,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28597.3193,Other,CMS Methodology,,65.6,,30484.13632,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23065.471,Other,"DRG Weight, with Charge Based Outlier",,70,,32528.804,Percent of Total Billed Charges,,,85,,39499.262,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27745.3198,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31599.4096,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24170.4353,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22220.4983,Other,"DRG Weight, with Charge Based Outlier",,65,,30205.318,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25827,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15954.3494,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17386,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17554,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16966,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17134,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17134,Other,CMS Methodology,,,"103% of Medicare, less IME",17302,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17596,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,DRG,,,,Inpatient,,,33591.09,8397.7725,5870,28552.4265,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22238.696,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15556.424,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17594.28,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19287.3592,Other,CMS Methodology,,65.6,,22035.75504,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15556.424,Other,"DRG Weight, with Charge Based Outlier",,70,,23513.763,Percent of Total Billed Charges,,,85,,28552.4265,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18712.7312,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22841.9412,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16301.6632,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14986.5352,Other,"DRG Weight, with Charge Based Outlier",,65,,21834.2085,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17419,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10760.3536,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11726,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11839,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11443,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11556,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11556,Other,CMS Methodology,,,"103% of Medicare, less IME",11669,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11867,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,DRG,,,,Inpatient,,,58904.54,14726.135,9270,50068.859,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,43060.257,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30121.533,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,34067.385,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,37345.6539,Other,CMS Methodology,,65.6,,38641.37824,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30121.533,Other,"DRG Weight, with Charge Based Outlier",,70,,41233.178,Percent of Total Billed Charges,,,85,,50068.859,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,36233.0154,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40055.0872,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31564.5219,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",29018.0709,Other,"DRG Weight, with Charge Based Outlier",,65,,38287.951,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33728,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20835.0162,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22704,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22924,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22156,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22375,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22375,Other,CMS Methodology,,,"103% of Medicare, less IME",22595,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22979,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
DYSEQUILIBRIUM,149,DRG,,,,Inpatient,,,39900.63,9975.1575,6720,33915.5355,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14030.575,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9814.675,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11100.375,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12168.5525,Other,CMS Methodology,,65.6,,26174.81328,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9814.675,Other,"DRG Weight, with Charge Based Outlier",,70,,27930.441,Percent of Total Billed Charges,,,85,,33915.5355,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11806.015,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27132.4284,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10284.8525,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9455.1275,Other,"DRG Weight, with Charge Based Outlier",,65,,25935.4095,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10990,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6788.795,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7398,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7469,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7219,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7291,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7291,Other,CMS Methodology,,,"103% of Medicare, less IME",7362,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7487,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
EPISTAXIS WITH MCC,150,DRG,,,,Inpatient,,,54836.29,13709.0725,7570,46610.8465,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25943.894,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18148.286,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20525.67,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22500.8338,Other,CMS Methodology,,65.6,,35972.60624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18148.286,Other,"DRG Weight, with Charge Based Outlier",,70,,38385.403,Percent of Total Billed Charges,,,85,,46610.8465,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21830.4668,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37288.6772,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19017.6898,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17483.4478,Other,"DRG Weight, with Charge Based Outlier",,65,,35643.5885,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20321,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12553.1404,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13679,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13812,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13349,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13481,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13481,Other,CMS Methodology,,,"103% of Medicare, less IME",13613,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13845,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
EPISTAXIS WITHOUT MCC,151,DRG,,,,Inpatient,,,65702.22,16425.555,6720,55846.887,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14227.66,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9952.54,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11256.3,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12339.482,Other,CMS Methodology,,65.6,,43100.65632,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9952.54,Other,"DRG Weight, with Charge Based Outlier",,70,,45991.554,Percent of Total Billed Charges,,,85,,55846.887,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11971.852,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44677.5096,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10429.322,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9587.942,Other,"DRG Weight, with Charge Based Outlier",,65,,42706.443,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11144,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6884.156,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7502,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7574,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7321,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7393,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7393,Other,CMS Methodology,,,"103% of Medicare, less IME",7466,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7592,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTITIS MEDIA AND URI WITH MCC,152,DRG,,,,Inpatient,,,60711.41,15177.8525,9270,51604.6985,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21300.196,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14899.924,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16851.78,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18473.4092,Other,CMS Methodology,,65.6,,39826.68496,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14899.924,Other,"DRG Weight, with Charge Based Outlier",,70,,42497.987,Percent of Total Billed Charges,,,85,,51604.6985,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17923.0312,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41283.7588,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15613.7132,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14354.0852,Other,"DRG Weight, with Charge Based Outlier",,65,,39462.4165,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16684,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10306.2536,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11231,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11339,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10960,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11068,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11068,Other,CMS Methodology,,,"103% of Medicare, less IME",11177,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11367,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
OTITIS MEDIA AND URI WITHOUT MCC,153,DRG,,,,Inpatient,,,23020.49,5755.1225,5870,19567.4165,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13358.609,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9344.621,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10568.745,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11585.7643,Other,CMS Methodology,,65.6,,15101.44144,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9344.621,Other,"DRG Weight, with Charge Based Outlier",,70,,16114.343,Percent of Total Billed Charges,,,85,,19567.4165,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11240.5898,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,15653.9332,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9792.2803,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9002.2933,Other,"DRG Weight, with Charge Based Outlier",,65,,14963.3185,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10463,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6463.6594,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7044,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7112,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6873,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6942,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6942,Other,CMS Methodology,,,"103% of Medicare, less IME",7010,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7129,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,DRG,,,,Inpatient,,,64354.04,16088.51,10120,54700.934,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30525.651,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21353.319,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24150.555,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26474.5377,Other,CMS Methodology,,65.6,,42216.25024,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21353.319,Other,"DRG Weight, with Charge Based Outlier",,70,,45047.828,Percent of Total Billed Charges,,,85,,54700.934,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25685.7822,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,43760.7472,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22376.2617,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20571.0687,Other,"DRG Weight, with Charge Based Outlier",,65,,41830.126,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23910,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14770.0566,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16095,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16251,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15707,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15862,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15862,Other,CMS Methodology,,,"103% of Medicare, less IME",16018,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16290,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,DRG,,,,Inpatient,,,29695.82,7423.955,6720,25241.447,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17523.672,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12258.168,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13863.96,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15198.0744,Other,CMS Methodology,,65.6,,19480.45792,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12258.168,Other,"DRG Weight, with Charge Based Outlier",,70,,20787.074,Percent of Total Billed Charges,,,85,,25241.447,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14745.2784,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20193.1576,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12845.4024,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11809.1064,Other,"DRG Weight, with Charge Based Outlier",,65,,19302.283,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13726,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8478.9552,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9240,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9329,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9017,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9106,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9106,Other,CMS Methodology,,,"103% of Medicare, less IME",9195,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9351,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,DRG,,,,Inpatient,,,19557.78,4889.445,6106.7368,16624.113,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12620.948,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8828.612,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9985.14,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10945.9996,Other,CMS Methodology,,65.6,,12829.90368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8828.612,Other,"DRG Weight, with Charge Based Outlier",,70,,13690.446,Percent of Total Billed Charges,,,85,,16624.113,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10619.8856,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,13299.2904,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9251.5516,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8505.1876,Other,"DRG Weight, with Charge Based Outlier",,65,,12712.557,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9886,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6106.7368,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6655,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6719,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6494,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6558,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6558,Other,CMS Methodology,,,"103% of Medicare, less IME",6623,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6735,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
DENTAL AND ORAL DISEASES WITH MCC,157,DRG,,,,Inpatient,,,72029.92,18007.48,10970,61225.432,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30735.875,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21500.375,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24316.875,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26656.8625,Other,CMS Methodology,,65.6,,47251.62752,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21500.375,Other,"DRG Weight, with Charge Based Outlier",,70,,50420.944,Percent of Total Billed Charges,,,85,,61225.432,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25862.675,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48980.3456,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22530.3625,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20712.7375,Other,"DRG Weight, with Charge Based Outlier",,65,,46819.448,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24074,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14871.775,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16206,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16363,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15815,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15971,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15971,Other,CMS Methodology,,,"103% of Medicare, less IME",16128,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16402,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
DENTAL AND ORAL DISEASES WITH CC,158,DRG,,,,Inpatient,,,30411.18,7602.795,7570,25849.503,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17655.062,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12350.078,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13967.91,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15312.0274,Other,CMS Methodology,,65.6,,19949.73408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12350.078,Other,"DRG Weight, with Charge Based Outlier",,70,,21287.826,Percent of Total Billed Charges,,,85,,25849.503,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14855.8364,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20679.6024,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12941.7154,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11897.6494,Other,"DRG Weight, with Charge Based Outlier",,65,,19767.267,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13829,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8542.5292,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9309,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9399,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9084,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9174,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9174,Other,CMS Methodology,,,"103% of Medicare, less IME",9264,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9421,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,DRG,,,,Inpatient,,,29647.8,7411.95,5990.4872,25200.63,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12380.692,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8660.548,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9795.06,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10737.6284,Other,CMS Methodology,,65.6,,19448.9568,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8660.548,Other,"DRG Weight, with Charge Based Outlier",,70,,20753.46,Percent of Total Billed Charges,,,85,,25200.63,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10417.7224,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20160.504,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9075.4364,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8343.2804,Other,"DRG Weight, with Charge Based Outlier",,65,,19271.07,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9697,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5990.4872,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6528,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6591,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6370,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6433,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6433,Other,CMS Methodology,,,"103% of Medicare, less IME",6496,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6607,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MAJOR CHEST PROCEDURES WITH MCC,163,DRG,,,,Inpatient,,,131951.7,32987.925,10970,112158.945,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,86514.684,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,60518.796,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,68446.62,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,75033.1668,Other,CMS Methodology,,65.6,,86560.3152,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,60518.796,Other,"DRG Weight, with Charge Based Outlier",,70,,92366.19,Percent of Total Billed Charges,,,85,,112158.945,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,72797.7048,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,89727.156,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,63417.9828,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",58301.7708,Other,"DRG Weight, with Charge Based Outlier",,65,,85768.605,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",67764,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,41860.7544,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",45617,Other,CMS Methodology,,,"104.5% of Medicare, less IME",46057,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",44515,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",44956,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",44956,Other,CMS Methodology,,,"103% of Medicare, less IME",45396,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",46168,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
MAJOR CHEST PROCEDURES WITH CC,164,DRG,,,,Inpatient,,,96957.2,24239.3,9270,82413.62,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,47244.09,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33048.21,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,37377.45,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,40974.243,Other,CMS Methodology,,65.6,,63603.9232,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33048.21,Other,"DRG Weight, with Charge Based Outlier",,70,,67870.04,Percent of Total Billed Charges,,,85,,82413.62,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,39753.498,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,65930.896,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,34631.403,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",31837.533,Other,"DRG Weight, with Charge Based Outlier",,65,,63022.18,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",37005,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22859.394,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",24910,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25151,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",24309,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24549,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24549,Other,CMS Methodology,,,"103% of Medicare, less IME",24790,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25211,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,DRG,,,,Inpatient,,,91935.27,22983.8175,7570,78144.9795,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34987.28,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24474.32,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27680.4,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30344.056,Other,CMS Methodology,,65.6,,60309.53712,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24474.32,Other,"DRG Weight, with Charge Based Outlier",,70,,64354.689,Percent of Total Billed Charges,,,85,,78144.9795,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29440.016,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,62515.9836,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25646.776,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23577.736,Other,"DRG Weight, with Charge Based Outlier",,65,,59757.9255,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27404,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16928.848,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18448,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18626,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18002,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18180,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18180,Other,CMS Methodology,,,"103% of Medicare, less IME",18359,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18671,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,DRG,,,,Inpatient,,,132767.18,33191.795,13520,112852.103,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,72270.131,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,50554.439,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,57176.955,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,62679.0337,Other,CMS Methodology,,65.6,,87095.27008,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,50554.439,Other,"DRG Weight, with Charge Based Outlier",,70,,92937.026,Percent of Total Billed Charges,,,85,,112852.103,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,60811.6382,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,90281.6824,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,52976.2777,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",48702.4447,Other,"DRG Weight, with Charge Based Outlier",,65,,86298.667,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",56607,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,34968.4246,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",38106,Other,CMS Methodology,,,"104.5% of Medicare, less IME",38474,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",37186,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",37554,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",37554,Other,CMS Methodology,,,"103% of Medicare, less IME",37922,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",38566,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,DRG,,,,Inpatient,,,93835.62,23458.905,10120,79760.277,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34296.544,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23991.136,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27133.92,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29744.9888,Other,CMS Methodology,,65.6,,61556.16672,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23991.136,Other,"DRG Weight, with Charge Based Outlier",,70,,65684.934,Percent of Total Billed Charges,,,85,,79760.277,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28858.7968,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,63808.2216,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25140.4448,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23112.2528,Other,"DRG Weight, with Charge Based Outlier",,65,,60993.153,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26863,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16594.6304,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18084,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18258,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17647,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17822,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17822,Other,CMS Methodology,,,"103% of Medicare, less IME",17996,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18302,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,DRG,,,,Inpatient,,,62635.56,15658.89,6720,53240.226,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25412.703,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17776.707,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20105.415,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22040.1381,Other,CMS Methodology,,65.6,,41088.92736,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17776.707,Other,"DRG Weight, with Charge Based Outlier",,70,,43844.892,Percent of Total Billed Charges,,,85,,53240.226,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21383.4966,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42592.1808,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18628.3101,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17125.4811,Other,"DRG Weight, with Charge Based Outlier",,65,,40713.114,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19905,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12296.1198,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13399,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13529,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13076,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13205,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13205,Other,CMS Methodology,,,"103% of Medicare, less IME",13335,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13561,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,DRG,,,,Inpatient,,,65775.57,16443.8925,6720,57597.622,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,57597.622,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40290.718,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,45568.71,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,49953.7394,Other,CMS Methodology,,65.6,,43148.77392,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40290.718,Other,"DRG Weight, with Charge Based Outlier",,70,,46042.899,Percent of Total Billed Charges,,,85,,55909.2345,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,48465.4684,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44727.3876,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,42220.8674,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",38814.7214,Other,"DRG Weight, with Charge Based Outlier",,65,,42754.1205,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",45114,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,27869.0252,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",30370,Other,CMS Methodology,,,"104.5% of Medicare, less IME",30663,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",29636,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",29929,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",29929,Other,CMS Methodology,,,"103% of Medicare, less IME",30223,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",30736,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,DRG,,,,Inpatient,,,52840.65,13210.1625,9270,44914.5525,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26448.807,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18501.483,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20925.135,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22938.7389,Other,CMS Methodology,,65.6,,34663.4664,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18501.483,Other,"DRG Weight, with Charge Based Outlier",,70,,36988.455,Percent of Total Billed Charges,,,85,,44914.5525,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22255.3254,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35931.642,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19387.8069,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17823.7059,Other,"DRG Weight, with Charge Based Outlier",,65,,34346.4225,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20716,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12797.4462,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13946,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14080,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13609,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13744,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13744,Other,CMS Methodology,,,"103% of Medicare, less IME",13878,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14114,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
PULMONARY EMBOLISM WITHOUT MCC,176,DRG,,,,Inpatient,,,28661.73,7165.4325,6720,24362.4705,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15288.165,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10694.385,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12095.325,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13259.2455,Other,CMS Methodology,,65.6,,18802.09488,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10694.385,Other,"DRG Weight, with Charge Based Outlier",,70,,20063.211,Percent of Total Billed Charges,,,85,,24362.4705,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12864.213,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19489.9764,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11206.7055,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10302.6105,Other,"DRG Weight, with Charge Based Outlier",,65,,18630.1245,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11975,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7397.289,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8061,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8139,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7866,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7944,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7944,Other,CMS Methodology,,,"103% of Medicare, less IME",8022,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8158,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,DRG,,,,Inpatient,,,56156.19,14039.0475,9270,47732.7615,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30341.705,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21224.645,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24005.025,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26315.0035,Other,CMS Methodology,,65.6,,36838.46064,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21224.645,Other,"DRG Weight, with Charge Based Outlier",,70,,39309.333,Percent of Total Billed Charges,,,85,,47732.7615,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25531.001,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38186.2092,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22241.4235,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20447.1085,Other,"DRG Weight, with Charge Based Outlier",,65,,36501.5235,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23766,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14681.053,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15998,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16153,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15612,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15766,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15766,Other,CMS Methodology,,,"103% of Medicare, less IME",15921,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16192,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,DRG,,,,Inpatient,,,37564.67,9391.1675,7570,31929.9695,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18621.717,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13026.273,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14732.685,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16150.3959,Other,CMS Methodology,,65.6,,24642.42352,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13026.273,Other,"DRG Weight, with Charge Based Outlier",,70,,26295.269,Percent of Total Billed Charges,,,85,,31929.9695,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15669.2274,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25543.9756,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13650.3039,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12549.0729,Other,"DRG Weight, with Charge Based Outlier",,65,,24417.0355,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14586,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9010.2522,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9819,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9914,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9582,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9676,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9676,Other,CMS Methodology,,,"103% of Medicare, less IME",9771,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9937,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,DRG,,,,Inpatient,,,24944.87,6236.2175,6720,21203.1395,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14447.269,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10106.161,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11430.045,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12529.9463,Other,CMS Methodology,,65.6,,16363.83472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10106.161,Other,"DRG Weight, with Charge Based Outlier",,70,,17461.409,Percent of Total Billed Charges,,,85,,21203.1395,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12156.6418,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,16962.5116,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10590.3023,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9735.9353,Other,"DRG Weight, with Charge Based Outlier",,65,,16214.1655,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11316,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6990.4154,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7618,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7691,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7434,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7507,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7507,Other,CMS Methodology,,,"103% of Medicare, less IME",7581,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7710,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
RESPIRATORY NEOPLASMS WITH MCC,180,DRG,,,,Inpatient,,,68948.79,17237.1975,10120,58606.4715,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32806.206,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22948.614,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25954.83,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28452.4362,Other,CMS Methodology,,65.6,,45230.40624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22948.614,Other,"DRG Weight, with Charge Based Outlier",,70,,48264.153,Percent of Total Billed Charges,,,85,,58606.4715,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27604.7532,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,46885.1772,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24047.9802,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22107.9222,Other,"DRG Weight, with Charge Based Outlier",,65,,44816.7135,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25696,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15873.5196,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17298,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17465,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16880,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17047,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17047,Other,CMS Methodology,,,"103% of Medicare, less IME",17214,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17507,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
RESPIRATORY NEOPLASMS WITH CC,181,DRG,,,,Inpatient,,,43942.73,10985.6825,8420,37351.3205,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20840.331,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14578.239,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16487.955,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18074.5737,Other,CMS Methodology,,65.6,,28826.43088,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14578.239,Other,"DRG Weight, with Charge Based Outlier",,70,,30759.911,Percent of Total Billed Charges,,,85,,37351.3205,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17536.0782,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29881.0564,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15276.6177,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14044.1847,Other,"DRG Weight, with Charge Based Outlier",,65,,28562.7745,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16324,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10083.7446,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10989,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11095,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10723,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10829,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10829,Other,CMS Methodology,,,"103% of Medicare, less IME",10935,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11121,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,DRG,,,,Inpatient,,,33559.63,8389.9075,7570,28525.6855,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15719.875,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10996.375,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12436.875,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13633.6625,Other,CMS Methodology,,65.6,,22015.11728,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10996.375,Other,"DRG Weight, with Charge Based Outlier",,70,,23491.741,Percent of Total Billed Charges,,,85,,28525.6855,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13227.475,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22820.5484,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11523.1625,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10593.5375,Other,"DRG Weight, with Charge Based Outlier",,65,,21813.7595,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12313,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7606.175,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8289,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8369,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8088,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8169,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8169,Other,CMS Methodology,,,"103% of Medicare, less IME",8249,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8389,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MAJOR CHEST TRAUMA WITH MCC,183,DRG,,,,Inpatient,,,61817.23,15454.3075,9270,52544.6455,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29793.621,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20841.249,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23571.405,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25839.6567,Other,CMS Methodology,,65.6,,40552.10288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20841.249,Other,"DRG Weight, with Charge Based Outlier",,70,,43272.061,Percent of Total Billed Charges,,,85,,52544.6455,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25069.8162,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42035.7164,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21839.6607,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20077.7577,Other,"DRG Weight, with Charge Based Outlier",,65,,40181.1995,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23336,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14415.8586,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15709,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15861,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15330,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15482,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15482,Other,CMS Methodology,,,"103% of Medicare, less IME",15633,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15899,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
MAJOR CHEST TRAUMA WITH CC,184,DRG,,,,Inpatient,,,35890.52,8972.63,7570,30506.942,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20048.237,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14024.153,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15861.285,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17387.5999,Other,CMS Methodology,,65.6,,23544.18112,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14024.153,Other,"DRG Weight, with Charge Based Outlier",,70,,25123.364,Percent of Total Billed Charges,,,85,,30506.942,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16869.5714,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24405.5536,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14695.9879,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13510.3969,Other,"DRG Weight, with Charge Based Outlier",,65,,23328.838,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15703,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9700.4842,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10571,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10673,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10316,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10418,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10418,Other,CMS Methodology,,,"103% of Medicare, less IME",10520,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10699,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,DRG,,,,Inpatient,,,27927.69,6981.9225,5870,23738.5365,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14597.429,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10211.201,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11548.845,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12660.1783,Other,CMS Methodology,,65.6,,18320.56464,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10211.201,Other,"DRG Weight, with Charge Based Outlier",,70,,19549.383,Percent of Total Billed Charges,,,85,,23738.5365,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12282.9938,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18990.8292,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10700.3743,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9837.1273,Other,"DRG Weight, with Charge Based Outlier",,65,,18152.9985,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11434,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7063.0714,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7697,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7771,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7511,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7585,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7585,Other,CMS Methodology,,,"103% of Medicare, less IME",7660,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7790,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
PLEURAL EFFUSION WITH MCC,186,DRG,,,,Inpatient,,,59250.75,14812.6875,10120,50363.1375,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29656.6,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20745.4,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23463,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25720.82,Other,CMS Methodology,,65.6,,38868.492,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20745.4,Other,"DRG Weight, with Charge Based Outlier",,70,,41475.525,Percent of Total Billed Charges,,,85,,50363.1375,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24954.52,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40290.51,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21739.22,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19985.42,Other,"DRG Weight, with Charge Based Outlier",,65,,38512.9875,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23229,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14349.56,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15637,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15788,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15259,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15410,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15410,Other,CMS Methodology,,,"103% of Medicare, less IME",15562,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15826,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
PLEURAL EFFUSION WITH CC,187,DRG,,,,Inpatient,,,33901.06,8475.265,6720,28815.901,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18845.08,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13182.52,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14909.4,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16344.116,Other,CMS Methodology,,65.6,,22239.09536,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13182.52,Other,"DRG Weight, with Charge Based Outlier",,70,,23730.742,Percent of Total Billed Charges,,,85,,28815.901,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15857.176,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23052.7208,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13814.036,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12699.596,Other,"DRG Weight, with Charge Based Outlier",,65,,22035.689,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14761,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9118.328,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9936,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10032,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9696,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9792,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9792,Other,CMS Methodology,,,"103% of Medicare, less IME",9888,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10056,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
PLEURAL EFFUSION WITHOUT CC/MCC,188,DRG,,,,Inpatient,,,31516.77,7879.1925,5870,26789.2545,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13780.934,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9640.046,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10902.87,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11952.0418,Other,CMS Methodology,,65.6,,20675.00112,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9640.046,Other,"DRG Weight, with Charge Based Outlier",,70,,22061.739,Percent of Total Billed Charges,,,85,,26789.2545,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11595.9548,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21431.4036,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10101.8578,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9286.8958,Other,"DRG Weight, with Charge Based Outlier",,65,,20485.9005,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10794,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6668.0044,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7266,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7337,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7091,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7161,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7161,Other,CMS Methodology,,,"103% of Medicare, less IME",7231,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7354,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,DRG,,,,Inpatient,,,48950.12,12237.53,8420,41607.602,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23225.998,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16247.062,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18375.39,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20143.6346,Other,CMS Methodology,,65.6,,32111.27872,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16247.062,Other,"DRG Weight, with Charge Based Outlier",,70,,34265.084,Percent of Total Billed Charges,,,85,,41607.602,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19543.4956,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33286.0816,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17025.3866,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15651.8726,Other,"DRG Weight, with Charge Based Outlier",,65,,31817.578,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18192,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11238.0668,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12246,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12365,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11951,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12069,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12069,Other,CMS Methodology,,,"103% of Medicare, less IME",12187,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12394,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,DRG,,,,Inpatient,,,37688.36,9422.09,7570,32035.106,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21078.71,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14744.99,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16676.55,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18281.317,Other,CMS Methodology,,65.6,,24723.56416,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14744.99,Other,"DRG Weight, with Charge Based Outlier",,70,,26381.852,Percent of Total Billed Charges,,,85,,32035.106,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17736.662,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25628.0848,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15451.357,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14204.827,Other,"DRG Weight, with Charge Based Outlier",,65,,24497.434,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16510,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10199.086,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11114,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11222,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10846,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10953,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10953,Other,CMS Methodology,,,"103% of Medicare, less IME",11061,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11248,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,DRG,,,,Inpatient,,,32167.96,8041.99,6720,27342.766,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16125.307,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11279.983,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12757.635,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13985.2889,Other,CMS Methodology,,65.6,,21102.18176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11279.983,Other,"DRG Weight, with Charge Based Outlier",,70,,22517.572,Percent of Total Billed Charges,,,85,,27342.766,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13568.6254,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21874.2128,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11820.3569,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10866.7559,Other,"DRG Weight, with Charge Based Outlier",,65,,20909.174,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12630,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7802.3462,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8502,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8585,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8297,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8379,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8379,Other,CMS Methodology,,,"103% of Medicare, less IME",8461,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8605,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,DRG,,,,Inpatient,,,23462.59,5865.6475,5870,19943.2015,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12147.944,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8497.736,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9610.92,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10535.7688,Other,CMS Methodology,,65.6,,15391.45904,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8497.736,Other,"DRG Weight, with Charge Based Outlier",,70,,16423.813,Percent of Total Billed Charges,,,85,,19943.2015,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10221.8768,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,15954.5612,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8904.8248,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8186.4328,Other,"DRG Weight, with Charge Based Outlier",,65,,15250.6835,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9515,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5877.8704,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6405,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6467,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6251,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6312,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6312,Other,CMS Methodology,,,"103% of Medicare, less IME",6374,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6483,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,DRG,,,,Inpatient,,,47643.42,11910.855,8420,40496.907,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24733.229,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17301.401,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19567.845,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21450.8383,Other,CMS Methodology,,65.6,,31254.08352,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17301.401,Other,"DRG Weight, with Charge Based Outlier",,70,,33350.394,Percent of Total Billed Charges,,,85,,40496.907,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20811.7538,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,32397.5256,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18130.2343,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16667.5873,Other,"DRG Weight, with Charge Based Outlier",,65,,30968.223,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19373,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11967.3514,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13041,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13167,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12726,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12852,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12852,Other,CMS Methodology,,,"103% of Medicare, less IME",12978,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13199,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,DRG,,,,Inpatient,,,31412.61,7853.1525,7447.24,26700.7185,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15391.4,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10766.6,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12177,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13348.78,Other,CMS Methodology,,65.6,,20606.67216,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10766.6,Other,"DRG Weight, with Charge Based Outlier",,70,,21988.827,Percent of Total Billed Charges,,,85,,26700.7185,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12951.08,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21360.5748,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11282.38,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10372.18,Other,"DRG Weight, with Charge Based Outlier",,65,,20418.1965,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12056,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7447.24,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8115,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8194,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7919,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7998,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7998,Other,CMS Methodology,,,"103% of Medicare, less IME",8076,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8213,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,DRG,,,,Inpatient,,,24911.1,6227.775,5655.3614,21174.435,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11688.079,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8176.051,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9247.095,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10136.9333,Other,CMS Methodology,,65.6,,16341.6816,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8176.051,Other,"DRG Weight, with Charge Based Outlier",,70,,17437.77,Percent of Total Billed Charges,,,85,,21174.435,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,9834.9238,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,16939.548,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8567.7293,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7876.5323,Other,"DRG Weight, with Charge Based Outlier",,65,,16192.215,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9155,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5655.3614,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6163,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6222,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6014,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6073,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6073,Other,CMS Methodology,,,"103% of Medicare, less IME",6133,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6237,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
INTERSTITIAL LUNG DISEASE WITH MCC,196,DRG,,,,Inpatient,,,53300.02,13325.005,9270,45305.017,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35364.557,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24738.233,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27978.885,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30671.2639,Other,CMS Methodology,,65.6,,34964.81312,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24738.233,Other,"DRG Weight, with Charge Based Outlier",,70,,37310.014,Percent of Total Billed Charges,,,85,,45305.017,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29757.4754,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36244.0136,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25923.3319,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23831.9809,Other,"DRG Weight, with Charge Based Outlier",,65,,34645.013,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27700,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17111.3962,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18647,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18827,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18196,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18376,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18376,Other,CMS Methodology,,,"103% of Medicare, less IME",18557,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18872,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
INTERSTITIAL LUNG DISEASE WITH CC,197,DRG,,,,Inpatient,,,42127.05,10531.7625,6720,35807.9925,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18582.3,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12998.7,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14701.5,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16116.21,Other,CMS Methodology,,65.6,,27635.3448,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12998.7,Other,"DRG Weight, with Charge Based Outlier",,70,,29488.935,Percent of Total Billed Charges,,,85,,35807.9925,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15636.06,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28646.394,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13621.41,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12522.51,Other,"DRG Weight, with Charge Based Outlier",,65,,27382.5825,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14555,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8991.18,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9798,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9893,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9561,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9656,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9656,Other,CMS Methodology,,,"103% of Medicare, less IME",9751,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9916,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,DRG,,,,Inpatient,,,67260.3,16815.075,6112.186,57171.255,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12632.21,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8836.49,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9994.05,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10955.767,Other,CMS Methodology,,65.6,,44122.7568,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8836.49,Other,"DRG Weight, with Charge Based Outlier",,70,,47082.21,Percent of Total Billed Charges,,,85,,57171.255,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10629.362,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45737.004,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9259.807,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8512.777,Other,"DRG Weight, with Charge Based Outlier",,65,,43719.195,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9894,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6112.186,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6661,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6725,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6500,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6564,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6564,Other,CMS Methodology,,,"103% of Medicare, less IME",6628,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6741,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
PNEUMOTHORAX WITH MCC,199,DRG,,,,Inpatient,,,60808.24,15202.06,10120,51687.004,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33134.681,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23178.389,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26214.705,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28737.3187,Other,CMS Methodology,,65.6,,39890.20544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23178.389,Other,"DRG Weight, with Charge Based Outlier",,70,,42565.768,Percent of Total Billed Charges,,,85,,51687.004,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27881.1482,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41349.6032,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24288.7627,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22329.2797,Other,"DRG Weight, with Charge Based Outlier",,65,,39525.356,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25953,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16032.4546,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17471,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17640,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17049,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17218,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17218,Other,CMS Methodology,,,"103% of Medicare, less IME",17387,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17682,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
PNEUMOTHORAX WITH CC,200,DRG,,,,Inpatient,,,32850.58,8212.645,7570,27922.993,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20787.775,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14541.475,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16446.375,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18028.9925,Other,CMS Methodology,,65.6,,21549.98048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14541.475,Other,"DRG Weight, with Charge Based Outlier",,70,,22995.406,Percent of Total Billed Charges,,,85,,27922.993,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17491.855,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22338.3944,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15238.0925,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14008.7675,Other,"DRG Weight, with Charge Based Outlier",,65,,21352.877,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16282,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10058.315,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10961,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11067,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10696,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10802,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10802,Other,CMS Methodology,,,"103% of Medicare, less IME",10908,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11093,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
PNEUMOTHORAX WITHOUT CC/MCC,201,DRG,,,,Inpatient,,,24732.98,6183.245,6149.4222,21023.033,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12709.167,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8890.323,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10054.935,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11022.5109,Other,CMS Methodology,,65.6,,16224.83488,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8890.323,Other,"DRG Weight, with Charge Based Outlier",,70,,17313.086,Percent of Total Billed Charges,,,85,,21023.033,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10694.1174,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,16818.4264,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9316.2189,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8564.6379,Other,"DRG Weight, with Charge Based Outlier",,65,,16076.437,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9955,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6149.4222,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6701,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6766,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6539,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6604,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6604,Other,CMS Methodology,,,"103% of Medicare, less IME",6669,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6782,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
BRONCHITIS AND ASTHMA WITH CC/MCC,202,DRG,,,,Inpatient,,,35024.64,8756.16,7570,29770.944,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18144.959,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12692.771,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14355.495,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15736.9093,Other,CMS Methodology,,65.6,,22976.16384,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12692.771,Other,"DRG Weight, with Charge Based Outlier",,70,,24517.248,Percent of Total Billed Charges,,,85,,29770.944,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15268.0598,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23816.7552,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13300.8253,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12227.7883,Other,"DRG Weight, with Charge Based Outlier",,65,,22766.016,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14212,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8779.5694,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9567,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9660,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9336,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9429,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9429,Other,CMS Methodology,,,"103% of Medicare, less IME",9521,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9683,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,DRG,,,,Inpatient,,,25343.62,6335.905,6326.5212,21542.077,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13075.182,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9146.358,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10344.51,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11339.9514,Other,CMS Methodology,,65.6,,16625.41472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9146.358,Other,"DRG Weight, with Charge Based Outlier",,70,,17740.534,Percent of Total Billed Charges,,,85,,21542.077,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11002.1004,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,17233.6616,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9584.5194,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8811.2934,Other,"DRG Weight, with Charge Based Outlier",,65,,16473.353,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10241,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6326.5212,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6894,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6961,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6728,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6794,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6794,Other,CMS Methodology,,,"103% of Medicare, less IME",6861,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6977,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
RESPIRATORY SIGNS AND SYMPTOMS,204,DRG,,,,Inpatient,,,33489.53,8372.3825,6720,28466.1005,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15222.47,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10648.43,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12043.35,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13202.269,Other,CMS Methodology,,65.6,,21969.13168,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10648.43,Other,"DRG Weight, with Charge Based Outlier",,70,,23442.671,Percent of Total Billed Charges,,,85,,28466.1005,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12808.934,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22772.8804,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11158.549,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10258.339,Other,"DRG Weight, with Charge Based Outlier",,65,,21768.1945,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11923,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7365.502,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8026,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8104,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7833,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7910,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7910,Other,CMS Methodology,,,"103% of Medicare, less IME",7988,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8123,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,DRG,,,,Inpatient,,,77226.2,19306.55,10970,65642.27,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35434.006,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24786.814,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28033.83,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30731.4962,Other,CMS Methodology,,65.6,,50660.3872,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24786.814,Other,"DRG Weight, with Charge Based Outlier",,70,,54058.34,Percent of Total Billed Charges,,,85,,65642.27,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29815.9132,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52513.816,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25974.2402,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23878.7822,Other,"DRG Weight, with Charge Based Outlier",,65,,50197.03,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27754,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17144.9996,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18683,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18864,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18232,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18413,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18413,Other,CMS Methodology,,,"103% of Medicare, less IME",18593,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18909,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,DRG,,,,Inpatient,,,30477.66,7619.415,6720,25906.011,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17001.866,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11893.154,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13451.13,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14745.5182,Other,CMS Methodology,,65.6,,19993.34496,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11893.154,Other,"DRG Weight, with Charge Based Outlier",,70,,21334.362,Percent of Total Billed Charges,,,85,,25906.011,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14306.2052,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20724.8088,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12462.9022,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11457.4642,Other,"DRG Weight, with Charge Based Outlier",,65,,19810.479,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13317,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8226.4756,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8965,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9051,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8748,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8835,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8835,Other,CMS Methodology,,,"103% of Medicare, less IME",8921,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9073,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,DRG,,,,Inpatient,,,225062.23,56265.5575,16920,191302.8955,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,121389.344,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,84914.336,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,102117.5645,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,105279.5488,Other,CMS Methodology,,65.6,,147640.8229,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,84914.336,Other,"DRG Weight, with Charge Based Outlier",,70,,157543.561,Percent of Total Billed Charges,,,85,,191302.8955,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,102142.9568,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,153042.3164,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,88982.2048,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",78771.7805,Other,"DRG Weight, with Charge Based Outlier",,65,,146290.4495,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",95080,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,58735.1104,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",64005,Other,CMS Methodology,,,"104.5% of Medicare, less IME",64624,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",62459,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",63078,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",63078,Other,CMS Methodology,,,"103% of Medicare, less IME",63696,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",64778,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,17515,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,17270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,DRG,,,,Inpatient,,,100486.48,25121.62,10120,85413.508,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,50374.926,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35238.294,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,39854.43,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,43689.5802,Other,CMS Methodology,,65.6,,65919.13088,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35238.294,Other,"DRG Weight, with Charge Based Outlier",,70,,70340.536,Percent of Total Billed Charges,,,85,,85413.508,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,42387.9372,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,68330.8064,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,36926.4042,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",33947.3862,Other,"DRG Weight, with Charge Based Outlier",,65,,65316.212,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",39457,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24374.2716,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",26561,Other,CMS Methodology,,,"104.5% of Medicare, less IME",26818,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",25920,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",26176,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",26176,Other,CMS Methodology,,,"103% of Medicare, less IME",26433,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",26882,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,DRG,,,,Inpatient,,,383195.99,95798.9975,16070,325716.5915,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,268057.7839,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,188315.303,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,236958.5126,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,177341.7981,Other,CMS Methodology,,65.6,,251376.5694,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,188315.303,Other,"DRG Weight, with Charge Based Outlier",,70,,268237.193,Percent of Total Billed Charges,,,85,,325716.5915,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,172058.2566,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,260573.2732,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,149889.1701,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",134118.5965,Other,"DRG Weight, with Charge Based Outlier",,65,,249077.3935,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",160161,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,135161.1166,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",107816,Other,CMS Methodology,,,"104.5% of Medicare, less IME",108857,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",105211,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",106253,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",106253,Other,CMS Methodology,,,"103% of Medicare, less IME",107295,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",109118,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,16622.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,16395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology
OTHER HEART ASSIST SYSTEM IMPLANT,215,DRG,,,,Inpatient,,,305498.23,76374.5575,10970,259673.4955,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,230354.502,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,153309.016,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,198562.9565,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,172472.7492,Other,CMS Methodology,,65.6,,200406.8389,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,153309.016,Other,"DRG Weight, with Charge Based Outlier",,70,,213848.761,Percent of Total Billed Charges,,,85,,259673.4955,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,167334.2712,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,207738.7964,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,145773.8532,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",106924.3805,Other,"DRG Weight, with Charge Based Outlier",,65,,198573.8495,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",155764,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,107581.4072,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",104856,Other,CMS Methodology,,,"104.5% of Medicare, less IME",105869,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",102323,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",103336,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",103336,Other,CMS Methodology,,,"103% of Medicare, less IME",104349,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",106122,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,DRG,,,,Inpatient,,,353686.89,88421.7225,15220,300633.8565,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,232543.1696,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,160193.699,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,205607.4559,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,157110.2569,Other,CMS Methodology,,65.6,,232018.5998,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,160193.699,Other,"DRG Weight, with Charge Based Outlier",,70,,247580.823,Percent of Total Billed Charges,,,85,,300633.8565,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,152429.4734,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,240507.0852,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,132789.4849,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",123790.4115,Other,"DRG Weight, with Charge Based Outlier",,65,,229896.4785,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",141889,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,114431.095,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",95516,Other,CMS Methodology,,,"104.5% of Medicare, less IME",96439,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",93209,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",94132,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",94132,Other,CMS Methodology,,,"103% of Medicare, less IME",95054,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",96669,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,DRG,,,,Inpatient,,,204798.6,51199.65,7570,174078.81,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,121214.783,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,84792.227,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,95899.815,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,105128.1541,Other,CMS Methodology,,65.6,,134347.8816,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,84792.227,Other,"DRG Weight, with Charge Based Outlier",,70,,143359.02,Percent of Total Billed Charges,,,85,,174078.81,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,101996.0726,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,139263.048,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,88854.2461,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",71679.51,Other,"DRG Weight, with Charge Based Outlier",,65,,133119.09,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",94943,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,58650.6478,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",63913,Other,CMS Methodology,,,"104.5% of Medicare, less IME",64531,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",62369,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",62987,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",62987,Other,CMS Methodology,,,"103% of Medicare, less IME",63604,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",64685,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,DRG,,,,Inpatient,,,216977.62,54244.405,5870,184430.977,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,111668.361,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,78114.309,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,90893.77494,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,96848.6547,Other,CMS Methodology,,65.6,,142337.3187,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,78114.309,Other,"DRG Weight, with Charge Based Outlier",,70,,151884.334,Percent of Total Billed Charges,,,85,,184430.977,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,93963.2442,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,147544.7816,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,81856.4187,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",75942.167,Other,"DRG Weight, with Charge Based Outlier",,65,,141035.453,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",87466,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,54031.5426,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",58880,Other,CMS Methodology,,,"104.5% of Medicare, less IME",59448,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",57457,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",58026,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",58026,Other,CMS Methodology,,,"103% of Medicare, less IME",58595,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",59591,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,DRG,,,,Inpatient,,,323100.22,80775.055,13520,274635.187,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,183992.6029,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,122833.463,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,163824.1211,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,125958.7625,Other,CMS Methodology,,65.6,,211953.7443,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,122833.463,Other,"DRG Weight, with Charge Based Outlier",,70,,226170.154,Percent of Total Billed Charges,,,85,,274635.187,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,122206.075,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,219708.1496,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,106460.2625,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",113085.077,Other,"DRG Weight, with Charge Based Outlier",,65,,210015.143,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",113756,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,87264.0454,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",76577,Other,CMS Methodology,,,"104.5% of Medicare, less IME",77317,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",74727,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",75467,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",75467,Other,CMS Methodology,,,"103% of Medicare, less IME",76207,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",77502,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,DRG,,,,Inpatient,,,266798.45,66699.6125,10970,226778.6825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,114926.1559,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,69545.671,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,102974.3677,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,86224.9793,Other,CMS Methodology,,65.6,,175019.7832,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,69545.671,Other,"DRG Weight, with Charge Based Outlier",,70,,186758.915,Percent of Total Billed Charges,,,85,,226778.6825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,83656.0798,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,181422.946,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,72877.2953,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",93379.4575,Other,"DRG Weight, with Charge Based Outlier",,65,,173418.9925,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",77872,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,48104.6294,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",52421,Other,CMS Methodology,,,"104.5% of Medicare, less IME",52927,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",51155,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",51661,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",51661,Other,CMS Methodology,,,"103% of Medicare, less IME",52168,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",53054,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,DRG,,,,Inpatient,,,209726.87,52431.7175,8420,178267.8395,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,86203.102,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,60300.838,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,68200.11,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,74762.9354,Other,CMS Methodology,,65.6,,137580.8267,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,60300.838,Other,"DRG Weight, with Charge Based Outlier",,70,,146808.809,Percent of Total Billed Charges,,,85,,178267.8395,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,72535.5244,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,142614.2716,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,63189.5834,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",73404.4045,Other,"DRG Weight, with Charge Based Outlier",,65,,136322.4655,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",67520,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,41709.9932,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",45452,Other,CMS Methodology,,,"104.5% of Medicare, less IME",45892,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",44355,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",44794,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",44794,Other,CMS Methodology,,,"103% of Medicare, less IME",45233,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",46001,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,DRG,,,,Inpatient,,,162423.82,40605.955,11820,138060.247,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,93536.541,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,65430.729,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,74002.005,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,81123.1407,Other,CMS Methodology,,65.6,,106550.0259,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,65430.729,Other,"DRG Weight, with Charge Based Outlier",,70,,113696.674,Percent of Total Billed Charges,,,85,,138060.247,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,78706.2402,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,110448.1976,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,68565.2247,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",63033.7617,Other,"DRG Weight, with Charge Based Outlier",,65,,105575.483,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",73264,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,45258.3306,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",49319,Other,CMS Methodology,,,"104.5% of Medicare, less IME",49796,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",48128,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",48604,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",48604,Other,CMS Methodology,,,"103% of Medicare, less IME",49081,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",49915,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,DRG,,,,Inpatient,,,120294.43,30073.6075,8420,102250.2655,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,58305.251,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40785.719,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,46128.555,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,50567.4577,Other,CMS Methodology,,65.6,,78913.14608,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40785.719,Other,"DRG Weight, with Charge Based Outlier",,70,,84206.101,Percent of Total Billed Charges,,,85,,102250.2655,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,49060.9022,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,81800.2124,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,42739.5817,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",39291.5887,Other,"DRG Weight, with Charge Based Outlier",,65,,78191.3795,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",45669,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,28211.4166,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",30743,Other,CMS Methodology,,,"104.5% of Medicare, less IME",31040,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",30000,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",30297,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",30297,Other,CMS Methodology,,,"103% of Medicare, less IME",30594,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",31114,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
CORONARY BYPASS WITH PTCA WITH MCC,231,DRG,,,,Inpatient,,,302745.52,75686.38,13520,257333.692,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,189408.3398,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,124360.515,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,165864.6572,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,137946.6181,Other,CMS Methodology,,65.6,,198601.0611,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,124360.515,Other,"DRG Weight, with Charge Based Outlier",,70,,211921.864,Percent of Total Billed Charges,,,85,,257333.692,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,133836.7766,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,205866.9536,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,116592.3901,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",105960.932,Other,"DRG Weight, with Charge Based Outlier",,65,,196784.588,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",124582,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,87438.5262,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",83865,Other,CMS Methodology,,,"104.5% of Medicare, less IME",84676,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",81840,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",82650,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",82650,Other,CMS Methodology,,,"103% of Medicare, less IME",83460,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",84878,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,DRG,,,,Inpatient,,,383490.35,95872.5875,16920,325966.7975,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,178361.1506,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,125603.371,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,166026.928,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,99443.5273,Other,CMS Methodology,,65.6,,251569.6696,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,125603.371,Other,"DRG Weight, with Charge Based Outlier",,70,,268443.245,Percent of Total Billed Charges,,,85,,325966.7975,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,96480.8078,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,260773.438,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,95041.6033,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",134221.6225,Other,"DRG Weight, with Charge Based Outlier",,65,,249268.7275,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",89809,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,91796.1254,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",60457,Other,CMS Methodology,,,"104.5% of Medicare, less IME",61041,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",58997,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",59581,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",59581,Other,CMS Methodology,,,"103% of Medicare, less IME",60165,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",61187,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,17515,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,17270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,DRG,,,,Inpatient,,,313984.75,78496.1875,14370,266887.0375,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,181708.8668,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,120223.232,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,161012.3258,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,127243.1756,Other,CMS Methodology,,65.6,,205973.996,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,120223.232,Other,"DRG Weight, with Charge Based Outlier",,70,,219789.325,Percent of Total Billed Charges,,,85,,266887.0375,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,123452.2216,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,213509.63,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,107545.8476,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",109894.6625,Other,"DRG Weight, with Charge Based Outlier",,65,,204090.0875,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",114916,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,85063.6648,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",77358,Other,CMS Methodology,,,"104.5% of Medicare, less IME",78105,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",75489,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",76237,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",76237,Other,CMS Methodology,,,"103% of Medicare, less IME",76984,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",78292,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,DRG,,,,Inpatient,,,259668.83,64917.2075,11820,220718.5055,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,112422.7178,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,69854.226,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,100207.6987,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,86607.5358,Other,CMS Methodology,,65.6,,170342.7525,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,69854.226,Other,"DRG Weight, with Charge Based Outlier",,70,,181768.181,Percent of Total Billed Charges,,,85,,220718.5055,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,84027.2388,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,176574.8044,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,73200.6318,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",90884.0905,Other,"DRG Weight, with Charge Based Outlier",,65,,168784.7395,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",78217,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,48318.0564,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",52653,Other,CMS Methodology,,,"104.5% of Medicare, less IME",53162,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",51382,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",51890,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",51890,Other,CMS Methodology,,,"103% of Medicare, less IME",52399,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",53289,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,DRG,,,,Inpatient,,,232001.55,58000.3875,11820,197201.3175,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,111582.4112,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,77259.546,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,96492.49735,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,95788.8918,Other,CMS Methodology,,65.6,,152193.0168,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,77259.546,Other,"DRG Weight, with Charge Based Outlier",,70,,162401.085,Percent of Total Billed Charges,,,85,,197201.3175,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,92935.0548,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,157761.054,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,80960.7078,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",81200.5425,Other,"DRG Weight, with Charge Based Outlier",,65,,150801.0075,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",86509,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,53440.3044,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",58235,Other,CMS Methodology,,,"104.5% of Medicare, less IME",58798,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",56829,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",57391,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",57391,Other,CMS Methodology,,,"103% of Medicare, less IME",57954,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",58939,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,DRG,,,,Inpatient,,,208055.92,52013.98,10120,176847.532,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,77184.117,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53991.873,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,61064.685,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,66940.8759,Other,CMS Methodology,,65.6,,136484.6835,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53991.873,Other,"DRG Weight, with Charge Based Outlier",,70,,145639.144,Percent of Total Billed Charges,,,85,,176847.532,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,64946.5074,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,141478.0256,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,56578.3839,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",72819.572,Other,"DRG Weight, with Charge Based Outlier",,65,,135236.348,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",60456,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,37346.0922,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",40697,Other,CMS Methodology,,,"104.5% of Medicare, less IME",41090,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",39714,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",40107,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",40107,Other,CMS Methodology,,,"103% of Medicare, less IME",40500,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",41189,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,DRG,,,,Inpatient,,,171488.89,42872.2225,15220,145765.5565,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,94542.613,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,66134.497,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,74797.965,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,81995.6951,Other,CMS Methodology,,65.6,,112496.7118,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,66134.497,Other,"DRG Weight, with Charge Based Outlier",,70,,120042.223,Percent of Total Billed Charges,,,85,,145765.5565,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,79552.7986,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,116612.4452,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,69302.7071,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",63711.7481,Other,"DRG Weight, with Charge Based Outlier",,65,,111467.7785,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",74052,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,45745.1258,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",49850,Other,CMS Methodology,,,"104.5% of Medicare, less IME",50331,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",48646,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",49127,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",49127,Other,CMS Methodology,,,"103% of Medicare, less IME",49609,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",50452,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,DRG,,,,Inpatient,,,96739.23,24184.8075,10970,82228.3455,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,54661.994,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38237.186,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,43246.17,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,47407.7038,Other,CMS Methodology,,65.6,,63460.93488,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38237.186,Other,"DRG Weight, with Charge Based Outlier",,70,,67717.461,Percent of Total Billed Charges,,,85,,82228.3455,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,45995.2868,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,65782.6764,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,40068.9598,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36836.4178,Other,"DRG Weight, with Charge Based Outlier",,65,,62880.4995,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",42815,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26448.6004,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28822,Other,CMS Methodology,,,"104.5% of Medicare, less IME",29100,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",28126,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",28404,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",28404,Other,CMS Methodology,,,"103% of Medicare, less IME",28682,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",29170,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,DRG,,,,Inpatient,,,43514.18,10878.545,7570,36987.053,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28340.823,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19824.987,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22422.015,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24579.6621,Other,CMS Methodology,,65.6,,28545.30208,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19824.987,Other,"DRG Weight, with Charge Based Outlier",,70,,30459.926,Percent of Total Billed Charges,,,85,,36987.053,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23847.3606,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29589.6424,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20774.7141,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19098.7251,Other,"DRG Weight, with Charge Based Outlier",,65,,28284.217,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22198,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13712.9118,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14943,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15088,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14582,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14727,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14727,Other,CMS Methodology,,,"103% of Medicare, less IME",14871,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15124,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,DRG,,,,Inpatient,,,127561.63,31890.4075,10970,108427.3855,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,63667.84,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,44536.96,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,50371.2,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,55218.368,Other,CMS Methodology,,65.6,,83680.42928,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,44536.96,Other,"DRG Weight, with Charge Based Outlier",,70,,89293.141,Percent of Total Billed Charges,,,85,,108427.3855,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,53573.248,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,86741.9084,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,46670.528,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",42905.408,Other,"DRG Weight, with Charge Based Outlier",,65,,82915.0595,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",49869,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,30806.144,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",33570,Other,CMS Methodology,,,"104.5% of Medicare, less IME",33895,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",32759,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",33084,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",33084,Other,CMS Methodology,,,"103% of Medicare, less IME",33408,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",33976,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,DRG,,,,Inpatient,,,80839.34,20209.835,7570,68713.439,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42285.056,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29579.264,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33454.08,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36673.3312,Other,CMS Methodology,,65.6,,53030.60704,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29579.264,Other,"DRG Weight, with Charge Based Outlier",,70,,56587.538,Percent of Total Billed Charges,,,85,,68713.439,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35580.7232,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,54970.7512,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30996.2752,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28495.6672,Other,"DRG Weight, with Charge Based Outlier",,65,,52545.571,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33120,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20459.9296,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22296,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22511,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21757,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21973,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21973,Other,CMS Methodology,,,"103% of Medicare, less IME",22188,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22565,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,DRG,,,,Inpatient,,,60707.62,15176.905,6720,51601.477,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33874.219,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23695.711,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26799.795,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29378.7113,Other,CMS Methodology,,65.6,,39824.19872,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23695.711,Other,"DRG Weight, with Charge Based Outlier",,70,,42495.334,Percent of Total Billed Charges,,,85,,51601.477,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28503.4318,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41281.1816,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24830.8673,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22827.6503,Other,"DRG Weight, with Charge Based Outlier",,65,,39459.953,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26533,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16390.2854,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17861,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18033,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17429,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17602,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17602,Other,CMS Methodology,,,"103% of Medicare, less IME",17775,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18077,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
AICD GENERATOR PROCEDURES,245,DRG,,,,Inpatient,,,165812.97,41453.2425,11820,140941.0245,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,91725.236,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,64163.684,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,72568.98,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,79552.2172,Other,CMS Methodology,,65.6,,108773.3083,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,64163.684,Other,"DRG Weight, with Charge Based Outlier",,70,,116069.079,Percent of Total Billed Charges,,,85,,140941.0245,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,77182.1192,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,112752.8196,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,67237.4812,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",61813.1332,Other,"DRG Weight, with Charge Based Outlier",,65,,107778.4305,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",71845,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,44381.9176,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",48364,Other,CMS Methodology,,,"104.5% of Medicare, less IME",48831,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",47196,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",47663,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",47663,Other,CMS Methodology,,,"103% of Medicare, less IME",48130,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",48948,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,DRG,,,,Inpatient,,,93144.75,23286.1875,7570,79173.0375,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,43407.502,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30364.438,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,34342.11,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,37646.8154,Other,CMS Methodology,,65.6,,61102.956,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30364.438,Other,"DRG Weight, with Charge Based Outlier",,70,,65201.325,Percent of Total Billed Charges,,,85,,79173.0375,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,36525.2044,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,63338.43,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31819.0634,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",29252.0774,Other,"DRG Weight, with Charge Based Outlier",,65,,60544.0875,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",34000,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21003.0332,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22888,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23109,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22335,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22556,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22556,Other,CMS Methodology,,,"103% of Medicare, less IME",22777,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",23164,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,DRG,,,,Inpatient,,,72173.32,18043.33,6720,61347.322,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29330.002,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20516.938,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23204.61,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25437.5654,Other,CMS Methodology,,65.6,,47345.69792,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20516.938,Other,"DRG Weight, with Charge Based Outlier",,70,,50521.324,Percent of Total Billed Charges,,,85,,61347.322,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24679.7044,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,49077.8576,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21499.8134,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19765.3274,Other,"DRG Weight, with Charge Based Outlier",,65,,46912.658,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22973,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14191.5332,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15465,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15614,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15091,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15241,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15241,Other,CMS Methodology,,,"103% of Medicare, less IME",15390,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15652,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER VASCULAR PROCEDURES WITH MCC,252,DRG,,,,Inpatient,,,131546.43,32886.6075,10970,111814.4655,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,64388.608,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45041.152,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,50941.44,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,55843.4816,Other,CMS Methodology,,65.6,,86294.45808,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45041.152,Other,"DRG Weight, with Charge Based Outlier",,70,,92082.501,Percent of Total Billed Charges,,,85,,111814.4655,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,54179.7376,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,89451.5724,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,47198.8736,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",43391.1296,Other,"DRG Weight, with Charge Based Outlier",,65,,85505.1795,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",50433,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31154.8928,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",33950,Other,CMS Methodology,,,"104.5% of Medicare, less IME",34278,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33130,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",33458,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",33458,Other,CMS Methodology,,,"103% of Medicare, less IME",33786,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",34360,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
OTHER VASCULAR PROCEDURES WITH CC,253,DRG,,,,Inpatient,,,101948.48,25487.12,8420,86656.208,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,47919.81,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33520.89,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,37912.05,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,41560.287,Other,CMS Methodology,,65.6,,66878.20288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33520.89,Other,"DRG Weight, with Charge Based Outlier",,70,,71363.936,Percent of Total Billed Charges,,,85,,86656.208,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,40322.082,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,69324.9664,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,35126.727,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",32292.897,Other,"DRG Weight, with Charge Based Outlier",,65,,66266.512,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",37534,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,23186.346,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",25267,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25511,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",24656,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24901,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24901,Other,CMS Methodology,,,"103% of Medicare, less IME",25145,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25572,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,DRG,,,,Inpatient,,,75234.09,18808.5225,6720,63948.9765,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32836.238,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22969.622,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25978.59,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28478.4826,Other,CMS Methodology,,65.6,,49353.56304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22969.622,Other,"DRG Weight, with Charge Based Outlier",,70,,52663.863,Percent of Total Billed Charges,,,85,,63948.9765,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27630.0236,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,51159.1812,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24069.9946,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22128.1606,Other,"DRG Weight, with Charge Based Outlier",,65,,48902.1585,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25720,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15888.0508,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17314,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17481,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16895,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17063,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17063,Other,CMS Methodology,,,"103% of Medicare, less IME",17230,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17523,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,DRG,,,,Inpatient,,,98568.7,24642.175,11820,83783.395,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,49111.705,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34354.645,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,38855.025,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,42594.0035,Other,CMS Methodology,,65.6,,64661.0672,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34354.645,Other,"DRG Weight, with Charge Based Outlier",,70,,68998.09,Percent of Total Billed Charges,,,85,,83783.395,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,41325.001,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,67026.716,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,36000.4235,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",33096.1085,Other,"DRG Weight, with Charge Based Outlier",,65,,64069.655,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",38468,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,23763.053,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",25895,Other,CMS Methodology,,,"104.5% of Medicare, less IME",26145,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",25270,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",25520,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",25520,Other,CMS Methodology,,,"103% of Medicare, less IME",25770,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",26208,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,DRG,,,,Inpatient,,,56029.69,14007.4225,8420,47625.2365,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31790.749,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22238.281,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25151.445,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27571.7423,Other,CMS Methodology,,65.6,,36755.47664,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22238.281,Other,"DRG Weight, with Charge Based Outlier",,70,,39220.783,Percent of Total Billed Charges,,,85,,47625.2365,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26750.2978,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38100.1892,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23303.6183,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21423.6113,Other,"DRG Weight, with Charge Based Outlier",,65,,36419.2985,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24901,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15382.1834,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16762,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16924,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16357,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16519,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16519,Other,CMS Methodology,,,"103% of Medicare, less IME",16681,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16965,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,DRG,,,,Inpatient,,,31487.86,7871.965,6720,26764.681,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14877.102,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10406.838,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11770.11,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12902.7354,Other,CMS Methodology,,65.6,,20656.03616,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10406.838,Other,"DRG Weight, with Charge Based Outlier",,70,,22041.502,Percent of Total Billed Charges,,,85,,26764.681,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12518.3244,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21411.7448,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10905.3834,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10025.5974,Other,"DRG Weight, with Charge Based Outlier",,65,,20467.109,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11653,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7198.3932,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7844,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7920,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7655,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7731,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7731,Other,CMS Methodology,,,"103% of Medicare, less IME",7806,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7939,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,DRG,,,,Inpatient,,,85914.23,21478.5575,10120,73027.0955,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,52659.235,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,36836.215,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,41661.675,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,45670.7345,Other,CMS Methodology,,65.6,,56359.73488,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,36836.215,Other,"DRG Weight, with Charge Based Outlier",,70,,60139.961,Percent of Total Billed Charges,,,85,,73027.0955,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,44310.067,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,58421.6764,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,38600.8745,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",35486.7695,Other,"DRG Weight, with Charge Based Outlier",,65,,55844.2495,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",41246,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,25479.551,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",27766,Other,CMS Methodology,,,"104.5% of Medicare, less IME",28034,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",27095,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",27363,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",27363,Other,CMS Methodology,,,"103% of Medicare, less IME",27632,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",28101,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,DRG,,,,Inpatient,,,121150.6,30287.65,9270,102978.01,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32992.029,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23078.601,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26101.845,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28613.5983,Other,CMS Methodology,,65.6,,79474.7936,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23078.601,Other,"DRG Weight, with Charge Based Outlier",,70,,84805.42,Percent of Total Billed Charges,,,85,,102978.01,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27761.1138,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,82382.408,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24184.1943,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22233.1473,Other,"DRG Weight, with Charge Based Outlier",,65,,78747.89,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25842,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15963.4314,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17396,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17564,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16976,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17144,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17144,Other,CMS Methodology,,,"103% of Medicare, less IME",17312,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17606,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,DRG,,,,Inpatient,,,112762.36,28190.59,11820,95848.006,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,63934.374,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,44723.406,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,50582.07,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,55449.5298,Other,CMS Methodology,,65.6,,73972.10816,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,44723.406,Other,"DRG Weight, with Charge Based Outlier",,70,,78933.652,Percent of Total Billed Charges,,,85,,95848.006,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,53797.5228,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,76678.4048,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,46865.9058,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",43085.0238,Other,"DRG Weight, with Charge Based Outlier",,65,,73295.534,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",50078,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,30935.1084,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",33711,Other,CMS Methodology,,,"104.5% of Medicare, less IME",34036,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",32897,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",33222,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",33222,Other,CMS Methodology,,,"103% of Medicare, less IME",33548,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",34118,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,DRG,,,,Inpatient,,,59775.11,14943.7775,8420,50808.8435,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35617.952,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24915.488,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28179.36,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30891.0304,Other,CMS Methodology,,65.6,,39212.47216,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24915.488,Other,"DRG Weight, with Charge Based Outlier",,70,,41842.577,Percent of Total Billed Charges,,,85,,50808.8435,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29970.6944,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40647.0748,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26109.0784,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24002.7424,Other,"DRG Weight, with Charge Based Outlier",,65,,38853.8215,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27898,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17234.0032,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18780,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18962,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18327,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18508,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18508,Other,CMS Methodology,,,"103% of Medicare, less IME",18690,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19007,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,DRG,,,,Inpatient,,,34850.5,8712.625,5870,29622.925,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28489.106,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19928.714,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22539.33,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24708.2662,Other,CMS Methodology,,65.6,,22861.928,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19928.714,Other,"DRG Weight, with Charge Based Outlier",,70,,24395.35,Percent of Total Billed Charges,,,85,,29622.925,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23972.1332,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23698.34,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20883.4102,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19198.6522,Other,"DRG Weight, with Charge Based Outlier",,65,,22652.825,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22315,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13784.6596,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15021,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15167,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14659,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14804,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14804,Other,CMS Methodology,,,"103% of Medicare, less IME",14949,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15203,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
VEIN LIGATION AND STRIPPING,263,DRG,,,,Inpatient,,,261803.64,65450.91,6720,222533.094,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,63787.25732,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35215.973,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,61964.82568,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,43661.9059,Other,CMS Methodology,,65.6,,171743.1878,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35215.973,Other,"DRG Weight, with Charge Based Outlier",,70,,183262.548,Percent of Total Billed Charges,,,85,,222533.094,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,42361.0874,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,178026.4752,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,36903.0139,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",91631.274,Other,"DRG Weight, with Charge Based Outlier",,65,,170172.366,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",39432,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24358.8322,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",26544,Other,CMS Methodology,,,"104.5% of Medicare, less IME",26801,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",25903,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",26160,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",26160,Other,CMS Methodology,,,"103% of Medicare, less IME",26416,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",26865,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,DRG,,,,Inpatient,,,124584.07,31146.0175,13520,105896.4595,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,65603.027,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45890.663,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,51902.235,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,56896.7329,Other,CMS Methodology,,65.6,,81727.14992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45890.663,Other,"DRG Weight, with Charge Based Outlier",,70,,87208.849,Percent of Total Billed Charges,,,85,,105896.4595,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,55201.6094,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,84717.1676,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,48089.0809,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",44209.5199,Other,"DRG Weight, with Charge Based Outlier",,65,,80979.6455,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",51385,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31742.4982,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",34591,Other,CMS Methodology,,,"104.5% of Medicare, less IME",34925,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33755,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34089,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34089,Other,CMS Methodology,,,"103% of Medicare, less IME",34424,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35008,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
AICD LEAD PROCEDURES,265,DRG,,,,Inpatient,,,107972.48,26993.12,7570,91776.608,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,66956.344,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46837.336,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,52972.92,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,58070.4488,Other,CMS Methodology,,65.6,,70829.94688,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46837.336,Other,"DRG Weight, with Charge Based Outlier",,70,,75580.736,Percent of Total Billed Charges,,,85,,91776.608,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,56340.3568,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,73421.2864,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,49081.1048,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",45121.5128,Other,"DRG Weight, with Charge Based Outlier",,65,,70182.112,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",52445,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,32397.3104,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",35304,Other,CMS Methodology,,,"104.5% of Medicare, less IME",35645,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",34451,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34793,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34793,Other,CMS Methodology,,,"103% of Medicare, less IME",35134,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35731,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,DRG,,,,Inpatient,,,125967.47,31491.8675,7570,112447.316,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,112447.316,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,78659.204,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,88963.38,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,97524.2332,Other,CMS Methodology,,65.6,,82634.66032,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,78659.204,Other,"DRG Weight, with Charge Based Outlier",,70,,88177.229,Percent of Total Billed Charges,,,85,,107072.3495,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,94618.6952,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,85657.8796,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,82427.4172,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",75777.6292,Other,"DRG Weight, with Charge Based Outlier",,65,,81878.8555,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",88076,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,54408.4456,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",59290,Other,CMS Methodology,,,"104.5% of Medicare, less IME",59863,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",57858,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",58431,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",58431,Other,CMS Methodology,,,"103% of Medicare, less IME",59004,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",60006,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,DRG,,,,Inpatient,,,102301.87,25575.4675,5870,88307.219,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,88307.219,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,61772.711,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,69864.795,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,76587.8113,Other,CMS Methodology,,65.6,,67110.02672,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,61772.711,Other,"DRG Weight, with Charge Based Outlier",,70,,71611.309,Percent of Total Billed Charges,,,85,,86956.5895,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,74306.0318,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,69565.2716,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,64731.9673,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",59509.7503,Other,"DRG Weight, with Charge Based Outlier",,65,,66496.2155,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",69168,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,42728.0854,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",46562,Other,CMS Methodology,,,"104.5% of Medicare, less IME",47012,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",45437,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",45887,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",45887,Other,CMS Methodology,,,"103% of Medicare, less IME",46337,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",47124,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,DRG,,,,Inpatient,,,306691.88,76672.97,15220,260688.098,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,157133.9354,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,102222.34,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,140765.6616,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,108541.8604,Other,CMS Methodology,,65.6,,201189.8733,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,102222.34,Other,"DRG Weight, with Charge Based Outlier",,70,,214684.316,Percent of Total Billed Charges,,,85,,260688.098,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,105308.0744,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,208550.4784,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,91739.5084,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",107342.158,Other,"DRG Weight, with Charge Based Outlier",,65,,199349.722,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",98026,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,72296.5448,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",65988,Other,CMS Methodology,,,"104.5% of Medicare, less IME",66626,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",64395,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",65032,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",65032,Other,CMS Methodology,,,"103% of Medicare, less IME",65670,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",66785,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,DRG,,,,Inpatient,,,120096.91,30024.2275,6720,102082.3735,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,78096.339,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,54629.991,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,61786.395,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,67732.0353,Other,CMS Methodology,,65.6,,78783.57296,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,54629.991,Other,"DRG Weight, with Charge Based Outlier",,70,,84067.837,Percent of Total Billed Charges,,,85,,102082.3735,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,65714.0958,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,81665.8988,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,57247.0713,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",52628.6943,Other,"DRG Weight, with Charge Based Outlier",,65,,78062.9915,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",61170,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,37787.4774,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",41178,Other,CMS Methodology,,,"104.5% of Medicare, less IME",41576,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",40183,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",40581,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",40581,Other,CMS Methodology,,,"103% of Medicare, less IME",40979,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",41675,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,DRG,,,,Inpatient,,,196677.59,49169.3975,12670,167175.9515,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,96346.41,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,67396.29,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,76225.05,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,83560.107,Other,CMS Methodology,,65.6,,129020.499,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,67396.29,Other,"DRG Weight, with Charge Based Outlier",,70,,137674.313,Percent of Total Billed Charges,,,85,,167175.9515,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,81070.602,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,133740.7612,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,70624.947,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",68837.1565,Other,"DRG Weight, with Charge Based Outlier",,65,,127840.4335,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",75465,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,46617.906,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",50801,Other,CMS Methodology,,,"104.5% of Medicare, less IME",51292,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",49574,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",50064,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",50064,Other,CMS Methodology,,,"103% of Medicare, less IME",50555,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",51414,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,DRG,,,,Inpatient,,,137987.01,34496.7525,10120,117288.9585,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,64651.388,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45224.972,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,51149.34,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,56071.3876,Other,CMS Methodology,,65.6,,90519.47856,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45224.972,Other,"DRG Weight, with Charge Based Outlier",,70,,96590.907,Percent of Total Billed Charges,,,85,,117288.9585,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,54400.8536,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,93831.1668,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,47391.4996,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",43568.2156,Other,"DRG Weight, with Charge Based Outlier",,65,,89691.5565,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",50639,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31282.0408,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",34089,Other,CMS Methodology,,,"104.5% of Medicare, less IME",34418,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33265,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",33595,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",33595,Other,CMS Methodology,,,"103% of Medicare, less IME",33924,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",34501,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,DRG,,,,Inpatient,,,108854.74,27213.685,6720,92526.529,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,46966.294,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32853.886,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,37157.67,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,40733.3138,Other,CMS Methodology,,65.6,,71408.70944,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32853.886,Other,"DRG Weight, with Charge Based Outlier",,70,,76198.318,Percent of Total Billed Charges,,,85,,92526.529,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,39519.7468,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,74021.2232,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,34427.7698,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",31650.3278,Other,"DRG Weight, with Charge Based Outlier",,65,,70755.581,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",36787,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22724.9804,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",24764,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25003,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",24166,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24405,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24405,Other,CMS Methodology,,,"103% of Medicare, less IME",24644,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25063,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,DRG,,,,Inpatient,,,131907.23,32976.8075,9270,112121.1455,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,73396.331,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51342.239,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,58067.955,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,63655.7737,Other,CMS Methodology,,65.6,,86531.14288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51342.239,Other,"DRG Weight, with Charge Based Outlier",,70,,92335.061,Percent of Total Billed Charges,,,85,,112121.1455,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,61759.2782,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,89696.9164,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,53801.8177,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",49461.3847,Other,"DRG Weight, with Charge Based Outlier",,65,,85739.6995,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",57489,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,35513.3446,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",38700,Other,CMS Methodology,,,"104.5% of Medicare, less IME",39074,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",37765,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",38139,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",38139,Other,CMS Methodology,,,"103% of Medicare, less IME",38513,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",39167,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,DRG,,,,Inpatient,,,76820.47,19205.1175,5020,65297.3995,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,58581.17,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40978.73,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,46346.85,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,50806.759,Other,CMS Methodology,,65.6,,50394.22832,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40978.73,Other,"DRG Weight, with Charge Based Outlier",,70,,53774.329,Percent of Total Billed Charges,,,85,,65297.3995,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,49293.074,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52237.9196,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,42941.839,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",39477.529,Other,"DRG Weight, with Charge Based Outlier",,65,,49933.3055,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",45885,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,28344.922,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",30888,Other,CMS Methodology,,,"104.5% of Medicare, less IME",31187,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",30142,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",30441,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",30441,Other,CMS Methodology,,,"103% of Medicare, less IME",30739,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",31261,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,DRG,,,,Inpatient,,,226983.19,56745.7975,11820,192935.7115,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,132647.59,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,92789.71,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,111864.054,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,115043.693,Other,CMS Methodology,,65.6,,148900.9726,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,92789.71,Other,"DRG Weight, with Charge Based Outlier",,70,,158888.233,Percent of Total Billed Charges,,,85,,192935.7115,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,111616.198,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,154348.5692,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,97234.853,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",79444.1165,Other,"DRG Weight, with Charge Based Outlier",,65,,147539.0735,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",103898,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,64182.494,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",69941,Other,CMS Methodology,,,"104.5% of Medicare, less IME",70617,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",68252,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",68928,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",68928,Other,CMS Methodology,,,"103% of Medicare, less IME",69603,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",70786,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,DRG,,,,Inpatient,,,182925.14,45731.285,10970,155486.369,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,116268.888,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,81332.472,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,91986.84,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,100838.6376,Other,CMS Methodology,,65.6,,119998.8918,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,81332.472,Other,"DRG Weight, with Charge Based Outlier",,70,,128047.598,Percent of Total Billed Charges,,,85,,155486.369,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,97834.3536,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,124389.0952,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,85228.7496,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",78352.9656,Other,"DRG Weight, with Charge Based Outlier",,65,,118901.341,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",91069,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,56257.5408,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",61305,Other,CMS Methodology,,,"104.5% of Medicare, less IME",61898,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",59824,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",60417,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",60417,Other,CMS Methodology,,,"103% of Medicare, less IME",61009,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",62046,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,DRG,,,,Inpatient,,,159414.79,39853.6975,8420,135502.5715,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,87316.163,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,61079.447,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,69080.715,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,75728.2801,Other,CMS Methodology,,65.6,,104576.1022,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,61079.447,Other,"DRG Weight, with Charge Based Outlier",,70,,111590.353,Percent of Total Billed Charges,,,85,,135502.5715,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,73472.1086,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,108402.0572,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,64005.4921,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",58841.8831,Other,"DRG Weight, with Charge Based Outlier",,65,,103619.6135,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",68392,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,42248.5558,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",46039,Other,CMS Methodology,,,"104.5% of Medicare, less IME",46484,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",44927,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",45372,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",45372,Other,CMS Methodology,,,"103% of Medicare, less IME",45817,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",46595,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,DRG,,,,Inpatient,,,189079.37,47269.8425,10120,160717.4645,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,93911.941,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,65693.329,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,74299.005,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,81448.7207,Other,CMS Methodology,,65.6,,124036.0667,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,65693.329,Other,"DRG Weight, with Charge Based Outlier",,70,,132355.559,Percent of Total Billed Charges,,,85,,160717.4645,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,79022.1202,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,128573.9716,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,68840.4047,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",66177.7795,Other,"DRG Weight, with Charge Based Outlier",,65,,122901.5905,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",73558,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,45439.9706,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",49517,Other,CMS Methodology,,,"104.5% of Medicare, less IME",49996,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",48321,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",48799,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",48799,Other,CMS Methodology,,,"103% of Medicare, less IME",49278,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",50115,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,DRG,,,,Inpatient,,,122326.99,30581.7475,7570,103977.9415,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,60146.588,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42073.772,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,47585.34,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,52164.4276,Other,CMS Methodology,,65.6,,80246.50544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42073.772,Other,"DRG Weight, with Charge Based Outlier",,70,,85628.893,Percent of Total Billed Charges,,,85,,103977.9415,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,50610.2936,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,83182.3532,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,44089.3396,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",40532.4556,Other,"DRG Weight, with Charge Based Outlier",,65,,79512.5435,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",47111,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,29102.3608,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",31714,Other,CMS Methodology,,,"104.5% of Medicare, less IME",32020,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",30948,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",31254,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",31254,Other,CMS Methodology,,,"103% of Medicare, less IME",31560,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",32097,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,DRG,,,,Inpatient,,,57235.66,14308.915,9270,48650.311,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30809.078,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21551.582,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24374.79,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26720.3506,Other,CMS Methodology,,65.6,,37546.59296,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21551.582,Other,"DRG Weight, with Charge Based Outlier",,70,,40064.962,Percent of Total Billed Charges,,,85,,48650.311,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25924.2716,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38920.2488,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22584.0226,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20762.0686,Other,"DRG Weight, with Charge Based Outlier",,65,,37203.179,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24132,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14907.1948,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16245,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16402,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15852,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16009,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16009,Other,CMS Methodology,,,"103% of Medicare, less IME",16166,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16441,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,DRG,,,,Inpatient,,,38959.18,9739.795,6720,33115.303,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17302.186,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12103.234,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13688.73,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15005.9822,Other,CMS Methodology,,65.6,,25557.22208,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12103.234,Other,"DRG Weight, with Charge Based Outlier",,70,,27271.426,Percent of Total Billed Charges,,,85,,33115.303,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14558.9092,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26492.2424,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12683.0462,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11659.8482,Other,"DRG Weight, with Charge Based Outlier",,65,,25323.467,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13552,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8371.7876,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9123,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9211,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8903,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8991,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8991,Other,CMS Methodology,,,"103% of Medicare, less IME",9079,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9233,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,DRG,,,,Inpatient,,,34284.5,8571.125,6585.3582,29141.825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13610.127,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9520.563,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10767.735,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11803.9029,Other,CMS Methodology,,65.6,,22490.632,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9520.563,Other,"DRG Weight, with Charge Based Outlier",,70,,23999.15,Percent of Total Billed Charges,,,85,,29141.825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11452.2294,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23313.46,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9976.6509,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9171.7899,Other,"DRG Weight, with Charge Based Outlier",,65,,22284.925,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10660,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6585.3582,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7176,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7246,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7003,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7072,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7072,Other,CMS Methodology,,,"103% of Medicare, less IME",7142,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7263,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,DRG,,,,Inpatient,,,74852.28,18713.07,8420,63624.438,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36702.858,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25674.402,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29037.69,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31831.9566,Other,CMS Methodology,,65.6,,49103.09568,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25674.402,Other,"DRG Weight, with Charge Based Outlier",,70,,52396.596,Percent of Total Billed Charges,,,85,,63624.438,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30883.5876,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,50899.5504,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26904.3486,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24733.8546,Other,"DRG Weight, with Charge Based Outlier",,65,,48653.982,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28748,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17758.9428,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19352,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19539,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18885,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19072,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19072,Other,CMS Methodology,,,"103% of Medicare, less IME",19259,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19586,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,DRG,,,,Inpatient,,,50334.05,12583.5125,6729.762,54163.419,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13908.57,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9729.33,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11003.85,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12062.739,Other,CMS Methodology,,65.6,,33019.1368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9729.33,Other,"DRG Weight, with Charge Based Outlier",,70,,35233.835,Percent of Total Billed Charges,,,85,,42783.9425,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,50430.354,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34227.154,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,54163.419,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9372.909,Other,"DRG Weight, with Charge Based Outlier",,65,,32717.1325,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10894,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6729.762,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7334,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7404,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7156,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7227,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7227,Other,CMS Methodology,,,"103% of Medicare, less IME",7298,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7422,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,16622.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,16395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,DRG,,,,Inpatient,,,54243.8,13560.95,5098.6348,46107.23,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,10537.478,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7371.182,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,8336.79,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,9139.0306,Other,CMS Methodology,,65.6,,35583.9328,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7371.182,Other,"DRG Weight, with Charge Based Outlier",,70,,37970.66,Percent of Total Billed Charges,,,85,,46107.23,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13169.7516,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36885.784,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,7724.3026,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7101.1486,Other,"DRG Weight, with Charge Based Outlier",,65,,35258.47,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",8254,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5098.6348,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",5556,Other,CMS Methodology,,,"104.5% of Medicare, less IME",5610,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5422,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5476,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5476,Other,CMS Methodology,,,"103% of Medicare, less IME",5529,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",5623,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,DRG,,,,Inpatient,,,82529.36,20632.34,10970,70149.956,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,41543.641,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29060.629,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,32867.505,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36030.3107,Other,CMS Methodology,,65.6,,54139.26016,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29060.629,Other,"DRG Weight, with Charge Based Outlier",,70,,57770.552,Percent of Total Billed Charges,,,85,,70149.956,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,34956.8602,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,56119.9648,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30452.7947,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27996.0317,Other,"DRG Weight, with Charge Based Outlier",,65,,53644.084,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",32540,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20101.1906,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21905,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22116,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21376,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21587,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21587,Other,CMS Methodology,,,"103% of Medicare, less IME",21799,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22169,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,DRG,,,,Inpatient,,,48763.5,12190.875,6720,41448.975,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20453.669,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14307.761,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16182.045,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17739.2263,Other,CMS Methodology,,65.6,,31988.856,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14307.761,Other,"DRG Weight, with Charge Based Outlier",,70,,34134.45,Percent of Total Billed Charges,,,85,,41448.975,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17210.7218,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33159.18,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14993.1823,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13783.6153,Other,"DRG Weight, with Charge Based Outlier",,65,,31696.275,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16021,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9896.6554,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10785,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10889,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10524,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10628,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10628,Other,CMS Methodology,,,"103% of Medicare, less IME",10733,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10915,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,DRG,,,,Inpatient,,,61046.05,15261.5125,10970,51889.1425,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,51270.255,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35864.595,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,40562.775,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,44466.0885,Other,CMS Methodology,,65.6,,40046.2088,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35864.595,Other,"DRG Weight, with Charge Based Outlier",,70,,42732.235,Percent of Total Billed Charges,,,85,,51889.1425,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,43141.311,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41511.314,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,37582.7085,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",34550.7435,Other,"DRG Weight, with Charge Based Outlier",,65,,39679.9325,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",40158,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24807.483,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",27033,Other,CMS Methodology,,,"104.5% of Medicare, less IME",27295,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",26380,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",26642,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",26642,Other,CMS Methodology,,,"103% of Medicare, less IME",26903,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",27360,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,DRG,,,,Inpatient,,,51762.37,12940.5925,10120,43998.0145,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29594.659,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20702.071,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23413.995,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25667.0993,Other,CMS Methodology,,65.6,,33956.11472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20702.071,Other,"DRG Weight, with Charge Based Outlier",,70,,36233.659,Percent of Total Billed Charges,,,85,,43998.0145,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24902.3998,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35198.4116,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21693.8153,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19943.6783,Other,"DRG Weight, with Charge Based Outlier",,65,,33645.5405,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23180,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14319.5894,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15604,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15755,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15228,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15378,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15378,Other,CMS Methodology,,,"103% of Medicare, less IME",15529,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15793,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
HEART FAILURE AND SHOCK WITH MCC,291,DRG,,,,Inpatient,,,46347.64,11586.91,8420,39395.494,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24491.096,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17132.024,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19376.28,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21240.8392,Other,CMS Methodology,,65.6,,30404.05184,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17132.024,Other,"DRG Weight, with Charge Based Outlier",,70,,32443.348,Percent of Total Billed Charges,,,85,,39395.494,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20608.0112,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31516.3952,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17952.7432,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16504.4152,Other,"DRG Weight, with Charge Based Outlier",,65,,30125.966,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19183,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11850.1936,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12913,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13038,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12602,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12726,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12726,Other,CMS Methodology,,,"103% of Medicare, less IME",12851,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13069,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
HEART FAILURE AND SHOCK WITH CC,292,DRG,,,,Inpatient,,,34027.97,8506.9925,7570,28923.7745,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16164.724,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11307.556,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12788.82,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14019.4748,Other,CMS Methodology,,65.6,,22322.34832,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11307.556,Other,"DRG Weight, with Charge Based Outlier",,70,,23819.579,Percent of Total Billed Charges,,,85,,28923.7745,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13601.7928,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23139.0196,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11849.2508,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10893.3188,Other,"DRG Weight, with Charge Based Outlier",,65,,22118.1805,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12661,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7821.4184,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8523,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8606,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8317,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8400,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8400,Other,CMS Methodology,,,"103% of Medicare, less IME",8482,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8626,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,DRG,,,,Inpatient,,,23266.62,5816.655,4983.2934,19776.627,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,10299.099,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7204.431,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,8148.195,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,8932.2873,Other,CMS Methodology,,65.6,,15262.90272,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7204.431,Other,"DRG Weight, with Charge Based Outlier",,70,,16286.634,Percent of Total Billed Charges,,,85,,19776.627,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,8666.1678,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,15821.3016,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,7549.5633,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",6940.5063,Other,"DRG Weight, with Charge Based Outlier",,65,,15123.303,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",8067,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,4983.2934,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",5430,Other,CMS Methodology,,,"104.5% of Medicare, less IME",5483,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5299,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5352,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5352,Other,CMS Methodology,,,"103% of Medicare, less IME",5404,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",5496,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,294,DRG,,,,Inpatient,,,46857.65,11714.4125,10120,39829.0025,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23049.56,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16123.64,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18235.8,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19990.612,Other,CMS Methodology,,65.6,,30738.6184,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16123.64,Other,"DRG Weight, with Charge Based Outlier",,70,,32800.355,Percent of Total Billed Charges,,,85,,39829.0025,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19395.032,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31863.202,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16896.052,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15532.972,Other,"DRG Weight, with Charge Based Outlier",,65,,30457.4725,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18054,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11152.696,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12153,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12271,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11860,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11977,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11977,Other,CMS Methodology,,,"103% of Medicare, less IME",12095,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12300,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,DRG,,,,Inpatient,,,126619.29,31654.8225,14879.9488,107626.3965,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30752.768,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21512.192,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24330.24,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26671.5136,Other,CMS Methodology,,65.6,,83062.25424,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21512.192,Other,"DRG Weight, with Charge Based Outlier",,70,,88633.503,Percent of Total Billed Charges,,,85,,107626.3965,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,43088.8896,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,86101.1172,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,50022.7456,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20724.1216,Other,"DRG Weight, with Charge Based Outlier",,65,,82302.5385,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24088,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14879.9488,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16215,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16372,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15823,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15980,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15980,Other,CMS Methodology,,,"103% of Medicare, less IME",16137,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16411,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,DRG,,,,Inpatient,,,19025.25,4756.3125,5020,16171.4625,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13221.588,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9248.772,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10460.34,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11466.9276,Other,CMS Methodology,,65.6,,12480.564,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9248.772,Other,"DRG Weight, with Charge Based Outlier",,70,,13317.675,Percent of Total Billed Charges,,,85,,16171.4625,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11125.2936,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,12937.17,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9691.8396,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8909.9556,Other,"DRG Weight, with Charge Based Outlier",,65,,12366.4125,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10356,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6397.3608,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6971,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7039,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6803,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6870,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6870,Other,CMS Methodology,,,"103% of Medicare, less IME",6938,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7056,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,DRG,,,,Inpatient,,,67326.18,16831.545,9270,57227.253,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30362.352,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21239.088,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24021.36,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26332.9104,Other,CMS Methodology,,65.6,,44165.97408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21239.088,Other,"DRG Weight, with Charge Based Outlier",,70,,47128.326,Percent of Total Billed Charges,,,85,,57227.253,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25548.3744,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45781.8024,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22256.5584,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20461.0224,Other,"DRG Weight, with Charge Based Outlier",,65,,43762.017,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23782,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14691.0432,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16009,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16164,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15623,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15777,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15777,Other,CMS Methodology,,,"103% of Medicare, less IME",15932,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16203,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
PERIPHERAL VASCULAR DISORDERS WITH CC,300,DRG,,,,Inpatient,,,42041.71,10510.4275,7570,35735.4535,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20095.162,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14056.978,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15898.41,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17428.2974,Other,CMS Methodology,,65.6,,27579.36176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14056.978,Other,"DRG Weight, with Charge Based Outlier",,70,,29429.197,Percent of Total Billed Charges,,,85,,35735.4535,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16909.0564,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28588.3628,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14730.3854,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13542.0194,Other,"DRG Weight, with Charge Based Outlier",,65,,27327.1115,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15740,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9723.1892,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10596,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10698,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10340,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10442,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10442,Other,CMS Methodology,,,"103% of Medicare, less IME",10544,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10724,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,DRG,,,,Inpatient,,,27610.86,6902.715,6479.0988,23469.231,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13390.518,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9366.942,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10593.99,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11613.4386,Other,CMS Methodology,,65.6,,18112.72416,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9366.942,Other,"DRG Weight, with Charge Based Outlier",,70,,19327.602,Percent of Total Billed Charges,,,85,,23469.231,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11267.4396,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18775.3848,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9815.6706,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9023.7966,Other,"DRG Weight, with Charge Based Outlier",,65,,17947.059,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10488,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6479.0988,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7060,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7129,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6890,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6958,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6958,Other,CMS Methodology,,,"103% of Medicare, less IME",7026,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7146,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
ATHEROSCLEROSIS WITH MCC,302,DRG,,,,Inpatient,,,44188.15,11047.0375,6720,37559.9275,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21835.141,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15274.129,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17275.005,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18937.3607,Other,CMS Methodology,,65.6,,28987.4264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15274.129,Other,"DRG Weight, with Charge Based Outlier",,70,,30931.705,Percent of Total Billed Charges,,,85,,37559.9275,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18373.1602,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30047.942,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16005.8447,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14714.5817,Other,"DRG Weight, with Charge Based Outlier",,65,,28722.2975,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17103,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10565.0906,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11513,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11624,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11235,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11346,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11346,Other,CMS Methodology,,,"103% of Medicare, less IME",11457,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11652,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
ATHEROSCLEROSIS WITHOUT MCC,303,DRG,,,,Inpatient,,,27709.02,6927.255,6106.7368,23552.667,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12620.948,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8828.612,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9985.14,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10945.9996,Other,CMS Methodology,,65.6,,18177.11712,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8828.612,Other,"DRG Weight, with Charge Based Outlier",,70,,19396.314,Percent of Total Billed Charges,,,85,,23552.667,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10619.8856,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18842.1336,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9251.5516,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8505.1876,Other,"DRG Weight, with Charge Based Outlier",,65,,18010.863,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9886,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6106.7368,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6655,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6719,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6494,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6558,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6558,Other,CMS Methodology,,,"103% of Medicare, less IME",6623,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6735,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
HYPERTENSION WITH MCC,304,DRG,,,,Inpatient,,,48077.89,12019.4725,8420,40866.2065,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22050.996,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15425.124,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17445.78,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19124.5692,Other,CMS Methodology,,65.6,,31539.09584,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15425.124,Other,"DRG Weight, with Charge Based Outlier",,70,,33654.523,Percent of Total Billed Charges,,,85,,40866.2065,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18554.7912,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,32692.9652,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16164.0732,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14860.0452,Other,"DRG Weight, with Charge Based Outlier",,65,,31250.6285,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17272,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10669.5336,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11627,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11739,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11346,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11458,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11458,Other,CMS Methodology,,,"103% of Medicare, less IME",11571,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11767,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
HYPERTENSION WITHOUT MCC,305,DRG,,,,Inpatient,,,30816.29,7704.0725,6720,26193.8465,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14090.639,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9856.691,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11147.895,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12220.6453,Other,CMS Methodology,,65.6,,20215.48624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9856.691,Other,"DRG Weight, with Charge Based Outlier",,70,,21571.403,Percent of Total Billed Charges,,,85,,26193.8465,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11856.5558,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20955.0772,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10328.8813,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9495.6043,Other,"DRG Weight, with Charge Based Outlier",,65,,20030.5885,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11037,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6817.8574,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7430,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7501,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7250,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7322,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7322,Other,CMS Methodology,,,"103% of Medicare, less IME",7394,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7519,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,DRG,,,,Inpatient,,,39558.64,9889.66,8420,33624.844,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28106.198,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19660.862,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22236.39,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24376.1746,Other,CMS Methodology,,65.6,,25950.46784,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19660.862,Other,"DRG Weight, with Charge Based Outlier",,70,,27691.048,Percent of Total Billed Charges,,,85,,33624.844,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23649.9356,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26899.8752,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20602.7266,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18940.6126,Other,"DRG Weight, with Charge Based Outlier",,65,,25713.116,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22015,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13599.3868,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14820,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14963,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14462,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14605,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14605,Other,CMS Methodology,,,"103% of Medicare, less IME",14748,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14999,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,DRG,,,,Inpatient,,,26584.76,6646.19,6720,22597.046,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17388.528,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12163.632,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13757.04,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15080.8656,Other,CMS Methodology,,65.6,,17439.60256,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12163.632,Other,"DRG Weight, with Charge Based Outlier",,70,,18609.332,Percent of Total Billed Charges,,,85,,22597.046,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14631.5616,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18077.6368,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12746.3376,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11718.0336,Other,"DRG Weight, with Charge Based Outlier",,65,,17280.094,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13620,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8413.5648,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9168,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9257,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8947,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9036,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9036,Other,CMS Methodology,,,"103% of Medicare, less IME",9124,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9279,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,DRG,,,,Inpatient,,,50042.59,12510.6475,8420,42536.2015,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22634.743,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15833.467,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17907.615,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19630.8461,Other,CMS Methodology,,65.6,,32827.93904,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15833.467,Other,"DRG Weight, with Charge Based Outlier",,70,,35029.813,Percent of Total Billed Charges,,,85,,42536.2015,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19045.9846,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34028.9612,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16591.9781,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15253.4291,Other,"DRG Weight, with Charge Based Outlier",,65,,32527.6835,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17729,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10951.9838,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11935,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12050,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11646,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11762,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11762,Other,CMS Methodology,,,"103% of Medicare, less IME",11877,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12079,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,DRG,,,,Inpatient,,,35120.23,8780.0575,6714.3226,29852.1955,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13876.661,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9707.009,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10978.605,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12035.0647,Other,CMS Methodology,,65.6,,23038.87088,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9707.009,Other,"DRG Weight, with Charge Based Outlier",,70,,24584.161,Percent of Total Billed Charges,,,85,,29852.1955,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11676.5042,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23881.7564,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10172.0287,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9351.4057,Other,"DRG Weight, with Charge Based Outlier",,65,,22828.1495,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10869,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6714.3226,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7317,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7387,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7140,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7211,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7211,Other,CMS Methodology,,,"103% of Medicare, less IME",7281,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7405,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,DRG,,,,Inpatient,,,24305.58,6076.395,5081.379,20659.743,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,10501.815,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7346.235,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,8308.575,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,9108.1005,Other,CMS Methodology,,65.6,,15944.46048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7346.235,Other,"DRG Weight, with Charge Based Outlier",,70,,17013.906,Percent of Total Billed Charges,,,85,,20659.743,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,8836.743,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,16527.7944,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,7698.1605,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7077.1155,Other,"DRG Weight, with Charge Based Outlier",,65,,15798.627,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",8226,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5081.379,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",5537,Other,CMS Methodology,,,"104.5% of Medicare, less IME",5591,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5404,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5457,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5457,Other,CMS Methodology,,,"103% of Medicare, less IME",5511,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",5604,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
ANGINA PECTORIS,311,DRG,,,,Inpatient,,,24463.13,6115.7825,5870,20793.6605,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13107.091,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9168.679,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10369.755,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11367.6257,Other,CMS Methodology,,65.6,,16047.81328,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9168.679,Other,"DRG Weight, with Charge Based Outlier",,70,,17124.191,Percent of Total Billed Charges,,,85,,20793.6605,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11028.9502,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,16634.9284,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9607.9097,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8832.7967,Other,"DRG Weight, with Charge Based Outlier",,65,,15901.0345,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10266,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6341.9606,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6911,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6978,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6744,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6811,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6811,Other,CMS Methodology,,,"103% of Medicare, less IME",6878,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6994,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
SYNCOPE AND COLLAPSE,312,DRG,,,,Inpatient,,,38182.41,9545.6025,7570,32455.0485,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16354.301,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11440.169,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12938.805,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14183.8927,Other,CMS Methodology,,65.6,,25047.66096,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11440.169,Other,"DRG Weight, with Charge Based Outlier",,70,,26727.687,Percent of Total Billed Charges,,,85,,32455.0485,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13761.3122,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25964.0388,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11988.2167,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11021.0737,Other,"DRG Weight, with Charge Based Outlier",,65,,24818.5665,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12810,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7913.1466,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8623,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8706,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8415,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8498,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8498,Other,CMS Methodology,,,"103% of Medicare, less IME",8582,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8727,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
CHEST PAIN,313,DRG,,,,Inpatient,,,23164.14,5791.035,5870,19689.519,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13390.518,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9366.942,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10593.99,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11613.4386,Other,CMS Methodology,,65.6,,15195.67584,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9366.942,Other,"DRG Weight, with Charge Based Outlier",,70,,16214.898,Percent of Total Billed Charges,,,85,,19689.519,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11267.4396,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,15751.6152,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9815.6706,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9023.7966,Other,"DRG Weight, with Charge Based Outlier",,65,,15056.691,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10488,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6479.0988,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7060,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7129,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6890,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6958,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6958,Other,CMS Methodology,,,"103% of Medicare, less IME",7026,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7146,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,DRG,,,,Inpatient,,,72344.97,18086.2425,10120,61493.2245,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40421.195,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28275.455,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31979.475,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,35056.8265,Other,CMS Methodology,,65.6,,47458.30032,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28275.455,Other,"DRG Weight, with Charge Based Outlier",,70,,50641.479,Percent of Total Billed Charges,,,85,,61493.2245,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,34012.379,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,49194.5796,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29630.0065,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27239.6215,Other,"DRG Weight, with Charge Based Outlier",,65,,47024.2305,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31661,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19558.087,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21313,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21519,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20798,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21004,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21004,Other,CMS Methodology,,,"103% of Medicare, less IME",21210,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21570,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,DRG,,,,Inpatient,,,39721.78,9930.445,7570,33763.513,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18062.371,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12634.999,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14290.155,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15665.2817,Other,CMS Methodology,,65.6,,26057.48768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12634.999,Other,"DRG Weight, with Charge Based Outlier",,70,,27805.246,Percent of Total Billed Charges,,,85,,33763.513,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15198.5662,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27010.8104,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13240.2857,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12172.1327,Other,"DRG Weight, with Charge Based Outlier",,65,,25819.157,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14148,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8739.6086,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9524,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9616,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9294,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9386,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9386,Other,CMS Methodology,,,"103% of Medicare, less IME",9478,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9639,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,DRG,,,,Inpatient,,,30493.22,7623.305,5870,25919.237,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12814.279,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8963.851,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10138.095,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11113.6733,Other,CMS Methodology,,65.6,,20003.55232,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8963.851,Other,"DRG Weight, with Charge Based Outlier",,70,,21345.254,Percent of Total Billed Charges,,,85,,25919.237,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10782.5638,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20735.3896,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9393.2693,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8635.4723,Other,"DRG Weight, with Charge Based Outlier",,65,,19820.593,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10037,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6200.2814,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6757,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6822,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6593,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6659,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6659,Other,CMS Methodology,,,"103% of Medicare, less IME",6724,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6838,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,DRG,,,,Inpatient,,,187094.13,46773.5325,15220,159030.0105,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,82452.856,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,57677.464,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,65233.08,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,71510.3912,Other,CMS Methodology,,65.6,,122733.7493,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,57677.464,Other,"DRG Weight, with Charge Based Outlier",,70,,130965.891,Percent of Total Billed Charges,,,85,,159030.0105,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,69379.8832,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,127224.0084,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,60440.5352,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",65482.9455,Other,"DRG Weight, with Charge Based Outlier",,65,,121611.1845,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",64582,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,39895.4096,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",43475,Other,CMS Methodology,,,"104.5% of Medicare, less IME",43895,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",42425,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",42845,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",42845,Other,CMS Methodology,,,"103% of Medicare, less IME",43265,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",44000,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,DRG,,,,Inpatient,,,58581.9,14645.475,5020,49794.615,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,43448.796,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30393.324,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,34374.78,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,37682.6292,Other,CMS Methodology,,65.6,,38429.7264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30393.324,Other,"DRG Weight, with Charge Based Outlier",,70,,41007.33,Percent of Total Billed Charges,,,85,,49794.615,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,36559.9512,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,39835.692,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31849.3332,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",29279.9052,Other,"DRG Weight, with Charge Based Outlier",,65,,38078.235,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",34032,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21023.0136,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22909,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23131,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22356,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22577,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22577,Other,CMS Methodology,,,"103% of Medicare, less IME",22799,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",23186,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,DRG,,,,Inpatient,,,126640.87,31660.2175,9270,107644.7395,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,53434.436,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37378.484,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,42274.98,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,46343.0572,Other,CMS Methodology,,65.6,,83076.41072,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37378.484,Other,"DRG Weight, with Charge Based Outlier",,70,,88648.609,Percent of Total Billed Charges,,,85,,107644.7395,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,44962.3592,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,86115.7916,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,39169.1212,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36009.1732,Other,"DRG Weight, with Charge Based Outlier",,65,,82316.5655,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",41853,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,25854.6376,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28174,Other,CMS Methodology,,,"104.5% of Medicare, less IME",28447,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",27494,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",27766,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",27766,Other,CMS Methodology,,,"103% of Medicare, less IME",28038,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",28515,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,DRG,,,,Inpatient,,,87182.96,21795.74,6720,74105.516,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33958.684,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23754.796,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26866.62,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29451.9668,Other,CMS Methodology,,65.6,,57192.02176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23754.796,Other,"DRG Weight, with Charge Based Outlier",,70,,61028.072,Percent of Total Billed Charges,,,85,,74105.516,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28574.5048,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,59284.4128,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24892.7828,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22884.5708,Other,"DRG Weight, with Charge Based Outlier",,65,,56668.924,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26599,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16431.1544,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17905,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18078,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17473,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17646,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17646,Other,CMS Methodology,,,"103% of Medicare, less IME",17819,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18122,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,DRG,,,,Inpatient,,,157914.01,39478.5025,10120,134226.9085,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,79948.938,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,55925.922,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,63252.09,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,69338.7726,Other,CMS Methodology,,65.6,,103591.5906,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,55925.922,Other,"DRG Weight, with Charge Based Outlier",,70,,110539.807,Percent of Total Billed Charges,,,85,,134226.9085,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,67272.9636,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,107381.5268,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,58605.0846,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",53877.1506,Other,"DRG Weight, with Charge Based Outlier",,65,,102644.1065,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",62621,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,38683.8708,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",42155,Other,CMS Methodology,,,"104.5% of Medicare, less IME",42562,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",41137,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",41544,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",41544,Other,CMS Methodology,,,"103% of Medicare, less IME",41951,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",42664,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,DRG,,,,Inpatient,,,124386.97,31096.7425,6720,105728.9245,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,59972.027,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,41951.663,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,47447.235,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,52013.0329,Other,CMS Methodology,,65.6,,81597.85232,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,41951.663,Other,"DRG Weight, with Charge Based Outlier",,70,,87070.879,Percent of Total Billed Charges,,,85,,105728.9245,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,50463.4094,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,84583.1396,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,43961.3809,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",40414.8199,Other,"DRG Weight, with Charge Based Outlier",,65,,80851.5305,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",46974,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,29017.8982,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",31622,Other,CMS Methodology,,,"104.5% of Medicare, less IME",31927,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",30858,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",31163,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",31163,Other,CMS Methodology,,,"103% of Medicare, less IME",31469,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",32003,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,DRG,,,,Inpatient,,,96882.82,24220.705,6720,82350.397,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,53721.617,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37579.373,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,42502.185,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,46592.1259,Other,CMS Methodology,,65.6,,63555.12992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37579.373,Other,"DRG Weight, with Charge Based Outlier",,70,,67817.974,Percent of Total Billed Charges,,,85,,82350.397,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,45204.0074,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,65880.3176,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,39379.6339,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36202.7029,Other,"DRG Weight, with Charge Based Outlier",,65,,62973.833,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",42078,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,25993.5922,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28326,Other,CMS Methodology,,,"104.5% of Medicare, less IME",28600,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",27642,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",27915,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",27915,Other,CMS Methodology,,,"103% of Medicare, less IME",28189,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",28668,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,DRG,,,,Inpatient,,,151243.16,37810.79,13520,128556.686,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,95332.83,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,66687.27,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,75423.15,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,82681.041,Other,CMS Methodology,,65.6,,99215.51296,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,66687.27,Other,"DRG Weight, with Charge Based Outlier",,70,,105870.212,Percent of Total Billed Charges,,,85,,128556.686,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,80217.726,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,102845.3488,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,69881.961,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",64244.271,Other,"DRG Weight, with Charge Based Outlier",,65,,98308.054,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",74671,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,46127.478,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",50266,Other,CMS Methodology,,,"104.5% of Medicare, less IME",50752,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",49052,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",49538,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",49538,Other,CMS Methodology,,,"103% of Medicare, less IME",50023,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",50873,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,DRG,,,,Inpatient,,,80858.98,20214.745,8420,68730.133,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,45575.437,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31880.953,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,36057.285,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,39527.0399,Other,CMS Methodology,,65.6,,53043.49088,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31880.953,Other,"DRG Weight, with Charge Based Outlier",,70,,56601.286,Percent of Total Billed Charges,,,85,,68730.133,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,38349.4114,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,54984.1064,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,33408.2279,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",30713.0369,Other,"DRG Weight, with Charge Based Outlier",,65,,52558.337,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",35698,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22052.0042,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",24031,Other,CMS Methodology,,,"104.5% of Medicare, less IME",24263,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23450,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23682,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23682,Other,CMS Methodology,,,"103% of Medicare, less IME",23915,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24321,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,DRG,,,,Inpatient,,,60660.12,15165.03,6720,51561.102,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29909.995,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20922.655,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23663.475,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25940.5865,Other,CMS Methodology,,65.6,,39793.03872,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20922.655,Other,"DRG Weight, with Charge Based Outlier",,70,,42462.084,Percent of Total Billed Charges,,,85,,51561.102,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25167.739,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41248.8816,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21924.9665,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20156.1815,Other,"DRG Weight, with Charge Based Outlier",,65,,39429.078,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23427,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14472.167,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15771,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15923,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15390,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15542,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15542,Other,CMS Methodology,,,"103% of Medicare, less IME",15695,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15961,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,DRG,,,,Inpatient,,,168734.09,42183.5225,15220,143423.9765,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,86189.963,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,60291.647,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,68189.715,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,74751.5401,Other,CMS Methodology,,65.6,,110689.563,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,60291.647,Other,"DRG Weight, with Charge Based Outlier",,70,,118113.863,Percent of Total Billed Charges,,,85,,143423.9765,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,72524.4686,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,114739.1812,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,63179.9521,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",58082.9431,Other,"DRG Weight, with Charge Based Outlier",,65,,109677.1585,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",67510,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,41703.6358,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",45446,Other,CMS Methodology,,,"104.5% of Medicare, less IME",45885,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",44348,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",44787,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",44787,Other,CMS Methodology,,,"103% of Medicare, less IME",45226,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",45994,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,DRG,,,,Inpatient,,,93601.82,23400.455,10120,79561.547,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,44366.649,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31035.381,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,35100.945,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,38478.6723,Other,CMS Methodology,,65.6,,61402.79392,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31035.381,Other,"DRG Weight, with Charge Based Outlier",,70,,65521.274,Percent of Total Billed Charges,,,85,,79561.547,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,37332.2778,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,63649.2376,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,32522.1483,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",29898.4413,Other,"DRG Weight, with Charge Based Outlier",,65,,60841.183,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",34751,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21467.1234,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23393,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23619,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22828,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23054,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23054,Other,CMS Methodology,,,"103% of Medicare, less IME",23280,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",23676,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,DRG,,,,Inpatient,,,63573,15893.25,7570,54037.05,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30989.27,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21677.63,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24517.35,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26876.629,Other,CMS Methodology,,65.6,,41703.888,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21677.63,Other,"DRG Weight, with Charge Based Outlier",,70,,44501.1,Percent of Total Billed Charges,,,85,,54037.05,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26075.894,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,43229.64,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22716.109,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20883.499,Other,"DRG Weight, with Charge Based Outlier",,65,,41322.45,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24273,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14994.382,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16340,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16498,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15945,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16103,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16103,Other,CMS Methodology,,,"103% of Medicare, less IME",16261,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16537,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
RECTAL RESECTION WITH CC,333,DRG,,,,Inpatient,,,112003.2,28000.8,10120,95202.72,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39891.881,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27905.189,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31560.705,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34597.7587,Other,CMS Methodology,,65.6,,73474.0992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27905.189,Other,"DRG Weight, with Charge Based Outlier",,70,,78402.24,Percent of Total Billed Charges,,,85,,95202.72,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33566.9882,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,76162.176,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29242.0027,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26882.9197,Other,"DRG Weight, with Charge Based Outlier",,65,,72802.08,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31246,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19301.9746,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21034,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21237,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20526,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20729,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20729,Other,CMS Methodology,,,"103% of Medicare, less IME",20932,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21288,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
PERITONEAL ADHESIOLYSIS WITH MCC,335,DRG,,,,Inpatient,,,140995.1,35248.775,14370,119845.835,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,68011.218,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47575.242,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,53807.49,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,58985.3286,Other,CMS Methodology,,65.6,,92492.7856,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47575.242,Other,"DRG Weight, with Charge Based Outlier",,70,,98696.57,Percent of Total Billed Charges,,,85,,119845.835,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,57227.9796,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,95876.668,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,49854.3606,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",45832.3866,Other,"DRG Weight, with Charge Based Outlier",,65,,91646.815,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",53271,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,32907.7188,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",35860,Other,CMS Methodology,,,"104.5% of Medicare, less IME",36207,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",34994,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",35341,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",35341,Other,CMS Methodology,,,"103% of Medicare, less IME",35687,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",36293,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
PERITONEAL ADHESIOLYSIS WITH CC,336,DRG,,,,Inpatient,,,80320.34,20080.085,10120,68272.289,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39647.871,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27734.499,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31367.655,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34386.1317,Other,CMS Methodology,,65.6,,52690.14304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27734.499,Other,"DRG Weight, with Charge Based Outlier",,70,,56224.238,Percent of Total Billed Charges,,,85,,68272.289,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33361.6662,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,54617.8312,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29063.1357,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26718.4827,Other,"DRG Weight, with Charge Based Outlier",,65,,52208.221,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31055,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19183.9086,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20905,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21107,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20400,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20602,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20602,Other,CMS Methodology,,,"103% of Medicare, less IME",20804,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21158,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,DRG,,,,Inpatient,,,64147.71,16036.9275,7570,54525.5535,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28813.827,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20155.863,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22796.235,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24989.8929,Other,CMS Methodology,,65.6,,42080.89776,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20155.863,Other,"DRG Weight, with Charge Based Outlier",,70,,44903.397,Percent of Total Billed Charges,,,85,,54525.5535,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24245.3694,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,43620.4428,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21121.4409,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19417.4799,Other,"DRG Weight, with Charge Based Outlier",,65,,41696.0115,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22569,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13941.7782,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15193,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15340,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14826,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14973,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14973,Other,CMS Methodology,,,"103% of Medicare, less IME",15119,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15376,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,DRG,,,,Inpatient,,,117681.41,29420.3525,16070,100029.1985,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,50575.765,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35378.785,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,40013.325,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,43863.7655,Other,CMS Methodology,,65.6,,77199.00496,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35378.785,Other,"DRG Weight, with Charge Based Outlier",,70,,82376.987,Percent of Total Billed Charges,,,85,,100029.1985,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,42556.933,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,80023.3588,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,37073.6255,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",34082.7305,Other,"DRG Weight, with Charge Based Outlier",,65,,76492.9165,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",39614,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24471.449,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",26667,Other,CMS Methodology,,,"104.5% of Medicare, less IME",26925,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",26023,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",26281,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",26281,Other,CMS Methodology,,,"103% of Medicare, less IME",26538,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",26989,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,16622.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,16395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,DRG,,,,Inpatient,,,51265.46,12816.365,8420,43575.641,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27942.899,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19546.631,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22107.195,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24234.5473,Other,CMS Methodology,,65.6,,33630.14176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19546.631,Other,"DRG Weight, with Charge Based Outlier",,70,,35885.822,Percent of Total Billed Charges,,,85,,43575.641,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23512.5278,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34860.5128,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20483.0233,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18830.5663,Other,"DRG Weight, with Charge Based Outlier",,65,,33322.549,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21887,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13520.3734,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14733,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14876,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14378,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14520,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14520,Other,CMS Methodology,,,"103% of Medicare, less IME",14662,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14911,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,DRG,,,,Inpatient,,,44904.5,11226.125,7570,38168.825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23374.281,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16350.789,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18492.705,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20272.2387,Other,CMS Methodology,,65.6,,29457.352,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16350.789,Other,"DRG Weight, with Charge Based Outlier",,70,,31433.15,Percent of Total Billed Charges,,,85,,38168.825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19668.2682,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30535.06,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17134.0827,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15751.7997,Other,"DRG Weight, with Charge Based Outlier",,65,,29187.925,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18308,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11309.8146,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12325,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12444,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12027,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12146,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12146,Other,CMS Methodology,,,"103% of Medicare, less IME",12265,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12473,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
ANAL AND STOMAL PROCEDURES WITH CC,348,DRG,,,,Inpatient,,,51603.76,12900.94,7570,43863.196,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23629.553,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16529.357,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18694.665,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20493.6331,Other,CMS Methodology,,65.6,,33852.06656,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16529.357,Other,"DRG Weight, with Charge Based Outlier",,70,,36122.632,Percent of Total Billed Charges,,,85,,43863.196,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19883.0666,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35090.5568,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17321.2051,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15923.8261,Other,"DRG Weight, with Charge Based Outlier",,65,,33542.444,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18508,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11433.3298,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12459,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12580,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12158,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12279,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12279,Other,CMS Methodology,,,"103% of Medicare, less IME",12399,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12610,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,DRG,,,,Inpatient,,,67140.68,16785.17,6720,57069.578,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16534.493,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11566.217,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13081.365,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14340.1711,Other,CMS Methodology,,65.6,,44044.28608,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11566.217,Other,"DRG Weight, with Charge Based Outlier",,70,,46998.476,Percent of Total Billed Charges,,,85,,57069.578,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13912.9346,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45655.6624,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12120.3031,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11142.5041,Other,"DRG Weight, with Charge Based Outlier",,65,,43641.442,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12951,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8000.3338,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8718,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8802,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8508,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8592,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8592,Other,CMS Methodology,,,"103% of Medicare, less IME",8676,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8823,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,DRG,,,,Inpatient,,,112760.81,28190.2025,9270,95846.6885,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,45398.999,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31757.531,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,35917.695,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,39374.0173,Other,CMS Methodology,,65.6,,73971.09136,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31757.531,Other,"DRG Weight, with Charge Based Outlier",,70,,78932.567,Percent of Total Billed Charges,,,85,,95846.6885,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,38200.9478,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,76677.3508,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,33278.8933,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",30594.1363,Other,"DRG Weight, with Charge Based Outlier",,65,,73294.5265,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",35559,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21966.6334,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23938,Other,CMS Methodology,,,"104.5% of Medicare, less IME",24169,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23359,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23591,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23591,Other,CMS Methodology,,,"103% of Medicare, less IME",23822,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24227,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,DRG,,,,Inpatient,,,66691.44,16672.86,7570,56687.724,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28239.465,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19754.085,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22341.825,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24491.7555,Other,CMS Methodology,,65.6,,43749.58464,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19754.085,Other,"DRG Weight, with Charge Based Outlier",,70,,46684.008,Percent of Total Billed Charges,,,85,,56687.724,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23762.073,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45350.1792,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20700.4155,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19030.4205,Other,"DRG Weight, with Charge Based Outlier",,65,,43349.436,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22119,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13663.869,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14890,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15034,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14530,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14674,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14674,Other,CMS Methodology,,,"103% of Medicare, less IME",14818,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15070,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,DRG,,,,Inpatient,,,62666.09,15666.5225,7570,53266.1765,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20695.802,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14477.138,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16373.61,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17949.2254,Other,CMS Methodology,,65.6,,41108.95504,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14477.138,Other,"DRG Weight, with Charge Based Outlier",,70,,43866.263,Percent of Total Billed Charges,,,85,,53266.1765,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17414.4644,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42612.9412,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15170.6734,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13946.7874,Other,"DRG Weight, with Charge Based Outlier",,65,,40732.9585,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16210,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10013.8132,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10912,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11018,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10649,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10754,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10754,Other,CMS Methodology,,,"103% of Medicare, less IME",10860,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11044,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,DRG,,,,Inpatient,,,98100.92,24525.23,10120,83385.782,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,55052.41,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38510.29,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,43555.05,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,47746.307,Other,CMS Methodology,,65.6,,64354.20352,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38510.29,Other,"DRG Weight, with Charge Based Outlier",,70,,68670.644,Percent of Total Billed Charges,,,85,,83385.782,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,46323.802,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,66708.6256,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,40355.147,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",37099.517,Other,"DRG Weight, with Charge Based Outlier",,65,,63765.598,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",43121,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26637.506,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",29028,Other,CMS Methodology,,,"104.5% of Medicare, less IME",29308,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",28326,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",28607,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",28607,Other,CMS Methodology,,,"103% of Medicare, less IME",28887,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",29378,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,DRG,,,,Inpatient,,,63166.45,15791.6125,6720,53691.4825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31929.647,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22335.443,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25261.335,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27692.2069,Other,CMS Methodology,,65.6,,41437.1912,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22335.443,Other,"DRG Weight, with Charge Based Outlier",,70,,44216.515,Percent of Total Billed Charges,,,85,,53691.4825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26867.1734,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42953.186,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23405.4349,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21517.2139,Other,"DRG Weight, with Charge Based Outlier",,65,,41058.1925,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25009,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15449.3902,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16836,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16998,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16429,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16592,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16592,Other,CMS Methodology,,,"103% of Medicare, less IME",16754,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17039,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,DRG,,,,Inpatient,,,49899.89,12474.9725,5870,42414.9065,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25024.164,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17504.916,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19798.02,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21703.1628,Other,CMS Methodology,,65.6,,32734.32784,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17504.916,Other,"DRG Weight, with Charge Based Outlier",,70,,34929.923,Percent of Total Billed Charges,,,85,,42414.9065,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21056.5608,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33931.9252,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18343.4988,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16863.6468,Other,"DRG Weight, with Charge Based Outlier",,65,,32434.9285,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19601,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12108.1224,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13195,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13322,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12876,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13003,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13003,Other,CMS Methodology,,,"103% of Medicare, less IME",13131,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13354,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,DRG,,,,Inpatient,,,136193.19,34048.2975,11820,115764.2115,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,80067.189,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,56008.641,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,63345.645,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,69441.3303,Other,CMS Methodology,,65.6,,89342.73264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,56008.641,Other,"DRG Weight, with Charge Based Outlier",,70,,95335.233,Percent of Total Billed Charges,,,85,,115764.2115,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,67372.4658,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,92611.3692,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,58691.7663,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",53956.8393,Other,"DRG Weight, with Charge Based Outlier",,65,,88525.5735,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",62714,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,38741.0874,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",42217,Other,CMS Methodology,,,"104.5% of Medicare, less IME",42625,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",41197,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",41605,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",41605,Other,CMS Methodology,,,"103% of Medicare, less IME",42013,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",42727,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,DRG,,,,Inpatient,,,76533.24,19133.31,8420,65053.254,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42270.04,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29568.76,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33442.2,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36660.308,Other,CMS Methodology,,65.6,,50205.80544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29568.76,Other,"DRG Weight, with Charge Based Outlier",,70,,53573.268,Percent of Total Billed Charges,,,85,,65053.254,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35568.088,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52042.6032,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30985.268,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28485.548,Other,"DRG Weight, with Charge Based Outlier",,65,,49746.606,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33109,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20452.664,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22288,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22503,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21749,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21965,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21965,Other,CMS Methodology,,,"103% of Medicare, less IME",22180,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22557,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,DRG,,,,Inpatient,,,53586.64,13396.66,7570,45548.644,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25435.227,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17792.463,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20123.235,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22059.6729,Other,CMS Methodology,,65.6,,35152.83584,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17792.463,Other,"DRG Weight, with Charge Based Outlier",,70,,37510.648,Percent of Total Billed Charges,,,85,,45548.644,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21402.4494,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36438.9152,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18644.8209,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17140.6599,Other,"DRG Weight, with Charge Based Outlier",,65,,34831.316,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19923,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12307.0182,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13411,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13541,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13087,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13217,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13217,Other,CMS Methodology,,,"103% of Medicare, less IME",13346,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13573,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,DRG,,,,Inpatient,,,82354.22,20588.555,10120,70001.087,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31345.9,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21927.1,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24799.5,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27185.93,Other,CMS Methodology,,65.6,,54024.36832,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21927.1,Other,"DRG Weight, with Charge Based Outlier",,70,,57647.954,Percent of Total Billed Charges,,,85,,70001.087,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26375.98,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,56000.8696,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22977.53,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21123.83,Other,"DRG Weight, with Charge Based Outlier",,65,,53530.243,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24552,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15166.94,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16528,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16687,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16129,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16288,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16288,Other,CMS Methodology,,,"103% of Medicare, less IME",16448,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16727,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,DRG,,,,Inpatient,,,34867.5,8716.875,7570,29637.375,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19100.352,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13361.088,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15111.36,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16565.5104,Other,CMS Methodology,,65.6,,22873.08,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13361.088,Other,"DRG Weight, with Charge Based Outlier",,70,,24407.25,Percent of Total Billed Charges,,,85,,29637.375,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16071.9744,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23709.9,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14001.1584,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12871.6224,Other,"DRG Weight, with Charge Based Outlier",,65,,22663.875,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14961,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9241.8432,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10071,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10168,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9828,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9925,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9925,Other,CMS Methodology,,,"103% of Medicare, less IME",10022,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10193,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,DRG,,,,Inpatient,,,26978.24,6744.56,6339.236,22931.504,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13101.46,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9164.74,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10365.3,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11362.742,Other,CMS Methodology,,65.6,,17697.72544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9164.74,Other,"DRG Weight, with Charge Based Outlier",,70,,18884.768,Percent of Total Billed Charges,,,85,,22931.504,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11024.212,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18345.2032,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9603.782,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8829.002,Other,"DRG Weight, with Charge Based Outlier",,65,,17535.856,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10262,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6339.236,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6908,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6975,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6741,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6808,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6808,Other,CMS Methodology,,,"103% of Medicare, less IME",6875,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6991,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,DRG,,,,Inpatient,,,50045.07,12511.2675,9270,42538.3095,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32809.96,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22951.24,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25957.8,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28455.692,Other,CMS Methodology,,65.6,,32829.56592,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22951.24,Other,"DRG Weight, with Charge Based Outlier",,70,,35031.549,Percent of Total Billed Charges,,,85,,42538.3095,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27607.912,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34030.6476,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24050.732,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22110.452,Other,"DRG Weight, with Charge Based Outlier",,65,,32529.2955,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25699,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15875.336,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17300,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17467,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16882,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17049,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17049,Other,CMS Methodology,,,"103% of Medicare, less IME",17216,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17509,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,DRG,,,,Inpatient,,,36944.18,9236.045,8420,31402.553,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19319.961,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13514.709,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15285.105,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16755.9747,Other,CMS Methodology,,65.6,,24235.38208,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13514.709,Other,"DRG Weight, with Charge Based Outlier",,70,,25860.926,Percent of Total Billed Charges,,,85,,31402.553,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16256.7642,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25122.0424,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14162.1387,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13019.6157,Other,"DRG Weight, with Charge Based Outlier",,65,,24013.717,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15133,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9348.1026,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10187,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10285,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9941,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10039,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10039,Other,CMS Methodology,,,"103% of Medicare, less IME",10138,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10310,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,DRG,,,,Inpatient,,,27625.35,6906.3375,6588.0828,23481.5475,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13615.758,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9524.502,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10772.19,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11808.7866,Other,CMS Methodology,,65.6,,18122.2296,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9524.502,Other,"DRG Weight, with Charge Based Outlier",,70,,19337.745,Percent of Total Billed Charges,,,85,,23481.5475,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11456.9676,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18785.238,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9980.7786,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9175.5846,Other,"DRG Weight, with Charge Based Outlier",,65,,17956.4775,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10665,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6588.0828,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7179,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7249,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7006,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7075,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7075,Other,CMS Methodology,,,"103% of Medicare, less IME",7145,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7266,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
DIGESTIVE MALIGNANCY WITH MCC,374,DRG,,,,Inpatient,,,66358.77,16589.6925,10970,56404.9545,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39630.978,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27722.682,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31354.29,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34371.4806,Other,CMS Methodology,,65.6,,43531.35312,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27722.682,Other,"DRG Weight, with Charge Based Outlier",,70,,46451.139,Percent of Total Billed Charges,,,85,,56404.9545,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33347.4516,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45123.9636,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29050.7526,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26707.0986,Other,"DRG Weight, with Charge Based Outlier",,65,,43133.2005,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31042,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19175.7348,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20896,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21098,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20392,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20593,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20593,Other,CMS Methodology,,,"103% of Medicare, less IME",20795,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21149,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
DIGESTIVE MALIGNANCY WITH CC,375,DRG,,,,Inpatient,,,48765.5,12191.375,9270,41450.675,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23062.699,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16132.831,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18246.195,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20002.0073,Other,CMS Methodology,,65.6,,31990.168,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16132.831,Other,"DRG Weight, with Charge Based Outlier",,70,,34135.85,Percent of Total Billed Charges,,,85,,41450.675,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19406.0878,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33160.54,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16905.6833,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15541.8263,Other,"DRG Weight, with Charge Based Outlier",,65,,31697.575,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18064,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11159.0534,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12160,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12278,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11867,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11984,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11984,Other,CMS Methodology,,,"103% of Medicare, less IME",12102,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12307,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,DRG,,,,Inpatient,,,28511.2,7127.8,6720,24234.52,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16573.91,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11593.79,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13112.55,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14374.357,Other,CMS Methodology,,65.6,,18703.3472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11593.79,Other,"DRG Weight, with Charge Based Outlier",,70,,19957.84,Percent of Total Billed Charges,,,85,,24234.52,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13946.102,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19387.616,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12149.197,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11169.067,Other,"DRG Weight, with Charge Based Outlier",,65,,18532.28,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12982,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8019.406,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8739,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8823,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8528,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8612,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8612,Other,CMS Methodology,,,"103% of Medicare, less IME",8697,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8844,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,DRG,,,,Inpatient,,,65726.74,16431.685,9270,55867.729,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34127.614,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23872.966,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27000.27,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29598.4778,Other,CMS Methodology,,65.6,,43116.74144,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23872.966,Other,"DRG Weight, with Charge Based Outlier",,70,,46008.718,Percent of Total Billed Charges,,,85,,55867.729,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28716.6508,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44694.1832,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25016.6138,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22998.4118,Other,"DRG Weight, with Charge Based Outlier",,65,,42722.381,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26731,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16512.8924,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17995,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18168,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17560,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17734,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17734,Other,CMS Methodology,,,"103% of Medicare, less IME",17908,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18212,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
GASTROINTESTINAL HEMORRHAGE WITH CC,378,DRG,,,,Inpatient,,,36793.68,9198.42,7570,31274.628,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18505.343,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12944.867,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14640.615,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16049.4661,Other,CMS Methodology,,65.6,,24136.65408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12944.867,Other,"DRG Weight, with Charge Based Outlier",,70,,25755.576,Percent of Total Billed Charges,,,85,,31274.628,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15571.3046,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25019.7024,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13564.9981,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12470.6491,Other,"DRG Weight, with Charge Based Outlier",,65,,23915.892,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14495,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8953.9438,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9757,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9852,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9522,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9616,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9616,Other,CMS Methodology,,,"103% of Medicare, less IME",9710,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9875,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,DRG,,,,Inpatient,,,25825.58,6456.395,5782.5094,21951.743,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11950.859,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8359.871,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9454.995,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10364.8393,Other,CMS Methodology,,65.6,,16941.58048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8359.871,Other,"DRG Weight, with Charge Based Outlier",,70,,18077.906,Percent of Total Billed Charges,,,85,,21951.743,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10056.0398,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,17561.3944,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8760.3553,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8053.6183,Other,"DRG Weight, with Charge Based Outlier",,65,,16786.627,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9361,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5782.5094,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6301,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6362,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6149,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6210,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6210,Other,CMS Methodology,,,"103% of Medicare, less IME",6271,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6377,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
COMPLICATED PEPTIC ULCER WITH MCC,380,DRG,,,,Inpatient,,,69661.89,17415.4725,10120,59212.6065,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36119.111,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25266.059,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28575.855,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31325.6797,Other,CMS Methodology,,65.6,,45698.19984,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25266.059,Other,"DRG Weight, with Charge Based Outlier",,70,,48763.323,Percent of Total Billed Charges,,,85,,59212.6065,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30392.3942,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47370.0852,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26476.4437,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24340.4707,Other,"DRG Weight, with Charge Based Outlier",,65,,45280.2285,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28291,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17476.4926,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19045,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19229,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18585,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18769,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18769,Other,CMS Methodology,,,"103% of Medicare, less IME",18953,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19275,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
COMPLICATED PEPTIC ULCER WITH CC,381,DRG,,,,Inpatient,,,40755.59,10188.8975,7570,34642.2515,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20442.407,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14299.883,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16173.135,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17729.4589,Other,CMS Methodology,,65.6,,26735.66704,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14299.883,Other,"DRG Weight, with Charge Based Outlier",,70,,28528.913,Percent of Total Billed Charges,,,85,,34642.2515,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17201.2454,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27713.8012,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14984.9269,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13776.0259,Other,"DRG Weight, with Charge Based Outlier",,65,,26491.1335,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16012,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9891.2062,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10779,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10883,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10518,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10622,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10622,Other,CMS Methodology,,,"103% of Medicare, less IME",10727,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10909,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,DRG,,,,Inpatient,,,32359.81,8089.9525,6720,27505.8385,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14064.361,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9838.309,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11127.105,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12197.8547,Other,CMS Methodology,,65.6,,21228.03536,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9838.309,Other,"DRG Weight, with Charge Based Outlier",,70,,22651.867,Percent of Total Billed Charges,,,85,,27505.8385,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11834.4442,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22004.6708,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10309.6187,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9477.8957,Other,"DRG Weight, with Charge Based Outlier",,65,,21033.8765,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11016,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6805.1426,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7416,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7487,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7237,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7308,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7308,Other,CMS Methodology,,,"103% of Medicare, less IME",7380,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7505,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,DRG,,,,Inpatient,,,39657.48,9914.37,7570,33708.858,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23729.034,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16598.946,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18773.37,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20579.9118,Other,CMS Methodology,,65.6,,26015.30688,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16598.946,Other,"DRG Weight, with Charge Based Outlier",,70,,27760.236,Percent of Total Billed Charges,,,85,,33708.858,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19966.7748,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26967.0864,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17394.1278,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15990.8658,Other,"DRG Weight, with Charge Based Outlier",,65,,25777.362,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18586,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11481.4644,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12512,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12633,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12209,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12330,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12330,Other,CMS Methodology,,,"103% of Medicare, less IME",12451,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12663,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,DRG,,,,Inpatient,,,36340.35,9085.0875,7570,30889.2975,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16322.392,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11417.848,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12913.56,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14156.2184,Other,CMS Methodology,,65.6,,23839.2696,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11417.848,Other,"DRG Weight, with Charge Based Outlier",,70,,25438.245,Percent of Total Billed Charges,,,85,,30889.2975,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13734.4624,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24711.438,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11964.8264,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10999.5704,Other,"DRG Weight, with Charge Based Outlier",,65,,23621.2275,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12785,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7897.7072,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8606,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8689,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8398,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8482,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8482,Other,CMS Methodology,,,"103% of Medicare, less IME",8565,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8710,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
INFLAMMATORY BOWEL DISEASE WITH MCC,385,DRG,,,,Inpatient,,,51050.82,12762.705,10120,43393.197,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30497.496,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21333.624,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24128.28,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26450.1192,Other,CMS Methodology,,65.6,,33489.33792,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21333.624,Other,"DRG Weight, with Charge Based Outlier",,70,,35735.574,Percent of Total Billed Charges,,,85,,43393.197,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25662.0912,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34714.5576,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22355.6232,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20552.0952,Other,"DRG Weight, with Charge Based Outlier",,65,,33183.033,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23888,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14756.4336,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16080,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16236,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15692,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15847,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15847,Other,CMS Methodology,,,"103% of Medicare, less IME",16003,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16275,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
INFLAMMATORY BOWEL DISEASE WITH CC,386,DRG,,,,Inpatient,,,32026.09,8006.5225,7570,27222.1765,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18629.225,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13031.525,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14738.625,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16156.9075,Other,CMS Methodology,,65.6,,21009.11504,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13031.525,Other,"DRG Weight, with Charge Based Outlier",,70,,22418.263,Percent of Total Billed Charges,,,85,,27222.1765,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15675.545,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21777.7412,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13655.8075,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12554.1325,Other,"DRG Weight, with Charge Based Outlier",,65,,20816.9585,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14592,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9013.885,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9823,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9918,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9585,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9680,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9680,Other,CMS Methodology,,,"103% of Medicare, less IME",9775,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9941,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,DRG,,,,Inpatient,,,29285.25,7321.3125,6087.6646,24892.4625,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12581.531,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8801.039,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9953.955,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10911.8137,Other,CMS Methodology,,65.6,,19211.124,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8801.039,Other,"DRG Weight, with Charge Based Outlier",,70,,20499.675,Percent of Total Billed Charges,,,85,,24892.4625,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10586.7182,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19913.97,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9222.6577,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8478.6247,Other,"DRG Weight, with Charge Based Outlier",,65,,19035.4125,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9855,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6087.6646,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6634,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6698,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6474,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6538,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6538,Other,CMS Methodology,,,"103% of Medicare, less IME",6602,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6714,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,DRG,,,,Inpatient,,,47502.84,11875.71,9270,40377.414,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27590.023,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19299.787,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21828.015,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23928.5021,Other,CMS Methodology,,65.6,,31161.86304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19299.787,Other,"DRG Weight, with Charge Based Outlier",,70,,33251.988,Percent of Total Billed Charges,,,85,,40377.414,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23215.6006,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,32301.9312,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20224.3541,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18592.7651,Other,"DRG Weight, with Charge Based Outlier",,65,,30876.846,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21610,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13349.6318,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14547,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14688,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14196,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14337,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14337,Other,CMS Methodology,,,"103% of Medicare, less IME",14477,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14723,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
GASTROINTESTINAL OBSTRUCTION WITH CC,389,DRG,,,,Inpatient,,,28959.4,7239.85,7280.1312,24615.49,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15046.032,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10525.008,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11903.76,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13049.2464,Other,CMS Methodology,,65.6,,18997.3664,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10525.008,Other,"DRG Weight, with Charge Based Outlier",,70,,20271.58,Percent of Total Billed Charges,,,85,,24615.49,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12660.4704,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19692.392,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11029.2144,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10139.4384,Other,"DRG Weight, with Charge Based Outlier",,65,,18823.61,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11785,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7280.1312,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7933,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8010,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7742,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7818,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7818,Other,CMS Methodology,,,"103% of Medicare, less IME",7895,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8029,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,DRG,,,,Inpatient,,,20858.14,5214.535,4969.6704,17729.419,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,10270.944,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7184.736,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,8125.92,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,8907.8688,Other,CMS Methodology,,65.6,,13682.93984,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7184.736,Other,"DRG Weight, with Charge Based Outlier",,70,,14600.698,Percent of Total Billed Charges,,,85,,17729.419,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,8642.4768,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,14183.5352,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,7528.9248,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",6921.5328,Other,"DRG Weight, with Charge Based Outlier",,65,,13557.791,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",8045,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,4969.6704,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",5416,Other,CMS Methodology,,,"104.5% of Medicare, less IME",5468,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5285,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5337,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5337,Other,CMS Methodology,,,"103% of Medicare, less IME",5389,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",5481,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,DRG,,,,Inpatient,,,45841.47,11460.3675,8420,38965.2495,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24110.065,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16865.485,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19074.825,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20910.3755,Other,CMS Methodology,,65.6,,30072.00432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16865.485,Other,"DRG Weight, with Charge Based Outlier",,70,,32089.029,Percent of Total Billed Charges,,,85,,38965.2495,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20287.393,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31172.1996,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17673.4355,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16247.6405,Other,"DRG Weight, with Charge Based Outlier",,65,,29796.9555,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18885,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11665.829,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12713,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12835,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12405,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12528,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12528,Other,CMS Methodology,,,"103% of Medicare, less IME",12651,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12866,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,DRG,,,,Inpatient,,,29552.02,7388.005,6720,25119.217,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14646.231,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10245.339,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11587.455,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12702.5037,Other,CMS Methodology,,65.6,,19386.12512,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10245.339,Other,"DRG Weight, with Charge Based Outlier",,70,,20686.414,Percent of Total Billed Charges,,,85,,25119.217,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12324.0582,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20095.3736,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10736.1477,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9870.0147,Other,"DRG Weight, with Charge Based Outlier",,65,,19208.813,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11472,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7086.6846,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7723,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7797,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7536,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7611,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7611,Other,CMS Methodology,,,"103% of Medicare, less IME",7685,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7816,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,DRG,,,,Inpatient,,,51515.23,12878.8075,8420,43787.9455,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31083.12,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21743.28,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24591.6,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26958.024,Other,CMS Methodology,,65.6,,33793.99088,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21743.28,Other,"DRG Weight, with Charge Based Outlier",,70,,36060.661,Percent of Total Billed Charges,,,85,,43787.9455,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26154.864,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35030.3564,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22784.904,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20946.744,Other,"DRG Weight, with Charge Based Outlier",,65,,33484.8995,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24346,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15039.792,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16389,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16548,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15993,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16152,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16152,Other,CMS Methodology,,,"103% of Medicare, less IME",16310,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16587,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,DRG,,,,Inpatient,,,36753.48,9188.37,7570,31240.458,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17668.201,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12359.269,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13978.305,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15323.4227,Other,CMS Methodology,,65.6,,24110.28288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12359.269,Other,"DRG Weight, with Charge Based Outlier",,70,,25727.436,Percent of Total Billed Charges,,,85,,31240.458,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14866.8922,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24992.3664,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12951.3467,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11906.5037,Other,"DRG Weight, with Charge Based Outlier",,65,,23889.762,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13839,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8548.8866,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9316,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9406,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9091,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9181,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9181,Other,CMS Methodology,,,"103% of Medicare, less IME",9271,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9428,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,DRG,,,,Inpatient,,,29138.68,7284.67,5779.7848,24767.878,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11945.228,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8355.932,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9450.54,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10359.9556,Other,CMS Methodology,,65.6,,19114.97408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8355.932,Other,"DRG Weight, with Charge Based Outlier",,70,,20397.076,Percent of Total Billed Charges,,,85,,24767.878,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10051.3016,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19814.3024,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8756.2276,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8049.8236,Other,"DRG Weight, with Charge Based Outlier",,65,,18940.142,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9356,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5779.7848,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6298,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6359,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6146,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6207,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6207,Other,CMS Methodology,,,"103% of Medicare, less IME",6268,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6374,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
APPENDIX PROCEDURES WITH MCC,397,DRG,,,,Inpatient,,,90692.89,22673.2225,10120,77088.9565,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,46508.306,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32533.514,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,36795.33,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,40336.1062,Other,CMS Methodology,,65.6,,59494.53584,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32533.514,Other,"DRG Weight, with Charge Based Outlier",,70,,63485.023,Percent of Total Billed Charges,,,85,,77088.9565,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,39134.3732,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,61671.1652,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,34092.0502,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",31341.6922,Other,"DRG Weight, with Charge Based Outlier",,65,,58950.3785,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",36428,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22503.3796,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",24523,Other,CMS Methodology,,,"104.5% of Medicare, less IME",24759,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23930,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24167,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24167,Other,CMS Methodology,,,"103% of Medicare, less IME",24404,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24819,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
APPENDIX PROCEDURES WITH CC,398,DRG,,,,Inpatient,,,61943.13,15485.7825,8420,52651.6605,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28402.764,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19868.316,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22471.02,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24633.3828,Other,CMS Methodology,,65.6,,40634.69328,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19868.316,Other,"DRG Weight, with Charge Based Outlier",,70,,43360.191,Percent of Total Billed Charges,,,85,,52651.6605,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23899.4808,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42121.3284,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20820.1188,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19140.4668,Other,"DRG Weight, with Charge Based Outlier",,65,,40263.0345,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22247,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13742.8824,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14976,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15121,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14614,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14759,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14759,Other,CMS Methodology,,,"103% of Medicare, less IME",14904,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15157,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
APPENDIX PROCEDURES WITHOUT CC/MCC,399,DRG,,,,Inpatient,,,48297.79,12074.4475,6720,41053.1215,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21093.726,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14755.494,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16688.43,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18294.3402,Other,CMS Methodology,,65.6,,31683.35024,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14755.494,Other,"DRG Weight, with Charge Based Outlier",,70,,33808.453,Percent of Total Billed Charges,,,85,,41053.1215,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17749.2972,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,32842.4972,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15462.3642,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14214.9462,Other,"DRG Weight, with Charge Based Outlier",,65,,31393.5635,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16522,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10206.3516,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11122,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11230,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10853,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10961,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10961,Other,CMS Methodology,,,"103% of Medicare, less IME",11068,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11256,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,DRG,,,,Inpatient,,,69526.96,17381.74,5870,73431.994,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,73431.994,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51367.186,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,58096.17,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,63686.7038,Other,CMS Methodology,,65.6,,45609.68576,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51367.186,Other,"DRG Weight, with Charge Based Outlier",,70,,48668.872,Percent of Total Billed Charges,,,85,,59097.916,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,61789.2868,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47278.3328,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,53827.9598,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",49485.4178,Other,"DRG Weight, with Charge Based Outlier",,65,,45192.524,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",57517,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,35530.6004,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",38719,Other,CMS Methodology,,,"104.5% of Medicare, less IME",39093,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",37783,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",38157,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",38157,Other,CMS Methodology,,,"103% of Medicare, less IME",38532,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",39186,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,DRG,,,,Inpatient,,,139419.61,34854.9025,14370,118506.6685,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,101896.699,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,71278.831,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,80616.195,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,88373.8073,Other,CMS Methodology,,65.6,,91459.26416,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,71278.831,Other,"DRG Weight, with Charge Based Outlier",,70,,97593.727,Percent of Total Billed Charges,,,85,,118506.6685,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,85740.8878,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,94805.3348,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,74693.4833,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",68667.6263,Other,"DRG Weight, with Charge Based Outlier",,65,,90622.7465,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",79812,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,49303.4534,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",53727,Other,CMS Methodology,,,"104.5% of Medicare, less IME",54246,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",52429,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",52949,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",52949,Other,CMS Methodology,,,"103% of Medicare, less IME",53468,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",54376,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,DRG,,,,Inpatient,,,90590.75,22647.6875,11820,77002.1375,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,52713.668,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,36874.292,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,41704.74,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,45717.9436,Other,CMS Methodology,,65.6,,59427.532,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,36874.292,Other,"DRG Weight, with Charge Based Outlier",,70,,63413.525,Percent of Total Billed Charges,,,85,,77002.1375,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,44355.8696,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,61601.71,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,38640.7756,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",35523.4516,Other,"DRG Weight, with Charge Based Outlier",,65,,58883.9875,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",41289,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,25505.8888,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",27794,Other,CMS Methodology,,,"104.5% of Medicare, less IME",28063,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",27123,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",27392,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",27392,Other,CMS Methodology,,,"103% of Medicare, less IME",27660,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",28130,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,DRG,,,,Inpatient,,,53084.44,13271.11,5870,45121.774,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40088.966,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28043.054,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31716.63,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34768.6882,Other,CMS Methodology,,65.6,,34823.39264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28043.054,Other,"DRG Weight, with Charge Based Outlier",,70,,37159.108,Percent of Total Billed Charges,,,85,,45121.774,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33732.8252,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36097.4192,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29386.4722,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27015.7342,Other,"DRG Weight, with Charge Based Outlier",,65,,34504.886,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31400,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19397.3356,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21138,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21342,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20627,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20831,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20831,Other,CMS Methodology,,,"103% of Medicare, less IME",21036,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21393,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,DRG,,,,Inpatient,,,149530.93,37382.7325,15220,127101.2905,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,65719.401,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45972.069,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,51994.305,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,56997.6627,Other,CMS Methodology,,65.6,,98092.29008,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45972.069,Other,"DRG Weight, with Charge Based Outlier",,70,,104671.651,Percent of Total Billed Charges,,,85,,127101.2905,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,55299.5322,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,101681.0324,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,48174.3867,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",44287.9437,Other,"DRG Weight, with Charge Based Outlier",,65,,97195.1045,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",51476,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31798.8066,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",34652,Other,CMS Methodology,,,"104.5% of Medicare, less IME",34987,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33815,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34150,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34150,Other,CMS Methodology,,,"103% of Medicare, less IME",34485,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35070,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,DRG,,,,Inpatient,,,70446.53,17611.6325,7570,59879.5505,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39351.305,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27527.045,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31133.025,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34128.9235,Other,CMS Methodology,,65.6,,46212.92368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27527.045,Other,"DRG Weight, with Charge Based Outlier",,70,,49312.571,Percent of Total Billed Charges,,,85,,59879.5505,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33112.121,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47903.6404,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,28845.7435,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26518.6285,Other,"DRG Weight, with Charge Based Outlier",,65,,45790.2445,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",30823,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19040.413,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20749,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20949,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20248,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20448,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20448,Other,CMS Methodology,,,"103% of Medicare, less IME",20649,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20999,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,DRG,,,,Inpatient,,,70058.08,17514.52,7570,59549.368,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29114.147,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20365.943,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23033.835,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25250.3569,Other,CMS Methodology,,65.6,,45958.10048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20365.943,Other,"DRG Weight, with Charge Based Outlier",,70,,49040.656,Percent of Total Billed Charges,,,85,,59549.368,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24498.0734,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47639.4944,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21341.5849,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19619.8639,Other,"DRG Weight, with Charge Based Outlier",,65,,45537.752,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22804,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14087.0902,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15351,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15499,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14980,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15129,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15129,Other,CMS Methodology,,,"103% of Medicare, less IME",15277,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15536,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,DRG,,,,Inpatient,,,59195.51,14798.8775,6720,50316.1835,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31205.125,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21828.625,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24688.125,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27063.8375,Other,CMS Methodology,,65.6,,38832.25456,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21828.625,Other,"DRG Weight, with Charge Based Outlier",,70,,41436.857,Percent of Total Billed Charges,,,85,,50316.1835,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26257.525,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40252.9468,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22874.3375,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21028.9625,Other,"DRG Weight, with Charge Based Outlier",,65,,38477.0815,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24442,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15098.825,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16454,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16613,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16056,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16215,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16215,Other,CMS Methodology,,,"103% of Medicare, less IME",16374,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16652,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,DRG,,,,Inpatient,,,126155.82,31538.955,11820,107232.447,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,65766.326,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46004.894,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,52031.43,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,57038.3602,Other,CMS Methodology,,65.6,,82758.21792,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46004.894,Other,"DRG Weight, with Charge Based Outlier",,70,,88309.074,Percent of Total Billed Charges,,,85,,107232.447,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,55339.0172,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,85785.9576,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,48208.7842,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",44319.5662,Other,"DRG Weight, with Charge Based Outlier",,65,,82001.283,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",51513,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31821.5116,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",34677,Other,CMS Methodology,,,"104.5% of Medicare, less IME",35012,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33839,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34174,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34174,Other,CMS Methodology,,,"103% of Medicare, less IME",34509,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35096,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,DRG,,,,Inpatient,,,85559.59,21389.8975,9270,72725.6515,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37128.937,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25972.453,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29374.785,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32201.4899,Other,CMS Methodology,,65.6,,56127.09104,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25972.453,Other,"DRG Weight, with Charge Based Outlier",,70,,59891.713,Percent of Total Billed Charges,,,85,,72725.6515,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31242.1114,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,58180.5212,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27216.6779,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25020.9869,Other,"DRG Weight, with Charge Based Outlier",,65,,55613.7335,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29082,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17965.1042,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19577,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19766,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19104,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19293,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19293,Other,CMS Methodology,,,"103% of Medicare, less IME",19482,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19813,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,DRG,,,,Inpatient,,,55988.53,13997.1325,6720,47590.2505,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25718.654,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17990.726,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20347.47,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22305.4858,Other,CMS Methodology,,65.6,,36728.47568,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17990.726,Other,"DRG Weight, with Charge Based Outlier",,70,,39191.971,Percent of Total Billed Charges,,,85,,47590.2505,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21640.9388,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38072.2004,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18852.5818,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17331.6598,Other,"DRG Weight, with Charge Based Outlier",,65,,36392.5445,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20145,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12444.1564,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13561,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13692,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13233,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13364,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13364,Other,CMS Methodology,,,"103% of Medicare, less IME",13495,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13724,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,DRG,,,,Inpatient,,,87809.65,21952.4125,9270,74638.2025,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,44606.905,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31203.445,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,35291.025,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,38687.0435,Other,CMS Methodology,,65.6,,57603.1304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31203.445,Other,"DRG Weight, with Charge Based Outlier",,70,,61466.755,Percent of Total Billed Charges,,,85,,74638.2025,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,37534.441,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,59710.562,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,32698.2635,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",30060.3485,Other,"DRG Weight, with Charge Based Outlier",,65,,57076.2725,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",34939,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21583.373,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23520,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23747,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22952,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23179,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23179,Other,CMS Methodology,,,"103% of Medicare, less IME",23406,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",23804,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,DRG,,,,Inpatient,,,68581.22,17145.305,8420,58294.037,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31128.168,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21774.792,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24627.24,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26997.0936,Other,CMS Methodology,,65.6,,44989.28032,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21774.792,Other,"DRG Weight, with Charge Based Outlier",,70,,48006.854,Percent of Total Billed Charges,,,85,,58294.037,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26192.7696,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,46635.2296,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22817.9256,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20977.1016,Other,"DRG Weight, with Charge Based Outlier",,65,,44577.793,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24382,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15061.5888,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16413,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16572,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16017,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16175,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16175,Other,CMS Methodology,,,"103% of Medicare, less IME",16334,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16611,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,DRG,,,,Inpatient,,,60342.33,15085.5825,6720,51290.9805,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24731.352,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17300.088,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19566.36,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21449.2104,Other,CMS Methodology,,65.6,,39584.56848,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17300.088,Other,"DRG Weight, with Charge Based Outlier",,70,,42239.631,Percent of Total Billed Charges,,,85,,51290.9805,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20810.1744,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41032.7844,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18128.8584,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16666.3224,Other,"DRG Weight, with Charge Based Outlier",,65,,39222.5145,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19371,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11966.4432,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13040,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13166,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12725,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12851,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12851,Other,CMS Methodology,,,"103% of Medicare, less IME",12977,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13198,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,DRG,,,,Inpatient,,,99798.28,24949.57,12670,84828.538,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,66248.715,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46342.335,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,52413.075,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,57456.7305,Other,CMS Methodology,,65.6,,65467.67168,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46342.335,Other,"DRG Weight, with Charge Based Outlier",,70,,69858.796,Percent of Total Billed Charges,,,85,,84828.538,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,55744.923,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,67862.8304,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,48562.3905,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",44644.6455,Other,"DRG Weight, with Charge Based Outlier",,65,,64868.882,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",51890,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,32054.919,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",34931,Other,CMS Methodology,,,"104.5% of Medicare, less IME",35269,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",34087,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34425,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34425,Other,CMS Methodology,,,"103% of Medicare, less IME",34762,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35353,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,DRG,,,,Inpatient,,,53491.91,13372.9775,8420,45468.1235,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30737.752,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21501.688,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24318.36,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26658.4904,Other,CMS Methodology,,65.6,,35090.69296,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21501.688,Other,"DRG Weight, with Charge Based Outlier",,70,,37444.337,Percent of Total Billed Charges,,,85,,45468.1235,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25864.2544,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36374.4988,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22531.7384,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20714.0024,Other,"DRG Weight, with Charge Based Outlier",,65,,34769.7415,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24076,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14872.6832,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16207,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16364,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15816,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15972,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15972,Other,CMS Methodology,,,"103% of Medicare, less IME",16129,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16403,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,DRG,,,,Inpatient,,,152002.27,38000.5675,13520,129201.9295,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,76345.098,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53404.962,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,60400.89,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,66213.2046,Other,CMS Methodology,,65.6,,99713.48912,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53404.962,Other,"DRG Weight, with Charge Based Outlier",,70,,106401.589,Percent of Total Billed Charges,,,85,,129201.9295,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,64240.5156,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,103361.5436,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,55963.3566,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",51448.5426,Other,"DRG Weight, with Charge Based Outlier",,65,,98801.4755,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",59798,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,36940.1268,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",40255,Other,CMS Methodology,,,"104.5% of Medicare, less IME",40644,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",39282,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",39671,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",39671,Other,CMS Methodology,,,"103% of Medicare, less IME",40060,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",40741,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,DRG,,,,Inpatient,,,81942.23,20485.5575,11820,69650.8955,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42857.541,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29979.729,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33907.005,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,37169.8407,Other,CMS Methodology,,65.6,,53754.10288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29979.729,Other,"DRG Weight, with Charge Based Outlier",,70,,57359.561,Percent of Total Billed Charges,,,85,,69650.8955,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,36062.4402,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,55720.7164,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31415.9247,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28881.4617,Other,"DRG Weight, with Charge Based Outlier",,65,,53262.4495,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33569,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20736.9306,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22598,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22816,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22052,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22270,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22270,Other,CMS Methodology,,,"103% of Medicare, less IME",22488,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22870,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,DRG,,,,Inpatient,,,98365.22,24591.305,7570,83610.437,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29014.666,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20296.354,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22955.13,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25164.0782,Other,CMS Methodology,,65.6,,64527.58432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20296.354,Other,"DRG Weight, with Charge Based Outlier",,70,,68855.654,Percent of Total Billed Charges,,,85,,83610.437,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24414.3652,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,66888.3496,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21268.6622,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19552.8242,Other,"DRG Weight, with Charge Based Outlier",,65,,63937.393,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22726,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14038.9556,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15299,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15446,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14929,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15077,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15077,Other,CMS Methodology,,,"103% of Medicare, less IME",15225,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15483,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,DRG,,,,Inpatient,,,188449.24,47112.31,19470,196623.258,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,196623.258,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,137542.002,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,155559.69,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,170529.0366,Other,CMS Methodology,,65.6,,123622.7014,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,137542.002,Other,"DRG Weight, with Charge Based Outlier",,70,,131914.468,Percent of Total Billed Charges,,,85,,160181.854,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,165448.4676,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,128145.4832,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,166115.0286,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",65957.234,Other,"DRG Weight, with Charge Based Outlier",,65,,122492.006,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",154008,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,95137.5828,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",103674,Other,CMS Methodology,,,"104.5% of Medicare, less IME",104676,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",101170,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",102171,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",102171,Other,CMS Methodology,,,"103% of Medicare, less IME",103173,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",104926,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,19470,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,20192.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,19895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,19470,Other,AR Medicaid Methodology
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,DRG,,,,Inpatient,,,134299.4,33574.85,13520,133317.679,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,133317.679,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,93258.451,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,105475.095,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,115624.8533,Other,CMS Methodology,,65.6,,88100.4064,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,93258.451,Other,"DRG Weight, with Charge Based Outlier",,70,,94009.58,Percent of Total Billed Charges,,,85,,114154.49,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,112180.0438,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,91323.592,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,108718.0493,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",89842.0523,Other,"DRG Weight, with Charge Based Outlier",,65,,87294.61,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",104423,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,64506.7214,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",70295,Other,CMS Methodology,,,"104.5% of Medicare, less IME",70974,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",68597,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",69276,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",69276,Other,CMS Methodology,,,"103% of Medicare, less IME",69955,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",71144,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,DRG,,,,Inpatient,,,114315.97,28578.9925,5870,103311.957,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,103311.957,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,72268.833,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,81735.885,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,89601.2439,Other,CMS Methodology,,65.6,,74991.27632,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,72268.833,Other,"DRG Weight, with Charge Based Outlier",,70,,80021.179,Percent of Total Billed Charges,,,85,,97168.5745,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,86931.7554,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,77734.8596,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,75730.9119,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",69621.3609,Other,"DRG Weight, with Charge Based Outlier",,65,,74305.3805,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",80921,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,49988.2362,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",54473,Other,CMS Methodology,,,"104.5% of Medicare, less IME",55000,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",53158,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",53684,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",53684,Other,CMS Methodology,,,"103% of Medicare, less IME",54210,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",55131,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,DRG,,,,Inpatient,,,47887.98,11971.995,5020,102681.285,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,102681.285,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,71827.665,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,81236.925,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,89054.2695,Other,CMS Methodology,,65.6,,31414.51488,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,71827.665,Other,"DRG Weight, with Charge Based Outlier",,70,,33521.586,Percent of Total Billed Charges,,,85,,40704.783,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,86401.077,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,32563.8264,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,75268.6095,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",69196.3545,Other,"DRG Weight, with Charge Based Outlier",,65,,31127.187,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",80427,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,49683.081,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",54141,Other,CMS Methodology,,,"104.5% of Medicare, less IME",54664,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",52833,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",53356,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",53356,Other,CMS Methodology,,,"103% of Medicare, less IME",53879,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",54795,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,DRG,,,,Inpatient,,,68298.39,17074.5975,9270,58053.6315,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36772.307,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25722.983,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29092.635,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31892.1889,Other,CMS Methodology,,65.6,,44803.74384,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25722.983,Other,"DRG Weight, with Charge Based Outlier",,70,,47808.873,Percent of Total Billed Charges,,,85,,58053.6315,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30942.0254,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,46442.9052,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26955.2569,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24780.6559,Other,"DRG Weight, with Charge Based Outlier",,65,,44393.9535,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28802,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17792.5462,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19389,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19576,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18921,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19108,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19108,Other,CMS Methodology,,,"103% of Medicare, less IME",19295,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19623,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,DRG,,,,Inpatient,,,39593.13,9898.2825,7570,33654.1605,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20080.146,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14046.474,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15886.53,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17415.2742,Other,CMS Methodology,,65.6,,25973.09328,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14046.474,Other,"DRG Weight, with Charge Based Outlier",,70,,27715.191,Percent of Total Billed Charges,,,85,,33654.1605,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16896.4212,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26923.3284,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14719.3782,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13531.9002,Other,"DRG Weight, with Charge Based Outlier",,65,,25735.5345,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15728,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9715.9236,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10588,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10690,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10332,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10434,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10434,Other,CMS Methodology,,,"103% of Medicare, less IME",10537,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10716,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,DRG,,,,Inpatient,,,29571.64,7392.91,6325.613,25135.894,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13073.305,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9145.045,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10343.025,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11338.3235,Other,CMS Methodology,,65.6,,19398.99584,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9145.045,Other,"DRG Weight, with Charge Based Outlier",,70,,20700.148,Percent of Total Billed Charges,,,85,,25135.894,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11000.521,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20108.7152,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9583.1435,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8810.0285,Other,"DRG Weight, with Charge Based Outlier",,65,,19221.566,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10240,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6325.613,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6893,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6960,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6727,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6793,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6793,Other,CMS Methodology,,,"103% of Medicare, less IME",6860,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6976,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,DRG,,,,Inpatient,,,70958.78,17739.695,10120,60314.963,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34247.742,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23956.998,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27095.31,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29702.6634,Other,CMS Methodology,,65.6,,46548.95968,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23956.998,Other,"DRG Weight, with Charge Based Outlier",,70,,49671.146,Percent of Total Billed Charges,,,85,,60314.963,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28817.7324,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48251.9704,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25104.6714,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23079.3654,Other,"DRG Weight, with Charge Based Outlier",,65,,46123.207,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26825,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16571.0172,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18058,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18232,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17622,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17796,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17796,Other,CMS Methodology,,,"103% of Medicare, less IME",17971,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18276,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,DRG,,,,Inpatient,,,39968.02,9992.005,7570,33972.817,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21166.929,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14806.701,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16746.345,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18357.8283,Other,CMS Methodology,,65.6,,26219.02112,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14806.701,Other,"DRG Weight, with Charge Based Outlier",,70,,27977.614,Percent of Total Billed Charges,,,85,,33972.817,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17810.8938,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27178.2536,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15516.0243,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14264.2773,Other,"DRG Weight, with Charge Based Outlier",,65,,25979.213,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16579,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10241.7714,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11161,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11269,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10891,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10999,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10999,Other,CMS Methodology,,,"103% of Medicare, less IME",11107,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11296,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,DRG,,,,Inpatient,,,31527.05,7881.7625,6720,26797.9925,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14738.204,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10309.676,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11660.22,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12782.2708,Other,CMS Methodology,,65.6,,20681.7448,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10309.676,Other,"DRG Weight, with Charge Based Outlier",,70,,22068.935,Percent of Total Billed Charges,,,85,,26797.9925,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12401.4488,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21438.394,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10803.5668,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9931.9948,Other,"DRG Weight, with Charge Based Outlier",,65,,20492.5825,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11544,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7131.1864,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7771,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7846,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7583,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7658,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7658,Other,CMS Methodology,,,"103% of Medicare, less IME",7733,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7865,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,DRG,,,,Inpatient,,,52312.67,13078.1675,9270,44465.7695,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31227.649,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21844.381,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24705.945,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27083.3723,Other,CMS Methodology,,65.6,,34317.11152,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21844.381,Other,"DRG Weight, with Charge Based Outlier",,70,,36618.869,Percent of Total Billed Charges,,,85,,44465.7695,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26276.4778,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35572.6156,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22890.8483,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21044.1413,Other,"DRG Weight, with Charge Based Outlier",,65,,34003.2355,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24460,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15109.7234,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16465,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16625,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16068,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16227,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16227,Other,CMS Methodology,,,"103% of Medicare, less IME",16386,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16664,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,DRG,,,,Inpatient,,,32071.71,8017.9275,7570,27260.9535,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16145.954,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11294.426,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12773.97,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14003.1958,Other,CMS Methodology,,65.6,,21039.04176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11294.426,Other,"DRG Weight, with Charge Based Outlier",,70,,22450.197,Percent of Total Billed Charges,,,85,,27260.9535,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13585.9988,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21808.7628,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11835.4918,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10880.6698,Other,"DRG Weight, with Charge Based Outlier",,65,,20846.6115,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12647,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7812.3364,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8513,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8596,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8308,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8390,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8390,Other,CMS Methodology,,,"103% of Medicare, less IME",8472,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8616,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,DRG,,,,Inpatient,,,26096.73,6524.1825,5586.3382,22182.2205,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11545.427,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8076.263,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9134.235,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10013.2129,Other,CMS Methodology,,65.6,,17119.45488,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8076.263,Other,"DRG Weight, with Charge Based Outlier",,70,,18267.711,Percent of Total Billed Charges,,,85,,22182.2205,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,9714.8894,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,17745.7764,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8463.1609,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7780.3999,Other,"DRG Weight, with Charge Based Outlier",,65,,16962.8745,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9043,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5586.3382,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6088,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6146,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5941,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5999,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5999,Other,CMS Methodology,,,"103% of Medicare, less IME",6058,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6161,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,DRG,,,,Inpatient,,,66478.12,16619.53,10120,56506.402,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35482.808,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24820.952,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28072.44,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30773.8216,Other,CMS Methodology,,65.6,,43609.64672,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24820.952,Other,"DRG Weight, with Charge Based Outlier",,70,,46534.684,Percent of Total Billed Charges,,,85,,56506.402,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29856.9776,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45205.1216,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26010.0136,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23911.6696,Other,"DRG Weight, with Charge Based Outlier",,65,,43210.778,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27792,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17168.6128,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18709,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18890,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18257,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18438,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18438,Other,CMS Methodology,,,"103% of Medicare, less IME",18619,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18935,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,DRG,,,,Inpatient,,,37322.5,9330.625,7570,31724.125,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18135.574,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12686.206,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14348.07,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15728.7698,Other,CMS Methodology,,65.6,,24483.56,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12686.206,Other,"DRG Weight, with Charge Based Outlier",,70,,26125.75,Percent of Total Billed Charges,,,85,,31724.125,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15260.1628,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25379.3,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13293.9458,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12221.4638,Other,"DRG Weight, with Charge Based Outlier",,65,,24259.625,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14205,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8775.0284,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9562,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9655,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9331,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9424,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9424,Other,CMS Methodology,,,"103% of Medicare, less IME",9516,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9678,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,DRG,,,,Inpatient,,,23566.56,5891.64,6381.9214,20031.576,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13189.679,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9226.451,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10435.095,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11439.2533,Other,CMS Methodology,,65.6,,15459.66336,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9226.451,Other,"DRG Weight, with Charge Based Outlier",,70,,16496.592,Percent of Total Billed Charges,,,85,,20031.576,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11098.4438,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,16025.2608,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9668.4493,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8888.4523,Other,"DRG Weight, with Charge Based Outlier",,65,,15318.264,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10331,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6381.9214,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6955,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7022,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6787,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6854,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6854,Other,CMS Methodology,,,"103% of Medicare, less IME",6921,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7039,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
DISORDERS OF THE BILIARY TRACT WITH MCC,444,DRG,,,,Inpatient,,,66652.13,16663.0325,10120,56654.3105,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31616.188,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22116.172,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25013.34,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27420.3476,Other,CMS Methodology,,65.6,,43723.79728,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22116.172,Other,"DRG Weight, with Charge Based Outlier",,70,,46656.491,Percent of Total Billed Charges,,,85,,56654.3105,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26603.4136,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45323.4484,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23175.6596,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21305.9756,Other,"DRG Weight, with Charge Based Outlier",,65,,43323.8845,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24764,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15297.7208,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16670,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16831,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16268,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16429,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16429,Other,CMS Methodology,,,"103% of Medicare, less IME",16590,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16872,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
DISORDERS OF THE BILIARY TRACT WITH CC,445,DRG,,,,Inpatient,,,45766.21,11441.5525,7570,38901.2785,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20356.065,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14239.485,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16104.825,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17654.5755,Other,CMS Methodology,,65.6,,30022.63376,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14239.485,Other,"DRG Weight, with Charge Based Outlier",,70,,32036.347,Percent of Total Billed Charges,,,85,,38901.2785,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17128.593,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31121.0228,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14921.6355,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13717.8405,Other,"DRG Weight, with Charge Based Outlier",,65,,29748.0365,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15944,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9849.429,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10733,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10837,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10474,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10578,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10578,Other,CMS Methodology,,,"103% of Medicare, less IME",10681,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10863,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,DRG,,,,Inpatient,,,33302.11,8325.5275,6720,28306.7935,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14965.321,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10468.549,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11839.905,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12979.2467,Other,CMS Methodology,,65.6,,21846.18416,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10468.549,Other,"DRG Weight, with Charge Based Outlier",,70,,23311.477,Percent of Total Billed Charges,,,85,,28306.7935,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12592.5562,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22645.4348,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10970.0507,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10085.0477,Other,"DRG Weight, with Charge Based Outlier",,65,,21646.3715,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11722,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7241.0786,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7891,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7967,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7700,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7776,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7776,Other,CMS Methodology,,,"103% of Medicare, less IME",7853,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7986,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,DRG,,,,Inpatient,,,149163.46,37290.865,10970,126788.941,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,125847.219,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,88032.711,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,99564.795,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,109145.8113,Other,CMS Methodology,,65.6,,97851.22976,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,88032.711,Other,"DRG Weight, with Charge Based Outlier",,70,,104414.422,Percent of Total Billed Charges,,,85,,126788.941,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,105894.0318,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,101431.1528,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,92249.9673,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",84807.7503,Other,"DRG Weight, with Charge Based Outlier",,65,,96956.249,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",98572,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,60892.0854,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",66356,Other,CMS Methodology,,,"104.5% of Medicare, less IME",66997,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",64753,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",65394,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",65394,Other,CMS Methodology,,,"103% of Medicare, less IME",66035,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",67157,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,DRG,,,,Inpatient,,,127237.22,31809.305,7570,108151.637,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,76647.295,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53616.355,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,60639.975,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,66475.2965,Other,CMS Methodology,,65.6,,83467.61632,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53616.355,Other,"DRG Weight, with Charge Based Outlier",,70,,89066.054,Percent of Total Billed Charges,,,85,,108151.637,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,64494.799,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,86521.3096,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,56184.8765,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",51652.1915,Other,"DRG Weight, with Charge Based Outlier",,65,,82704.193,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",60035,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,37086.347,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",40414,Other,CMS Methodology,,,"104.5% of Medicare, less IME",40804,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",39438,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",39828,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",39828,Other,CMS Methodology,,,"103% of Medicare, less IME",40219,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",40902,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,DRG,,,,Inpatient,,,60571.78,15142.945,5020,96667.377,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,96667.377,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,67620.813,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,76478.985,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,83838.4779,Other,CMS Methodology,,65.6,,39735.08768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,67620.813,Other,"DRG Weight, with Charge Based Outlier",,70,,42400.246,Percent of Total Billed Charges,,,85,,51486.013,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,81340.6794,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41188.8104,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,70860.2259,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",65143.6149,Other,"DRG Weight, with Charge Based Outlier",,65,,39371.657,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",75716,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,46773.2082,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",50970,Other,CMS Methodology,,,"104.5% of Medicare, less IME",51462,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",49739,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",50231,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",50231,Other,CMS Methodology,,,"103% of Medicare, less IME",50724,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",51586,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,DRG,,,,Inpatient,,,97055.43,24263.8575,7570,82497.1155,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,57924.22,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40519.18,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,45827.1,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,50236.994,Other,CMS Methodology,,65.6,,63668.36208,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40519.18,Other,"DRG Weight, with Charge Based Outlier",,70,,67938.801,Percent of Total Billed Charges,,,85,,82497.1155,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,48740.284,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,65997.6924,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,42460.274,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",39034.814,Other,"DRG Weight, with Charge Based Outlier",,65,,63086.0295,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",45370,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,28027.052,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",30542,Other,CMS Methodology,,,"104.5% of Medicare, less IME",30837,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",29804,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",30099,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",30099,Other,CMS Methodology,,,"103% of Medicare, less IME",30394,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",30911,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,453,DRG,,,,Inpatient,,,234974.24,58743.56,15220,199728.104,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,168692.1761,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,116350.182,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,142002.9829,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,144254.7306,Other,CMS Methodology,,65.6,,154143.1014,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,116350.182,Other,"DRG Weight, with Charge Based Outlier",,70,,164481.968,Percent of Total Billed Charges,,,85,,199728.104,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,139956.9516,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,159782.4832,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,121924.0026,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",82240.984,Other,"DRG Weight, with Charge Based Outlier",,65,,152733.256,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",130279,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,80479.2348,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",87700,Other,CMS Methodology,,,"104.5% of Medicare, less IME",88548,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",85582,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",86429,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",86429,Other,CMS Methodology,,,"103% of Medicare, less IME",87277,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",88759,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,454,DRG,,,,Inpatient,,,157367.31,39341.8275,10970,133762.2135,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,114802.951,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,80307.019,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,90827.055,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,99567.2477,Other,CMS Methodology,,65.6,,103232.9554,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,80307.019,Other,"DRG Weight, with Charge Based Outlier",,70,,110157.117,Percent of Total Billed Charges,,,85,,133762.2135,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,96600.8422,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,107009.7708,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,84154.1717,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",77365.0787,Other,"DRG Weight, with Charge Based Outlier",,65,,102288.7515,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",89921,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,55548.2366,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",60532,Other,CMS Methodology,,,"104.5% of Medicare, less IME",61117,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",59070,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",59655,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",59655,Other,CMS Methodology,,,"103% of Medicare, less IME",60240,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",61263,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,455,DRG,,,,Inpatient,,,95960.64,23990.16,5870,86447.112,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,86447.112,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,60471.528,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,68393.16,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,74974.5624,Other,CMS Methodology,,65.6,,62950.17984,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,60471.528,Other,"DRG Weight, with Charge Based Outlier",,70,,67172.448,Percent of Total Billed Charges,,,85,,81566.544,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,72740.8464,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,65253.2352,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,63368.4504,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",58256.2344,Other,"DRG Weight, with Charge Based Outlier",,65,,62374.416,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",67711,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,41828.0592,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",45581,Other,CMS Methodology,,,"104.5% of Medicare, less IME",46022,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",44480,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",44921,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",44921,Other,CMS Methodology,,,"103% of Medicare, less IME",45361,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",46132,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,DRG,,,,Inpatient,,,220160.92,55040.23,22020,187136.782,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,158966.884,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,111200.596,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,129705.392,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,137870.1068,Other,CMS Methodology,,65.6,,144425.5635,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,111200.596,Other,"DRG Weight, with Charge Based Outlier",,70,,154112.644,Percent of Total Billed Charges,,,85,,187136.782,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,133762.5448,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,149709.4256,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,138511.7228,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",77056.322,Other,"DRG Weight, with Charge Based Outlier",,65,,143104.598,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",124513,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,76917.2744,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",83819,Other,CMS Methodology,,,"104.5% of Medicare, less IME",84629,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",81794,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",82604,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",82604,Other,CMS Methodology,,,"103% of Medicare, less IME",83414,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",84831,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,22020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,22870,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,22520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,22020,Other,AR Medicaid Methodology
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,DRG,,,,Inpatient,,,156799.05,39199.7625,12670,133279.1925,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,107728.538,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,75358.322,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,85230.09,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,93431.6926,Other,CMS Methodology,,65.6,,102860.1768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,75358.322,Other,"DRG Weight, with Charge Based Outlier",,70,,109759.335,Percent of Total Billed Charges,,,85,,133279.1925,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,90648.0836,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,106623.354,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,78968.4046,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",72597.6706,Other,"DRG Weight, with Charge Based Outlier",,65,,101919.3825,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",84380,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,52125.2308,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",56802,Other,CMS Methodology,,,"104.5% of Medicare, less IME",57351,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",55430,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",55979,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",55979,Other,CMS Methodology,,,"103% of Medicare, less IME",56528,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",57488,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,DRG,,,,Inpatient,,,131436.76,32859.19,9270,111721.246,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,81048.86,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,56695.34,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,64122.3,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,70292.722,Other,CMS Methodology,,65.6,,86222.51456,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,56695.34,Other,"DRG Weight, with Charge Based Outlier",,70,,92005.732,Percent of Total Billed Charges,,,85,,111721.246,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,68198.492,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,89376.9968,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,59411.362,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",54618.382,Other,"DRG Weight, with Charge Based Outlier",,65,,85433.894,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",63483,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,39216.076,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",42735,Other,CMS Methodology,,,"104.5% of Medicare, less IME",43148,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",41703,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",42115,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",42115,Other,CMS Methodology,,,"103% of Medicare, less IME",42528,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",43251,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
SPINAL FUSION EXCEPT CERVICAL WITH MCC,459,DRG,,,,Inpatient,,,186126.73,46531.6825,13520,158207.7205,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,124488.271,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,87082.099,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,98489.655,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,107967.2117,Other,CMS Methodology,,65.6,,122099.1349,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,87082.099,Other,"DRG Weight, with Charge Based Outlier",,70,,130288.711,Percent of Total Billed Charges,,,85,,158207.7205,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,104750.5462,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,126566.1764,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,91253.8157,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",65144.3555,Other,"DRG Weight, with Charge Based Outlier",,65,,120982.3745,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",97507,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,60234.5486,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",65639,Other,CMS Methodology,,,"104.5% of Medicare, less IME",66273,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",64054,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",64688,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",64688,Other,CMS Methodology,,,"103% of Medicare, less IME",65322,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",66432,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,460,DRG,,,,Inpatient,,,98096.59,24524.1475,7570,83382.1015,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,68658.783,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,48028.227,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,54319.815,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,59546.9541,Other,CMS Methodology,,65.6,,64351.36304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,48028.227,Other,"DRG Weight, with Charge Based Outlier",,70,,68667.613,Percent of Total Billed Charges,,,85,,83382.1015,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,57772.8726,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,66705.6812,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,50329.0461,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",46268.7771,Other,"DRG Weight, with Charge Based Outlier",,65,,63762.7835,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",53778,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,33221.0478,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",36202,Other,CMS Methodology,,,"104.5% of Medicare, less IME",36552,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",35327,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",35677,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",35677,Other,CMS Methodology,,,"103% of Medicare, less IME",36027,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",36639,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,DRG,,,,Inpatient,,,152113.96,38028.49,8420,129296.866,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,53753.526,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37601.694,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,42527.43,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,46619.8002,Other,CMS Methodology,,65.6,,99786.75776,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37601.694,Other,"DRG Weight, with Charge Based Outlier",,70,,106479.772,Percent of Total Billed Charges,,,85,,129296.866,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,45230.8572,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,103437.4928,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,39403.0242,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36224.2062,Other,"DRG Weight, with Charge Based Outlier",,65,,98874.074,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",42103,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26009.0316,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28343,Other,CMS Methodology,,,"104.5% of Medicare, less IME",28617,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",27658,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",27932,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",27932,Other,CMS Methodology,,,"103% of Medicare, less IME",28206,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",28685,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,DRG,,,,Inpatient,,,156407.89,39101.9725,13520,132946.7065,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,101376.77,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,70915.13,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,80204.85,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,87922.879,Other,CMS Methodology,,65.6,,102603.5758,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,70915.13,Other,"DRG Weight, with Charge Based Outlier",,70,,109485.523,Percent of Total Billed Charges,,,85,,132946.7065,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,85303.394,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,106357.3652,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,74312.359,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",68317.249,Other,"DRG Weight, with Charge Based Outlier",,65,,101665.1285,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",79405,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,49051.882,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",53453,Other,CMS Methodology,,,"104.5% of Medicare, less IME",53970,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",52162,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",52678,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",52678,Other,CMS Methodology,,,"103% of Medicare, less IME",53195,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",54099,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,DRG,,,,Inpatient,,,90623.69,22655.9225,10120,77030.1365,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,55345.222,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38715.118,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,43786.71,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,48000.2594,Other,CMS Methodology,,65.6,,59449.14064,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38715.118,Other,"DRG Weight, with Charge Based Outlier",,70,,63436.583,Percent of Total Billed Charges,,,85,,77030.1365,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,46570.1884,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,61624.1092,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,40569.7874,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",37296.8414,Other,"DRG Weight, with Charge Based Outlier",,65,,58905.3985,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",43350,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26779.1852,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",29182,Other,CMS Methodology,,,"104.5% of Medicare, less IME",29464,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",28477,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",28759,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",28759,Other,CMS Methodology,,,"103% of Medicare, less IME",29041,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",29534,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,DRG,,,,Inpatient,,,55246.44,13811.61,6720,46959.474,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32586.597,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22794.993,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25781.085,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28261.9719,Other,CMS Methodology,,65.6,,36241.66464,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22794.993,Other,"DRG Weight, with Charge Based Outlier",,70,,38672.508,Percent of Total Billed Charges,,,85,,46959.474,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27419.9634,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37567.5792,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23886.9999,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21959.9289,Other,"DRG Weight, with Charge Based Outlier",,65,,35910.186,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25524,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15767.2602,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17182,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17348,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16767,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16933,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16933,Other,CMS Methodology,,,"103% of Medicare, less IME",17099,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17389,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,DRG,,,,Inpatient,,,147371.64,36842.91,11820,125265.894,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,95625.642,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,66892.098,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,75654.81,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,82934.9934,Other,CMS Methodology,,65.6,,96675.79584,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,66892.098,Other,"DRG Weight, with Charge Based Outlier",,70,,103160.148,Percent of Total Billed Charges,,,85,,125265.894,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,80464.1124,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,100212.7152,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,70096.6014,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",64441.5954,Other,"DRG Weight, with Charge Based Outlier",,65,,95791.566,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",74900,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,46269.1572,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",50421,Other,CMS Methodology,,,"104.5% of Medicare, less IME",50908,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",49203,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",49690,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",49690,Other,CMS Methodology,,,"103% of Medicare, less IME",50177,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",51030,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,DRG,,,,Inpatient,,,101938.1,25484.525,8420,86647.385,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,64291.004,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,44972.876,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,50864.22,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,55758.8308,Other,CMS Methodology,,65.6,,66871.3936,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,44972.876,Other,"DRG Weight, with Charge Based Outlier",,70,,71356.67,Percent of Total Billed Charges,,,85,,86647.385,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,54097.6088,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,69317.908,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,47127.3268,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",43325.3548,Other,"DRG Weight, with Charge Based Outlier",,65,,66259.765,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",50357,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31107.6664,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",33899,Other,CMS Methodology,,,"104.5% of Medicare, less IME",34226,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33080,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",33408,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",33408,Other,CMS Methodology,,,"103% of Medicare, less IME",33735,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",34308,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,DRG,,,,Inpatient,,,82608.39,20652.0975,6720,70217.1315,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,49239.341,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34443.929,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,38956.005,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,42704.7007,Other,CMS Methodology,,65.6,,54191.10384,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34443.929,Other,"DRG Weight, with Charge Based Outlier",,70,,57825.873,Percent of Total Billed Charges,,,85,,70217.1315,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,41432.4002,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,56173.7052,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,36093.9847,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",33182.1217,Other,"DRG Weight, with Charge Based Outlier",,65,,53695.4535,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",38567,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,23824.8106,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",25963,Other,CMS Methodology,,,"104.5% of Medicare, less IME",26213,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",25335,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",25586,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",25586,Other,CMS Methodology,,,"103% of Medicare, less IME",25837,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",26276,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,DRG,,,,Inpatient,,,106398.63,26599.6575,8420,90438.8355,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,61353.499,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42918.031,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,48540.195,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,53211.1673,Other,CMS Methodology,,65.6,,69797.50128,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42918.031,Other,"DRG Weight, with Charge Based Outlier",,70,,74479.041,Percent of Total Billed Charges,,,85,,90438.8355,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,51625.8478,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,72351.0684,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,44974.0433,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",41345.7863,Other,"DRG Weight, with Charge Based Outlier",,65,,69159.1095,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",48056,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,29686.3334,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",32350,Other,CMS Methodology,,,"104.5% of Medicare, less IME",32663,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",31569,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",31881,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",31881,Other,CMS Methodology,,,"103% of Medicare, less IME",32194,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",32741,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,DRG,,,,Inpatient,,,70757.28,17689.32,5870,60143.688,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35390.835,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24756.615,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27999.675,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30694.0545,Other,CMS Methodology,,65.6,,46416.77568,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24756.615,Other,"DRG Weight, with Charge Based Outlier",,70,,49530.096,Percent of Total Billed Charges,,,85,,60143.688,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29779.587,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48114.9504,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25942.5945,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23849.6895,Other,"DRG Weight, with Charge Based Outlier",,65,,45992.232,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27720,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17124.111,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18661,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18841,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18210,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18390,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18390,Other,CMS Methodology,,,"103% of Medicare, less IME",18570,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18886,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
CERVICAL SPINAL FUSION WITH MCC,471,DRG,,,,Inpatient,,,140053.45,35013.3625,11820,119045.4325,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,91171.521,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,63776.349,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,72130.905,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,79071.9867,Other,CMS Methodology,,65.6,,91875.0632,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,63776.349,Other,"DRG Weight, with Charge Based Outlier",,70,,98037.415,Percent of Total Billed Charges,,,85,,119045.4325,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,76716.1962,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,95236.346,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,66831.5907,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",61439.9877,Other,"DRG Weight, with Charge Based Outlier",,65,,91034.7425,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",71412,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,44113.9986,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",48072,Other,CMS Methodology,,,"104.5% of Medicare, less IME",48537,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",46911,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",47375,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",47375,Other,CMS Methodology,,,"103% of Medicare, less IME",47840,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",48653,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
CERVICAL SPINAL FUSION WITH CC,472,DRG,,,,Inpatient,,,77380.33,19345.0825,7570,65773.2805,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,54380.444,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38040.236,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,43023.42,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,47163.5188,Other,CMS Methodology,,65.6,,50761.49648,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38040.236,Other,"DRG Weight, with Charge Based Outlier",,70,,54166.231,Percent of Total Billed Charges,,,85,,65773.2805,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,45758.3768,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52618.6244,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,39862.5748,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36646.6828,Other,"DRG Weight, with Charge Based Outlier",,65,,50297.2145,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",42594,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26312.3704,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28673,Other,CMS Methodology,,,"104.5% of Medicare, less IME",28950,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",27981,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",28258,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",28258,Other,CMS Methodology,,,"103% of Medicare, less IME",28535,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",29020,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,DRG,,,,Inpatient,,,63624.85,15906.2125,5870,54081.1225,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,44436.098,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31083.962,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,35155.89,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,38538.9046,Other,CMS Methodology,,65.6,,41737.9016,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31083.962,Other,"DRG Weight, with Charge Based Outlier",,70,,44537.395,Percent of Total Billed Charges,,,85,,54081.1225,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,37390.7156,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,43264.898,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,32573.0566,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",29945.2426,Other,"DRG Weight, with Charge Based Outlier",,65,,41356.1525,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",34805,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21500.7268,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23430,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23656,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22864,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23090,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23090,Other,CMS Methodology,,,"103% of Medicare, less IME",23317,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",23713,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,DRG,,,,Inpatient,,,102473.41,25618.3525,12670,87102.3985,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,84177.819,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,58884.111,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,66597.795,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,73006.4313,Other,CMS Methodology,,65.6,,67222.55696,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,58884.111,Other,"DRG Weight, with Charge Based Outlier",,70,,71731.387,Percent of Total Billed Charges,,,85,,87102.3985,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,70831.3518,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,69681.9188,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,61704.9873,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",56726.9703,Other,"DRG Weight, with Charge Based Outlier",,65,,66607.7165,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",65934,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,40730.0454,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",44385,Other,CMS Methodology,,,"104.5% of Medicare, less IME",44813,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",43312,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",43741,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",43741,Other,CMS Methodology,,,"103% of Medicare, less IME",44170,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",44921,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,DRG,,,,Inpatient,,,72992.65,18248.1625,10120,62043.7525,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40492.521,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28325.349,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,32035.905,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,35118.6867,Other,CMS Methodology,,65.6,,47883.1784,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28325.349,Other,"DRG Weight, with Charge Based Outlier",,70,,51094.855,Percent of Total Billed Charges,,,85,,62043.7525,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,34072.3962,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,49635.002,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29682.2907,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27287.6877,Other,"DRG Weight, with Charge Based Outlier",,65,,47445.2225,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31716,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19592.5986,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21351,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21557,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20835,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21041,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21041,Other,CMS Methodology,,,"103% of Medicare, less IME",21247,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21608,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,DRG,,,,Inpatient,,,34982.16,8745.54,5870,29734.836,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21831.387,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15271.503,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17272.035,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18934.1049,Other,CMS Methodology,,65.6,,22948.29696,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15271.503,Other,"DRG Weight, with Charge Based Outlier",,70,,24487.512,Percent of Total Billed Charges,,,85,,29734.836,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18370.0014,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23787.8688,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16003.0929,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14712.0519,Other,"DRG Weight, with Charge Based Outlier",,65,,22738.404,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17100,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10563.2742,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11511,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11622,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11233,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11344,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11344,Other,CMS Methodology,,,"103% of Medicare, less IME",11455,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11650,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,DRG,,,,Inpatient,,,98081.96,24520.49,12670,83369.666,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,64550.03,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45154.07,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,51069.15,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,55983.481,Other,CMS Methodology,,65.6,,64341.76576,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45154.07,Other,"DRG Weight, with Charge Based Outlier",,70,,68657.372,Percent of Total Billed Charges,,,85,,83369.666,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,54315.566,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,66695.7328,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,47317.201,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",43499.911,Other,"DRG Weight, with Charge Based Outlier",,65,,63753.274,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",50560,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31232.998,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",34035,Other,CMS Methodology,,,"104.5% of Medicare, less IME",34364,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33213,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",33542,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",33542,Other,CMS Methodology,,,"103% of Medicare, less IME",33871,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",34446,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,DRG,,,,Inpatient,,,60240.45,15060.1125,10120,51204.3825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,43895.522,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30705.818,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,34728.21,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,38070.0694,Other,CMS Methodology,,65.6,,39517.7352,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30705.818,Other,"DRG Weight, with Charge Based Outlier",,70,,42168.315,Percent of Total Billed Charges,,,85,,51204.3825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,36935.8484,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40963.506,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,32176.7974,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",29580.9514,Other,"DRG Weight, with Charge Based Outlier",,65,,39156.2925,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",34382,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21239.1652,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23145,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23368,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22586,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22809,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22809,Other,CMS Methodology,,,"103% of Medicare, less IME",23033,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",23424,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,DRG,,,,Inpatient,,,34371.75,8592.9375,9270,33331.766,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33331.766,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23316.254,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26370.63,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28908.2482,Other,CMS Methodology,,65.6,,22547.868,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23316.254,Other,"DRG Weight, with Charge Based Outlier",,70,,24060.225,Percent of Total Billed Charges,,,85,,29215.9875,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28046.9852,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23372.79,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24433.2322,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22462.0942,Other,"DRG Weight, with Charge Based Outlier",,65,,22341.6375,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26108,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16127.8156,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17575,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17745,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17150,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17320,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17320,Other,CMS Methodology,,,"103% of Medicare, less IME",17490,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17787,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,DRG,,,,Inpatient,,,109850.04,27462.51,10970,93372.534,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,55202.57,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38615.33,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,43673.85,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,47876.539,Other,CMS Methodology,,65.6,,72061.62624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38615.33,Other,"DRG Weight, with Charge Based Outlier",,70,,76895.028,Percent of Total Billed Charges,,,85,,93372.534,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,46450.154,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,74698.0272,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,40465.219,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",37200.709,Other,"DRG Weight, with Charge Based Outlier",,65,,71402.526,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",43238,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26710.162,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",29107,Other,CMS Methodology,,,"104.5% of Medicare, less IME",29388,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",28404,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",28685,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",28685,Other,CMS Methodology,,,"103% of Medicare, less IME",28966,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",29458,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,DRG,,,,Inpatient,,,78697.79,19674.4475,9270,66893.1215,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,38945.873,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27243.437,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,30812.265,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,33777.2971,Other,CMS Methodology,,65.6,,51625.75024,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27243.437,Other,"DRG Weight, with Charge Based Outlier",,70,,55088.453,Percent of Total Billed Charges,,,85,,66893.1215,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,32770.9706,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,53514.4972,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,28548.5491,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26245.4101,Other,"DRG Weight, with Charge Based Outlier",,65,,51153.5635,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",30505,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18844.2418,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20535,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20733,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20039,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20237,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20237,Other,CMS Methodology,,,"103% of Medicare, less IME",20436,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20783,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,DRG,,,,Inpatient,,,54623.67,13655.9175,7570,46430.1195,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29776.728,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20829.432,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23558.04,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25825.0056,Other,CMS Methodology,,65.6,,35833.12752,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20829.432,Other,"DRG Weight, with Charge Based Outlier",,70,,38236.569,Percent of Total Billed Charges,,,85,,46430.1195,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25055.6016,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37144.0956,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21827.2776,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20066.3736,Other,"DRG Weight, with Charge Based Outlier",,65,,35505.3855,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23323,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14407.6848,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15700,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15852,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15321,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15473,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15473,Other,CMS Methodology,,,"103% of Medicare, less IME",15625,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15890,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,DRG,,,,Inpatient,,,93454.45,23363.6125,6720,79436.2825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,47829.714,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33457.866,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,37840.77,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,41482.1478,Other,CMS Methodology,,65.6,,61306.1192,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33457.866,Other,"DRG Weight, with Charge Based Outlier",,70,,65418.115,Percent of Total Billed Charges,,,85,,79436.2825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,40246.2708,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,63549.026,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,35060.6838,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",32232.1818,Other,"DRG Weight, with Charge Based Outlier",,65,,60745.3925,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",37463,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,23142.7524,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",25219,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25463,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",24610,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24854,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24854,Other,CMS Methodology,,,"103% of Medicare, less IME",25097,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25524,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,DRG,,,,Inpatient,,,169797.95,42449.4875,14370,144328.2575,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,60426.261,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42269.409,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,47806.605,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,52406.9847,Other,CMS Methodology,,65.6,,111387.4552,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42269.409,Other,"DRG Weight, with Charge Based Outlier",,70,,118858.565,Percent of Total Billed Charges,,,85,,144328.2575,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,50845.6242,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,115462.606,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,44294.3487,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",40720.9257,Other,"DRG Weight, with Charge Based Outlier",,65,,110368.6675,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",47330,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,29237.6826,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",31861,Other,CMS Methodology,,,"104.5% of Medicare, less IME",32169,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",31091,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",31399,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",31399,Other,CMS Methodology,,,"103% of Medicare, less IME",31707,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",32246,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,DRG,,,,Inpatient,,,70448.83,17612.2075,9270,59881.5055,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39809.293,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27847.417,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31495.365,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34526.1311,Other,CMS Methodology,,65.6,,46214.43248,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27847.417,Other,"DRG Weight, with Charge Based Outlier",,70,,49314.181,Percent of Total Billed Charges,,,85,,59881.5055,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33497.4946,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47905.2044,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29181.4631,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26827.2641,Other,"DRG Weight, with Charge Based Outlier",,65,,45791.7395,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31181,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19262.0138,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20990,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21193,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20483,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20686,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20686,Other,CMS Methodology,,,"103% of Medicare, less IME",20889,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21244,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,DRG,,,,Inpatient,,,63010.31,15752.5775,9270,53558.7635,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29660.354,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20748.026,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23465.97,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25724.0758,Other,CMS Methodology,,65.6,,41334.76336,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20748.026,Other,"DRG Weight, with Charge Based Outlier",,70,,44107.217,Percent of Total Billed Charges,,,85,,53558.7635,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24957.6788,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42847.0108,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21741.9718,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19987.9498,Other,"DRG Weight, with Charge Based Outlier",,65,,40956.7015,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23232,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14351.3764,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15639,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15790,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15261,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15412,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15412,Other,CMS Methodology,,,"103% of Medicare, less IME",15564,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15828,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,DRG,,,,Inpatient,,,90722.83,22680.7075,9270,77114.4055,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36890.558,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25805.702,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29186.19,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31994.7466,Other,CMS Methodology,,65.6,,59514.17648,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25805.702,Other,"DRG Weight, with Charge Based Outlier",,70,,63505.981,Percent of Total Billed Charges,,,85,,77114.4055,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31041.5276,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,61691.5244,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27041.9386,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24860.3446,Other,"DRG Weight, with Charge Based Outlier",,65,,58969.8395,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28895,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17849.7628,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19451,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19639,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18982,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19169,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19169,Other,CMS Methodology,,,"103% of Medicare, less IME",19357,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19686,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,DRG,,,,Inpatient,,,50282.14,12570.535,5870,42739.819,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23244.768,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16260.192,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18390.24,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20159.9136,Other,CMS Methodology,,65.6,,32985.08384,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16260.192,Other,"DRG Weight, with Charge Based Outlier",,70,,35197.498,Percent of Total Billed Charges,,,85,,42739.819,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19559.2896,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34191.8552,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17039.1456,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15664.5216,Other,"DRG Weight, with Charge Based Outlier",,65,,32683.391,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18207,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11247.1488,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12256,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12375,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11960,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12079,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12079,Other,CMS Methodology,,,"103% of Medicare, less IME",12197,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12404,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,DRG,,,,Inpatient,,,126511.93,31627.9825,11820,107535.1405,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,66656.024,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46627.256,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,52735.32,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,57809.9848,Other,CMS Methodology,,65.6,,82991.82608,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46627.256,Other,"DRG Weight, with Charge Based Outlier",,70,,88558.351,Percent of Total Billed Charges,,,85,,107535.1405,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,56087.6528,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,86028.1124,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,48860.9608,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",44919.1288,Other,"DRG Weight, with Charge Based Outlier",,65,,82232.7545,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",52209,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,32251.9984,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",35146,Other,CMS Methodology,,,"104.5% of Medicare, less IME",35485,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",34297,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34636,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34636,Other,CMS Methodology,,,"103% of Medicare, less IME",34976,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35570,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,DRG,,,,Inpatient,,,85353.36,21338.34,9270,72550.356,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,45066.77,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31525.13,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,35654.85,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,39085.879,Other,CMS Methodology,,65.6,,55991.80416,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,31525.13,Other,"DRG Weight, with Charge Based Outlier",,70,,59747.352,Percent of Total Billed Charges,,,85,,72550.356,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,37921.394,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,58040.2848,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,33035.359,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",30370.249,Other,"DRG Weight, with Charge Based Outlier",,65,,55479.684,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",35299,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21805.882,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23762,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23992,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23188,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23418,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23418,Other,CMS Methodology,,,"103% of Medicare, less IME",23648,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24049,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,DRG,,,,Inpatient,,,66498.25,16624.5625,6720,56523.5125,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35388.958,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24755.302,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27998.19,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30692.4266,Other,CMS Methodology,,65.6,,43622.852,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24755.302,Other,"DRG Weight, with Charge Based Outlier",,70,,46548.775,Percent of Total Billed Charges,,,85,,56523.5125,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29778.0076,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45218.81,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25941.2186,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23848.4246,Other,"DRG Weight, with Charge Based Outlier",,65,,43223.8625,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27719,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17123.2028,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18660,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18840,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18209,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18389,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18389,Other,CMS Methodology,,,"103% of Medicare, less IME",18569,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18885,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,DRG,,,,Inpatient,,,93943.81,23485.9525,16920,79852.2385,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,66081.662,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46225.478,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,52280.91,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,57311.8474,Other,CMS Methodology,,65.6,,61627.13936,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,46225.478,Other,"DRG Weight, with Charge Based Outlier",,70,,65760.667,Percent of Total Billed Charges,,,85,,79852.2385,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,55604.3564,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,63881.7908,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,53935.9354,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",44532.0694,Other,"DRG Weight, with Charge Based Outlier",,65,,61063.4765,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",51760,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31974.0892,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",34843,Other,CMS Methodology,,,"104.5% of Medicare, less IME",35180,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",34001,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34338,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34338,Other,CMS Methodology,,,"103% of Medicare, less IME",34675,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35264,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,17515,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,17270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,DRG,,,,Inpatient,,,77175.32,19293.83,8420,65599.022,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37033.21,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25905.49,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29299.05,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32118.467,Other,CMS Methodology,,65.6,,50627.00992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25905.49,Other,"DRG Weight, with Charge Based Outlier",,70,,54022.724,Percent of Total Billed Charges,,,85,,65599.022,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31161.562,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52479.2176,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27146.507,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24956.477,Other,"DRG Weight, with Charge Based Outlier",,65,,50163.958,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29007,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17918.786,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19527,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19715,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19055,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19244,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19244,Other,CMS Methodology,,,"103% of Medicare, less IME",19432,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19762,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,DRG,,,,Inpatient,,,52926.08,13231.52,5870,44987.168,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25200.602,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17628.338,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19937.61,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21856.1854,Other,CMS Methodology,,65.6,,34719.50848,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17628.338,Other,"DRG Weight, with Charge Based Outlier",,70,,37048.256,Percent of Total Billed Charges,,,85,,44987.168,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21205.0244,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35989.7344,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18472.8334,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16982.5474,Other,"DRG Weight, with Charge Based Outlier",,65,,34401.952,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19739,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12193.4932,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13288,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13416,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12967,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13095,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13095,Other,CMS Methodology,,,"103% of Medicare, less IME",13223,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13448,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,DRG,,,,Inpatient,,,136931.56,34232.89,12670,116391.826,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,47392.373,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33151.937,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,37494.765,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,41102.8471,Other,CMS Methodology,,65.6,,89827.10336,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33151.937,Other,"DRG Weight, with Charge Based Outlier",,70,,95852.092,Percent of Total Billed Charges,,,85,,116391.826,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,39878.2706,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,93113.4608,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,34740.0991,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",31937.4601,Other,"DRG Weight, with Charge Based Outlier",,65,,89005.514,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",37121,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22931.1418,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",24989,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25230,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",24385,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24626,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24626,Other,CMS Methodology,,,"103% of Medicare, less IME",24868,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25290,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,DRG,,,,Inpatient,,,28408.69,7102.1725,5020,24147.3865,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20622.599,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14425.931,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16315.695,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17885.7373,Other,CMS Methodology,,65.6,,18636.10064,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14425.931,Other,"DRG Weight, with Charge Based Outlier",,70,,19886.083,Percent of Total Billed Charges,,,85,,24147.3865,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17352.8678,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19317.9092,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15117.0133,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13897.4563,Other,"DRG Weight, with Charge Based Outlier",,65,,18465.6485,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16153,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9978.3934,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10874,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10979,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10611,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10716,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10716,Other,CMS Methodology,,,"103% of Medicare, less IME",10821,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11005,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
SOFT TISSUE PROCEDURES WITH MCC,500,DRG,,,,Inpatient,,,94724.12,23681.03,11820,80515.502,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,59476.499,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,41605.031,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,47055.195,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,51583.2673,Other,CMS Methodology,,65.6,,62139.02272,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,41605.031,Other,"DRG Weight, with Charge Based Outlier",,70,,66306.884,Percent of Total Billed Charges,,,85,,80515.502,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,50046.4478,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,64412.4016,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,43598.1433,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",40080.8863,Other,"DRG Weight, with Charge Based Outlier",,65,,61570.678,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",46586,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,28778.1334,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",31360,Other,CMS Methodology,,,"104.5% of Medicare, less IME",31663,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",30603,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",30906,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",30906,Other,CMS Methodology,,,"103% of Medicare, less IME",31209,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",31739,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
SOFT TISSUE PROCEDURES WITH CC,501,DRG,,,,Inpatient,,,64752.6,16188.15,9270,55039.71,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33498.819,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23433.111,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26502.795,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29053.1313,Other,CMS Methodology,,65.6,,42477.7056,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23433.111,Other,"DRG Weight, with Charge Based Outlier",,70,,45326.82,Percent of Total Billed Charges,,,85,,55039.71,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28187.5518,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44031.768,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24555.6873,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22574.6703,Other,"DRG Weight, with Charge Based Outlier",,65,,42089.19,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26238,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16208.6454,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17663,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17834,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17236,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17407,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17407,Other,CMS Methodology,,,"103% of Medicare, less IME",17578,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17876,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,DRG,,,,Inpatient,,,55598.15,13899.5375,7570,47258.4275,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26225.444,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18345.236,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20748.42,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22745.0188,Other,CMS Methodology,,65.6,,36472.3864,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18345.236,Other,"DRG Weight, with Charge Based Outlier",,70,,38918.705,Percent of Total Billed Charges,,,85,,47258.4275,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22067.3768,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37806.742,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19224.0748,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17673.1828,Other,"DRG Weight, with Charge Based Outlier",,65,,36138.7975,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20541,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12689.3704,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13828,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13962,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13494,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13628,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13628,Other,CMS Methodology,,,"103% of Medicare, less IME",13761,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13995,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
FOOT PROCEDURES WITH MCC,503,DRG,,,,Inpatient,,,50546.65,12636.6625,7570,49676.682,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,49676.682,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34749.858,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,39302.01,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,43084.0014,Other,CMS Methodology,,65.6,,33158.6024,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34749.858,Other,"DRG Weight, with Charge Based Outlier",,70,,35382.655,Percent of Total Billed Charges,,,85,,42964.6525,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,41800.4004,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34371.722,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,36414.5694,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",33476.8434,Other,"DRG Weight, with Charge Based Outlier",,65,,32855.3225,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",38910,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24036.4212,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",26193,Other,CMS Methodology,,,"104.5% of Medicare, less IME",26446,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",25560,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",25813,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",25813,Other,CMS Methodology,,,"103% of Medicare, less IME",26067,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",26509,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
FOOT PROCEDURES WITH CC,504,DRG,,,,Inpatient,,,70142.88,17535.72,9270,59621.448,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32941.35,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23043.15,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26061.75,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28569.645,Other,CMS Methodology,,65.6,,46013.72928,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23043.15,Other,"DRG Weight, with Charge Based Outlier",,70,,49100.016,Percent of Total Billed Charges,,,85,,59621.448,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27718.47,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47697.1584,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24147.045,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22198.995,Other,"DRG Weight, with Charge Based Outlier",,65,,45592.872,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25802,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15938.91,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17369,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17537,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16949,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17117,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17117,Other,CMS Methodology,,,"103% of Medicare, less IME",17285,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17579,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
FOOT PROCEDURES WITHOUT CC/MCC,505,DRG,,,,Inpatient,,,71827.27,17956.8175,6720,61053.1795,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32941.35,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23043.15,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26061.75,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28569.645,Other,CMS Methodology,,65.6,,47118.68912,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23043.15,Other,"DRG Weight, with Charge Based Outlier",,70,,50279.089,Percent of Total Billed Charges,,,85,,61053.1795,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27718.47,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48842.5436,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24147.045,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22198.995,Other,"DRG Weight, with Charge Based Outlier",,65,,46687.7255,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25802,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15938.91,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17369,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17537,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16949,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17117,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17117,Other,CMS Methodology,,,"103% of Medicare, less IME",17285,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17579,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MAJOR THUMB OR JOINT PROCEDURES,506,DRG,,,,Inpatient,,,60348.97,15087.2425,8420,51296.6245,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28138.107,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19683.183,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22261.635,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24403.8489,Other,CMS Methodology,,65.6,,39588.92432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19683.183,Other,"DRG Weight, with Charge Based Outlier",,70,,42244.279,Percent of Total Billed Charges,,,85,,51296.6245,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23676.7854,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41037.2996,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20626.1169,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18962.1159,Other,"DRG Weight, with Charge Based Outlier",,65,,39226.8305,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22040,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13614.8262,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14836,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14980,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14478,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14621,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14621,Other,CMS Methodology,,,"103% of Medicare, less IME",14765,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15016,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,DRG,,,,Inpatient,,,106237.95,26559.4875,12670,90302.2575,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36380.014,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25448.566,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28782.27,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31551.9578,Other,CMS Methodology,,65.6,,69692.0952,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25448.566,Other,"DRG Weight, with Charge Based Outlier",,70,,74366.565,Percent of Total Billed Charges,,,85,,90302.2575,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30611.9308,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,72241.806,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26667.6938,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24516.2918,Other,"DRG Weight, with Charge Based Outlier",,65,,69054.6675,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28495,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17602.7324,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19182,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19367,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18719,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18904,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18904,Other,CMS Methodology,,,"103% of Medicare, less IME",19089,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19414,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,DRG,,,,Inpatient,,,78334.14,19583.535,7570,66584.019,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,53646.537,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37526.853,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,42442.785,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,46527.0099,Other,CMS Methodology,,65.6,,51387.19584,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37526.853,Other,"DRG Weight, with Charge Based Outlier",,70,,54833.898,Percent of Total Billed Charges,,,85,,66584.019,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,45140.8314,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,53267.2152,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,39324.5979,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36152.1069,Other,"DRG Weight, with Charge Based Outlier",,65,,50917.191,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",42019,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,25957.2642,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28286,Other,CMS Methodology,,,"104.5% of Medicare, less IME",28560,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",27603,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",27876,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",27876,Other,CMS Methodology,,,"103% of Medicare, less IME",28150,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",28628,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,DRG,,,,Inpatient,,,75635.22,18908.805,8420,64289.937,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36811.724,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25750.556,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29123.82,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31926.3748,Other,CMS Methodology,,65.6,,49616.70432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25750.556,Other,"DRG Weight, with Charge Based Outlier",,70,,52944.654,Percent of Total Billed Charges,,,85,,64289.937,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30975.1928,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,51431.9496,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26984.1508,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24807.2188,Other,"DRG Weight, with Charge Based Outlier",,65,,49162.893,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28833,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17811.6184,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19410,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19597,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18941,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19128,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19128,Other,CMS Methodology,,,"103% of Medicare, less IME",19316,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19644,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,DRG,,,,Inpatient,,,74087.32,18521.83,6720,62974.222,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30178.406,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21110.414,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23875.83,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26173.3762,Other,CMS Methodology,,65.6,,48601.28192,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21110.414,Other,"DRG Weight, with Charge Based Outlier",,70,,51861.124,Percent of Total Billed Charges,,,85,,62974.222,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25393.5932,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,50379.3776,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22121.7202,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20337.0622,Other,"DRG Weight, with Charge Based Outlier",,65,,48156.758,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23638,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14602.0396,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15912,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16066,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15528,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15682,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15682,Other,CMS Methodology,,,"103% of Medicare, less IME",15835,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16104,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,DRG,,,,Inpatient,,,61015.24,15253.81,7570,51862.954,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28260.112,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19768.528,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22358.16,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24509.6624,Other,CMS Methodology,,65.6,,40025.99744,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19768.528,Other,"DRG Weight, with Charge Based Outlier",,70,,42710.668,Percent of Total Billed Charges,,,85,,51862.954,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23779.4464,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41490.3632,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20715.5504,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19044.3344,Other,"DRG Weight, with Charge Based Outlier",,65,,39659.906,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22135,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13673.8592,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14901,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15045,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14541,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14685,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14685,Other,CMS Methodology,,,"103% of Medicare, less IME",14829,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15081,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,DRG,,,,Inpatient,,,37585.23,9396.3075,6720,31947.4455,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19137.892,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13387.348,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15141.06,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16598.0684,Other,CMS Methodology,,65.6,,24655.91088,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13387.348,Other,"DRG Weight, with Charge Based Outlier",,70,,26309.661,Percent of Total Billed Charges,,,85,,31947.4455,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16103.5624,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25557.9564,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14028.6764,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12896.9204,Other,"DRG Weight, with Charge Based Outlier",,65,,24430.3995,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14990,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9260.0072,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10091,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10188,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9847,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9945,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9945,Other,CMS Methodology,,,"103% of Medicare, less IME",10042,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10213,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,DRG,,,,Inpatient,,,106218.64,26554.66,11820,90285.844,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,58044.348,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40603.212,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,45922.14,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,50341.1796,Other,CMS Methodology,,65.6,,69679.42784,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40603.212,Other,"DRG Weight, with Charge Based Outlier",,70,,74353.048,Percent of Total Billed Charges,,,85,,90285.844,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,48841.3656,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,72228.6752,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,42548.3316,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",39115.7676,Other,"DRG Weight, with Charge Based Outlier",,65,,69042.116,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",45464,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,28085.1768,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",30605,Other,CMS Methodology,,,"104.5% of Medicare, less IME",30901,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",29866,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",30162,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",30162,Other,CMS Methodology,,,"103% of Medicare, less IME",30457,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",30975,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,DRG,,,,Inpatient,,,74678.61,18669.6525,9270,63476.8185,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37759.609,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26413.621,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29873.745,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32748.4643,Other,CMS Methodology,,65.6,,48989.16816,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26413.621,Other,"DRG Weight, with Charge Based Outlier",,70,,52275.027,Percent of Total Billed Charges,,,85,,63476.8185,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31772.7898,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,50781.4548,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27678.9803,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25445.9933,Other,"DRG Weight, with Charge Based Outlier",,65,,48541.0965,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29576,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18270.2594,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19910,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20102,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19429,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19621,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19621,Other,CMS Methodology,,,"103% of Medicare, less IME",19813,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20150,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,DRG,,,,Inpatient,,,64915.11,16228.7775,7570,55177.8435,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28017.979,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19599.151,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22166.595,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24299.6633,Other,CMS Methodology,,65.6,,42584.31216,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19599.151,Other,"DRG Weight, with Charge Based Outlier",,70,,45440.577,Percent of Total Billed Charges,,,85,,55177.8435,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23575.7038,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44142.2748,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20538.0593,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18881.1623,Other,"DRG Weight, with Charge Based Outlier",,65,,42194.8215,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21946,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13556.7014,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14773,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14916,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14416,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14559,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14559,Other,CMS Methodology,,,"103% of Medicare, less IME",14702,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14952,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,DRG,,,,Inpatient,,,122866.31,30716.5775,11820,104436.3635,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,67271.68,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47057.92,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,53222.4,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,58343.936,Other,CMS Methodology,,65.6,,80600.29936,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47057.92,Other,"DRG Weight, with Charge Based Outlier",,70,,86006.417,Percent of Total Billed Charges,,,85,,104436.3635,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,56605.696,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,83549.0908,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,49312.256,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",45334.016,Other,"DRG Weight, with Charge Based Outlier",,65,,79863.1015,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",52692,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,32549.888,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",35470,Other,CMS Methodology,,,"104.5% of Medicare, less IME",35813,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",34614,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34956,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34956,Other,CMS Methodology,,,"103% of Medicare, less IME",35299,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35899,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,DRG,,,,Inpatient,,,74066.83,18516.7075,9270,62956.8055,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37012.563,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25891.047,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29282.715,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32100.5601,Other,CMS Methodology,,65.6,,48587.84048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25891.047,Other,"DRG Weight, with Charge Based Outlier",,70,,51846.781,Percent of Total Billed Charges,,,85,,62956.8055,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31144.1886,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,50365.4444,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27131.3721,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24942.5631,Other,"DRG Weight, with Charge Based Outlier",,65,,48143.4395,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28991,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17908.7958,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19516,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19704,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19044,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19233,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19233,Other,CMS Methodology,,,"103% of Medicare, less IME",19421,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19751,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,DRG,,,,Inpatient,,,54344.49,13586.1225,6720,46192.8165,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26901.164,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18817.916,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21283.02,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23331.0628,Other,CMS Methodology,,65.6,,35649.98544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18817.916,Other,"DRG Weight, with Charge Based Outlier",,70,,38041.143,Percent of Total Billed Charges,,,85,,46192.8165,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22635.9608,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36954.2532,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19719.3988,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18128.5468,Other,"DRG Weight, with Charge Based Outlier",,65,,35323.9185,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21071,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13016.3224,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14184,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14321,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13842,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13979,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13979,Other,CMS Methodology,,,"103% of Medicare, less IME",14116,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14356,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,DRG,,,,Inpatient,,,130007.93,32501.9825,11820,110506.7405,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,54708.919,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38270.011,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,43283.295,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,47448.4013,Other,CMS Methodology,,65.6,,85285.20208,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38270.011,Other,"DRG Weight, with Charge Based Outlier",,70,,91005.551,Percent of Total Billed Charges,,,85,,110506.7405,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,46034.7718,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,88405.3924,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,40103.3573,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36868.0403,Other,"DRG Weight, with Charge Based Outlier",,65,,84505.1545,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",42852,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26471.3054,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28846,Other,CMS Methodology,,,"104.5% of Medicare, less IME",29125,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",28150,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",28428,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",28428,Other,CMS Methodology,,,"103% of Medicare, less IME",28707,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",29195,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,DRG,,,,Inpatient,,,78697.77,19674.4425,8420,66893.1045,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39569.037,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27679.353,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31305.285,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34317.7599,Other,CMS Methodology,,65.6,,51625.73712,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27679.353,Other,"DRG Weight, with Charge Based Outlier",,70,,55088.439,Percent of Total Billed Charges,,,85,,66893.1045,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33295.3314,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,53514.4836,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29005.3479,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26665.3569,Other,"DRG Weight, with Charge Based Outlier",,65,,51153.5505,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",30993,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19145.7642,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20864,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21065,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20360,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20561,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20561,Other,CMS Methodology,,,"103% of Medicare, less IME",20763,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21116,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
FRACTURES OF FEMUR WITH MCC,533,DRG,,,,Inpatient,,,175069.49,43767.3725,13520,148809.0665,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28622.373,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20021.937,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22644.765,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24823.8471,Other,CMS Methodology,,65.6,,114845.5854,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20021.937,Other,"DRG Weight, with Charge Based Outlier",,70,,122548.643,Percent of Total Billed Charges,,,85,,148809.0665,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24084.2706,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,119047.2532,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26477.0991,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19288.4601,Other,"DRG Weight, with Charge Based Outlier",,65,,113795.1685,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22419,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13849.1418,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15092,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15238,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14727,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14873,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14873,Other,CMS Methodology,,,"103% of Medicare, less IME",15019,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15274,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
FRACTURES OF FEMUR WITHOUT MCC,534,DRG,,,,Inpatient,,,28189.6,7047.4,7392.748,23961.16,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15278.78,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10687.82,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12087.9,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13251.106,Other,CMS Methodology,,65.6,,18492.3776,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10687.82,Other,"DRG Weight, with Charge Based Outlier",,70,,19732.72,Percent of Total Billed Charges,,,85,,23961.16,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12856.316,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19168.928,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11199.826,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10296.286,Other,"DRG Weight, with Charge Based Outlier",,65,,18323.24,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11967,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7392.748,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8056,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8134,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7861,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7939,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7939,Other,CMS Methodology,,,"103% of Medicare, less IME",8017,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8153,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
FRACTURES OF HIP AND PELVIS WITH MCC,535,DRG,,,,Inpatient,,,41441.29,10360.3225,8420,35225.0965,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24962.223,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17461.587,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19749.015,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21649.4421,Other,CMS Methodology,,65.6,,27185.48624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17461.587,Other,"DRG Weight, with Charge Based Outlier",,70,,29008.903,Percent of Total Billed Charges,,,85,,35225.0965,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21004.4406,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28180.0772,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18298.0941,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16821.9051,Other,"DRG Weight, with Charge Based Outlier",,65,,26936.8385,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19552,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12078.1518,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13162,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13289,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12844,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12971,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12971,Other,CMS Methodology,,,"103% of Medicare, less IME",13098,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13321,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,DRG,,,,Inpatient,,,28515.84,7128.96,7364.5938,24238.464,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15220.593,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10647.117,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12041.865,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13200.6411,Other,CMS Methodology,,65.6,,18706.39104,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10647.117,Other,"DRG Weight, with Charge Based Outlier",,70,,19961.088,Percent of Total Billed Charges,,,85,,24238.464,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12807.3546,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19390.7712,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11157.1731,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10257.0741,Other,"DRG Weight, with Charge Based Outlier",,65,,18535.296,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11922,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7364.5938,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8025,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8103,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7832,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7909,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7909,Other,CMS Methodology,,,"103% of Medicare, less IME",7987,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8122,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OSTEOMYELITIS WITH MCC,539,DRG,,,,Inpatient,,,44870.46,11217.615,10970,38139.891,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37960.448,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26554.112,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,30032.64,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32922.6496,Other,CMS Methodology,,65.6,,29435.02176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26554.112,Other,"DRG Weight, with Charge Based Outlier",,70,,31409.322,Percent of Total Billed Charges,,,85,,38139.891,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31941.7856,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30511.9128,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27826.2016,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25581.3376,Other,"DRG Weight, with Charge Based Outlier",,65,,29165.799,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29733,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18367.4368,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20015,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20209,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19532,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19725,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19725,Other,CMS Methodology,,,"103% of Medicare, less IME",19919,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20257,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
OSTEOMYELITIS WITH CC,540,DRG,,,,Inpatient,,,43726.67,10931.6675,9270,37167.6695,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24290.257,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16991.533,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19217.385,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21066.6539,Other,CMS Methodology,,65.6,,28684.69552,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16991.533,Other,"DRG Weight, with Charge Based Outlier",,70,,30608.669,Percent of Total Billed Charges,,,85,,37167.6695,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20439.0154,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29734.1356,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17805.5219,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16369.0709,Other,"DRG Weight, with Charge Based Outlier",,65,,28422.3355,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19026,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11753.0162,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12808,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12931,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12498,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12622,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12622,Other,CMS Methodology,,,"103% of Medicare, less IME",12746,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12962,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
OSTEOMYELITIS WITHOUT CC/MCC,541,DRG,,,,Inpatient,,,27106.88,6776.72,7570,23040.848,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16421.873,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11487.437,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12992.265,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14242.4971,Other,CMS Methodology,,65.6,,17782.11328,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11487.437,Other,"DRG Weight, with Charge Based Outlier",,70,,18974.816,Percent of Total Billed Charges,,,85,,23040.848,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13818.1706,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18432.6784,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12037.7491,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11066.6101,Other,"DRG Weight, with Charge Based Outlier",,65,,17619.472,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12863,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7945.8418,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8659,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8742,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8450,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8533,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8533,Other,CMS Methodology,,,"103% of Medicare, less IME",8617,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8763,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,DRG,,,,Inpatient,,,59576.84,14894.21,10970,50640.314,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35007.927,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24488.763,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27696.735,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30361.9629,Other,CMS Methodology,,65.6,,39082.40704,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24488.763,Other,"DRG Weight, with Charge Based Outlier",,70,,41703.788,Percent of Total Billed Charges,,,85,,50640.314,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29457.3894,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40512.2512,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25661.9109,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23591.6499,Other,"DRG Weight, with Charge Based Outlier",,65,,38724.946,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27421,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16938.8382,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18459,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18637,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18013,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18191,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18191,Other,CMS Methodology,,,"103% of Medicare, less IME",18370,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18682,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,DRG,,,,Inpatient,,,42169.46,10542.365,8420,35844.041,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19913.093,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13929.617,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15754.365,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17270.3911,Other,CMS Methodology,,65.6,,27663.16576,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13929.617,Other,"DRG Weight, with Charge Based Outlier",,70,,29518.622,Percent of Total Billed Charges,,,85,,35844.041,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16755.8546,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28675.2328,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14596.9231,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13419.3241,Other,"DRG Weight, with Charge Based Outlier",,65,,27410.149,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15597,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9635.0938,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10500,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10601,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10246,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10347,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10347,Other,CMS Methodology,,,"103% of Medicare, less IME",10449,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10626,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,DRG,,,,Inpatient,,,29410.88,7352.72,6720,24999.248,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14184.489,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9922.341,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11222.145,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12302.0403,Other,CMS Methodology,,65.6,,19293.53728,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9922.341,Other,"DRG Weight, with Charge Based Outlier",,70,,20587.616,Percent of Total Billed Charges,,,85,,24999.248,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11935.5258,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19999.3984,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10397.6763,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9558.8493,Other,"DRG Weight, with Charge Based Outlier",,65,,19117.072,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11110,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6863.2674,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7479,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7551,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7298,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7371,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7371,Other,CMS Methodology,,,"103% of Medicare, less IME",7443,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7569,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CONNECTIVE TISSUE DISORDERS WITH MCC,545,DRG,,,,Inpatient,,,118390.29,29597.5725,14370,100631.7465,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,47429.913,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33178.197,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,37524.465,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,41135.4051,Other,CMS Methodology,,65.6,,77664.03024,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33178.197,Other,"DRG Weight, with Charge Based Outlier",,70,,82873.203,Percent of Total Billed Charges,,,85,,100631.7465,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,39909.8586,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,80505.3972,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,34767.6171,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",31962.7581,Other,"DRG Weight, with Charge Based Outlier",,65,,76953.6885,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",37150,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22949.3058,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",25008,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25250,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",24404,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24646,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24646,Other,CMS Methodology,,,"103% of Medicare, less IME",24888,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25310,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
CONNECTIVE TISSUE DISORDERS WITH CC,546,DRG,,,,Inpatient,,,56111.55,14027.8875,8420,47694.8175,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21730.029,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15200.601,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17191.845,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18846.1983,Other,CMS Methodology,,65.6,,36809.1768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15200.601,Other,"DRG Weight, with Charge Based Outlier",,70,,39278.085,Percent of Total Billed Charges,,,85,,47694.8175,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18284.7138,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38155.854,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15928.7943,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14643.7473,Other,"DRG Weight, with Charge Based Outlier",,65,,36472.5075,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17020,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10514.2314,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11458,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11568,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11181,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11292,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11292,Other,CMS Methodology,,,"103% of Medicare, less IME",11402,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11596,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,DRG,,,,Inpatient,,,60417.42,15104.355,6776.9884,51354.807,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14006.174,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9797.606,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11081.07,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12147.3898,Other,CMS Methodology,,65.6,,39633.82752,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9797.606,Other,"DRG Weight, with Charge Based Outlier",,70,,42292.194,Percent of Total Billed Charges,,,85,,51354.807,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11785.4828,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41083.8456,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10266.9658,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9438.6838,Other,"DRG Weight, with Charge Based Outlier",,65,,39271.323,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10971,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6776.9884,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7385,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7456,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7207,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7278,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7278,Other,CMS Methodology,,,"103% of Medicare, less IME",7349,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7474,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
SEPTIC ARTHRITIS WITH MCC,548,DRG,,,,Inpatient,,,55635.1,13908.775,9270,47289.835,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37814.042,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26451.698,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29916.81,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32795.6734,Other,CMS Methodology,,65.6,,36496.6256,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26451.698,Other,"DRG Weight, with Charge Based Outlier",,70,,38944.57,Percent of Total Billed Charges,,,85,,47289.835,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31818.5924,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37831.868,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27718.8814,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25482.6754,Other,"DRG Weight, with Charge Based Outlier",,65,,36162.815,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29618,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18296.5972,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19938,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20131,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19457,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19649,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19649,Other,CMS Methodology,,,"103% of Medicare, less IME",19842,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20179,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
SEPTIC ARTHRITIS WITH CC,549,DRG,,,,Inpatient,,,49262.05,12315.5125,8420,41872.7425,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22619.727,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15822.963,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17895.735,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19617.8229,Other,CMS Methodology,,65.6,,32315.9048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15822.963,Other,"DRG Weight, with Charge Based Outlier",,70,,34483.435,Percent of Total Billed Charges,,,85,,41872.7425,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19033.3494,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33498.194,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16580.9709,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15243.3099,Other,"DRG Weight, with Charge Based Outlier",,65,,32020.3325,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17717,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10944.7182,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11927,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12042,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11639,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11754,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11754,Other,CMS Methodology,,,"103% of Medicare, less IME",11869,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12071,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,DRG,,,,Inpatient,,,29891.78,7472.945,6720,25408.013,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16181.617,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11319.373,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12802.185,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14034.1259,Other,CMS Methodology,,65.6,,19609.00768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11319.373,Other,"DRG Weight, with Charge Based Outlier",,70,,20924.246,Percent of Total Billed Charges,,,85,,25408.013,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13616.0074,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20326.4104,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11861.6339,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10904.7029,Other,"DRG Weight, with Charge Based Outlier",,65,,19429.657,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12675,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7829.5922,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8532,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8615,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8326,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8408,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8408,Other,CMS Methodology,,,"103% of Medicare, less IME",8491,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8635,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MEDICAL BACK PROBLEMS WITH MCC,551,DRG,,,,Inpatient,,,61267.37,15316.8425,10120,52077.2645,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32029.128,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22405.032,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25340.04,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27778.4856,Other,CMS Methodology,,65.6,,40191.39472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22405.032,Other,"DRG Weight, with Charge Based Outlier",,70,,42887.159,Percent of Total Billed Charges,,,85,,52077.2645,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26950.8816,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41661.8116,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23478.3576,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21584.2536,Other,"DRG Weight, with Charge Based Outlier",,65,,39823.7905,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25087,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15497.5248,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16888,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17051,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16480,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16643,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16643,Other,CMS Methodology,,,"103% of Medicare, less IME",16806,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17092,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
MEDICAL BACK PROBLEMS WITHOUT MCC,552,DRG,,,,Inpatient,,,35733.56,8933.39,7570,30373.526,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18090.526,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12654.694,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14312.43,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15689.7002,Other,CMS Methodology,,65.6,,23441.21536,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12654.694,Other,"DRG Weight, with Charge Based Outlier",,70,,25013.492,Percent of Total Billed Charges,,,85,,30373.526,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15222.2572,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24298.8208,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13260.9242,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12191.1062,Other,"DRG Weight, with Charge Based Outlier",,65,,23226.814,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14170,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8753.2316,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9539,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9631,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9308,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9400,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9400,Other,CMS Methodology,,,"103% of Medicare, less IME",9493,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9654,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,DRG,,,,Inpatient,,,30155.25,7538.8125,8420,25631.9625,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24513.62,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17147.78,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19394.1,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21260.374,Other,CMS Methodology,,65.6,,19781.844,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17147.78,Other,"DRG Weight, with Charge Based Outlier",,70,,21108.675,Percent of Total Billed Charges,,,85,,25631.9625,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20626.964,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20505.57,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17969.254,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16519.594,Other,"DRG Weight, with Charge Based Outlier",,65,,19600.9125,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19201,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11861.092,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12925,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13050,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12613,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12738,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12738,Other,CMS Methodology,,,"103% of Medicare, less IME",12863,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13081,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,DRG,,,,Inpatient,,,42205.1,10551.275,7579.8372,35874.335,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15665.442,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10958.298,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12393.81,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13586.4534,Other,CMS Methodology,,65.6,,27686.5456,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10958.298,Other,"DRG Weight, with Charge Based Outlier",,70,,29543.57,Percent of Total Billed Charges,,,85,,35874.335,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13181.6724,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28699.468,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11483.2614,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10556.8554,Other,"DRG Weight, with Charge Based Outlier",,65,,27433.315,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12270,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7579.8372,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8260,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8340,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8060,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8140,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8140,Other,CMS Methodology,,,"103% of Medicare, less IME",8220,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8360,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,DRG,,,,Inpatient,,,37620.05,9405.0125,9270,31977.0425,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25275.682,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17680.858,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19997.01,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21921.3014,Other,CMS Methodology,,65.6,,24678.7528,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17680.858,Other,"DRG Weight, with Charge Based Outlier",,70,,26334.035,Percent of Total Billed Charges,,,85,,31977.0425,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21268.2004,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25581.634,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18527.8694,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17033.1434,Other,"DRG Weight, with Charge Based Outlier",,65,,24453.0325,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19798,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12229.8212,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13327,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13456,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13005,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13134,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13134,Other,CMS Methodology,,,"103% of Medicare, less IME",13263,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13488,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,DRG,,,,Inpatient,,,35089.51,8772.3775,7415.453,29826.0835,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15325.705,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10720.645,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12125.025,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13291.8035,Other,CMS Methodology,,65.6,,23018.71856,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10720.645,Other,"DRG Weight, with Charge Based Outlier",,70,,24562.657,Percent of Total Billed Charges,,,85,,29826.0835,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12895.801,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23860.8668,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11234.2235,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10327.9085,Other,"DRG Weight, with Charge Based Outlier",,65,,22808.1815,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12004,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7415.453,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8081,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8159,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7886,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7964,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7964,Other,CMS Methodology,,,"103% of Medicare, less IME",8042,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8178,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,DRG,,,,Inpatient,,,58885.21,14721.3025,10120,50052.4285,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29087.869,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20347.561,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23013.045,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25227.5663,Other,CMS Methodology,,65.6,,38628.69776,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20347.561,Other,"DRG Weight, with Charge Based Outlier",,70,,41219.647,Percent of Total Billed Charges,,,85,,50052.4285,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24475.9618,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40041.9428,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21322.3223,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19602.1553,Other,"DRG Weight, with Charge Based Outlier",,65,,38275.3865,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22784,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14074.3754,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15337,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15485,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14967,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15115,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15115,Other,CMS Methodology,,,"103% of Medicare, less IME",15263,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15522,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,DRG,,,,Inpatient,,,30648.33,7662.0825,7570,26051.0805,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16213.526,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11341.694,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12827.43,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14061.8002,Other,CMS Methodology,,65.6,,20105.30448,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11341.694,Other,"DRG Weight, with Charge Based Outlier",,70,,21453.831,Percent of Total Billed Charges,,,85,,26051.0805,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13642.8572,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20840.8644,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11885.0242,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10926.2062,Other,"DRG Weight, with Charge Based Outlier",,65,,19921.4145,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12699,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7845.0316,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8549,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8632,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8342,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8425,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8425,Other,CMS Methodology,,,"103% of Medicare, less IME",8508,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8652,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,DRG,,,,Inpatient,,,63524.08,15881.02,12670,53995.468,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34842.751,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24373.219,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27566.055,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30218.7077,Other,CMS Methodology,,65.6,,41671.79648,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24373.219,Other,"DRG Weight, with Charge Based Outlier",,70,,44466.856,Percent of Total Billed Charges,,,85,,53995.468,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29318.4022,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,43196.3744,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25540.8317,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23480.3387,Other,"DRG Weight, with Charge Based Outlier",,65,,41290.652,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27291,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16858.9166,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18372,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18549,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17928,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18105,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18105,Other,CMS Methodology,,,"103% of Medicare, less IME",18283,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18593,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,DRG,,,,Inpatient,,,53977.5,13494.375,10341.6734,45880.875,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21373.399,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14951.131,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16909.695,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18536.8973,Other,CMS Methodology,,65.6,,35409.24,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14951.131,Other,"DRG Weight, with Charge Based Outlier",,70,,37784.25,Percent of Total Billed Charges,,,85,,45880.875,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17984.6278,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36704.7,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21163.3733,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14403.4163,Other,"DRG Weight, with Charge Based Outlier",,65,,35085.375,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16741,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10341.6734,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11270,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11378,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10997,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11106,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11106,Other,CMS Methodology,,,"103% of Medicare, less IME",11215,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11406,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,DRG,,,,Inpatient,,,51628.97,12907.2425,7425.4432,43884.6245,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15346.352,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10735.088,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12141.36,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13309.7104,Other,CMS Methodology,,65.6,,33868.60432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10735.088,Other,"DRG Weight, with Charge Based Outlier",,70,,36140.279,Percent of Total Billed Charges,,,85,,43884.6245,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12913.1744,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35107.6996,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16745.3584,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10341.8224,Other,"DRG Weight, with Charge Based Outlier",,65,,33558.8305,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12020,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7425.4432,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8092,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8170,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7896,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7974,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7974,Other,CMS Methodology,,,"103% of Medicare, less IME",8053,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8189,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,DRG,,,,Inpatient,,,61953.92,15488.48,10120,52660.832,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27469.895,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19215.755,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21732.975,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23824.3165,Other,CMS Methodology,,65.6,,40641.77152,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19215.755,Other,"DRG Weight, with Charge Based Outlier",,70,,43367.744,Percent of Total Billed Charges,,,85,,52660.832,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23114.519,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42128.6656,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20136.2965,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18511.8115,Other,"DRG Weight, with Charge Based Outlier",,65,,40270.048,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21516,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13291.507,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14484,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14624,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14134,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14274,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14274,Other,CMS Methodology,,,"103% of Medicare, less IME",14414,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14659,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,DRG,,,,Inpatient,,,29184.33,7296.0825,6720,24806.6805,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16776.626,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11735.594,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13272.93,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14550.1702,Other,CMS Methodology,,65.6,,19144.92048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11735.594,Other,"DRG Weight, with Charge Based Outlier",,70,,20429.031,Percent of Total Billed Charges,,,85,,24806.6805,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14116.6772,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19845.3444,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12297.7942,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11305.6762,Other,"DRG Weight, with Charge Based Outlier",,65,,18969.8145,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13141,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8117.4916,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8846,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8931,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8632,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8718,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8718,Other,CMS Methodology,,,"103% of Medicare, less IME",8803,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8953,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,DRG,,,,Inpatient,,,64783.87,16195.9675,10120,55066.2895,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29453.884,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20603.596,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23302.62,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25545.0068,Other,CMS Methodology,,65.6,,42498.21872,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20603.596,Other,"DRG Weight, with Charge Based Outlier",,70,,45348.709,Percent of Total Billed Charges,,,85,,55066.2895,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24783.9448,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44053.0316,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21590.6228,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19848.8108,Other,"DRG Weight, with Charge Based Outlier",,65,,42109.5155,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23070,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14251.4744,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15530,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15680,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15155,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15305,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15305,Other,CMS Methodology,,,"103% of Medicare, less IME",15455,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15718,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,DRG,,,,Inpatient,,,30265.68,7566.42,7570,25725.828,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19139.769,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13388.661,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15142.545,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16599.6963,Other,CMS Methodology,,65.6,,19854.28608,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13388.661,Other,"DRG Weight, with Charge Based Outlier",,70,,21185.976,Percent of Total Billed Charges,,,85,,25725.828,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16105.1418,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20580.6624,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14030.0523,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12898.1853,Other,"DRG Weight, with Charge Based Outlier",,65,,19672.692,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14992,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9260.9154,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10092,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10189,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9848,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9946,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9946,Other,CMS Methodology,,,"103% of Medicare, less IME",10043,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10214,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,DRG,,,,Inpatient,,,38774.2,9693.55,6794.2442,32958.07,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14041.837,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9822.553,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11109.285,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12178.3199,Other,CMS Methodology,,65.6,,25435.8752,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9822.553,Other,"DRG Weight, with Charge Based Outlier",,70,,27141.94,Percent of Total Billed Charges,,,85,,32958.07,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11815.4914,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26366.456,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10293.1079,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9462.7169,Other,"DRG Weight, with Charge Based Outlier",,65,,25203.23,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10998,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6794.2442,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7404,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7475,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7225,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7297,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7297,Other,CMS Methodology,,,"103% of Medicare, less IME",7368,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7493,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
SKIN DEBRIDEMENT WITH MCC,570,DRG,,,,Inpatient,,,81756.45,20439.1125,10120,69492.9825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,56501.454,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,39523.926,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,44701.47,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,49003.0458,Other,CMS Methodology,,65.6,,53632.2312,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,39523.926,Other,"DRG Weight, with Charge Based Outlier",,70,,57229.515,Percent of Total Billed Charges,,,85,,69492.9825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,47543.0988,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,55594.386,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,41417.3418,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",38076.0198,Other,"DRG Weight, with Charge Based Outlier",,65,,53141.6925,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",44256,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,27338.6364,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",29792,Other,CMS Methodology,,,"104.5% of Medicare, less IME",30079,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",29072,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",29360,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",29360,Other,CMS Methodology,,,"103% of Medicare, less IME",29648,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",30151,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
SKIN DEBRIDEMENT WITH CC,571,DRG,,,,Inpatient,,,54329.44,13582.36,8420,46180.024,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31426.611,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21983.559,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24863.355,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27255.9297,Other,CMS Methodology,,65.6,,35640.11264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21983.559,Other,"DRG Weight, with Charge Based Outlier",,70,,38030.608,Percent of Total Billed Charges,,,85,,46180.024,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26443.8942,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36944.0192,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23036.6937,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21178.2207,Other,"DRG Weight, with Charge Based Outlier",,65,,35314.136,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24615,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15205.9926,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16570,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16730,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16170,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16330,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16330,Other,CMS Methodology,,,"103% of Medicare, less IME",16490,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16770,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,DRG,,,,Inpatient,,,44683.68,11170.92,6720,37981.128,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21442.848,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14999.712,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16964.64,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18597.1296,Other,CMS Methodology,,65.6,,29312.49408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14999.712,Other,"DRG Weight, with Charge Based Outlier",,70,,31278.576,Percent of Total Billed Charges,,,85,,37981.128,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18043.0656,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30384.9024,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15718.2816,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14450.2176,Other,"DRG Weight, with Charge Based Outlier",,65,,29044.392,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16795,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10375.2768,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11306,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11415,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11033,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11142,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11142,Other,CMS Methodology,,,"103% of Medicare, less IME",11252,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11443,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,DRG,,,,Inpatient,,,55737.22,13934.305,10970,65036.173,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,65036.173,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45494.137,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,51453.765,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,56405.1071,Other,CMS Methodology,,65.6,,36563.61632,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45494.137,Other,"DRG Weight, with Charge Based Outlier",,70,,39016.054,Percent of Total Billed Charges,,,85,,47376.637,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,54724.6306,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37901.3096,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,47673.5591,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",43827.5201,Other,"DRG Weight, with Charge Based Outlier",,65,,36229.193,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",50941,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31468.2218,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",34292,Other,CMS Methodology,,,"104.5% of Medicare, less IME",34623,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33463,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",33795,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",33795,Other,CMS Methodology,,,"103% of Medicare, less IME",34126,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",34706,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,DRG,,,,Inpatient,,,159492.71,39873.1775,8420,135568.8035,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,101269.781,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,70840.289,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,80120.205,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,87830.0887,Other,CMS Methodology,,65.6,,104627.2178,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,70840.289,Other,"DRG Weight, with Charge Based Outlier",,70,,111644.897,Percent of Total Billed Charges,,,85,,135568.8035,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,85213.3682,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,108455.0428,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,74233.9327,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",68245.1497,Other,"DRG Weight, with Charge Based Outlier",,65,,103670.2615,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",79321,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,49000.1146,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",53397,Other,CMS Methodology,,,"104.5% of Medicare, less IME",53913,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",52107,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",52623,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",52623,Other,CMS Methodology,,,"103% of Medicare, less IME",53139,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",54042,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,DRG,,,,Inpatient,,,116576.58,29144.145,9270,99090.093,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,49980.756,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34962.564,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,39542.58,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,43347.7212,Other,CMS Methodology,,65.6,,76474.23648,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34962.564,Other,"DRG Weight, with Charge Based Outlier",,70,,81603.606,Percent of Total Billed Charges,,,85,,99090.093,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,42056.2632,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,79272.0744,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,36637.4652,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",33681.7572,Other,"DRG Weight, with Charge Based Outlier",,65,,75774.777,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",39148,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24183.5496,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",26353,Other,CMS Methodology,,,"104.5% of Medicare, less IME",26608,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",25717,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",25971,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",25971,Other,CMS Methodology,,,"103% of Medicare, less IME",26226,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",26672,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,DRG,,,,Inpatient,,,64835.99,16208.9975,5870,55110.5915,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31728.808,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22194.952,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25102.44,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27518.0216,Other,CMS Methodology,,65.6,,42532.40944,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22194.952,Other,"DRG Weight, with Charge Based Outlier",,70,,45385.193,Percent of Total Billed Charges,,,85,,55110.5915,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26698.1776,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44088.4732,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23258.2136,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21381.8696,Other,"DRG Weight, with Charge Based Outlier",,65,,42143.3935,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24852,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15352.2128,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16730,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16891,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16326,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16487,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16487,Other,CMS Methodology,,,"103% of Medicare, less IME",16649,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16932,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,DRG,,,,Inpatient,,,98212.84,24553.21,11820,83480.914,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,61178.938,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42795.922,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,48402.09,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,53059.7726,Other,CMS Methodology,,65.6,,64427.62304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42795.922,Other,"DRG Weight, with Charge Based Outlier",,70,,68748.988,Percent of Total Billed Charges,,,85,,83480.914,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,51478.9636,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,66784.7312,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,44846.0846,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",41228.1506,Other,"DRG Weight, with Charge Based Outlier",,65,,63838.346,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",47919,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,29601.8708,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",32258,Other,CMS Methodology,,,"104.5% of Medicare, less IME",32570,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",31479,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",31790,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",31790,Other,CMS Methodology,,,"103% of Medicare, less IME",32102,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",32648,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,DRG,,,,Inpatient,,,59272.12,14818.03,9270,50381.302,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33279.21,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23279.49,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26329.05,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28862.667,Other,CMS Methodology,,65.6,,38882.51072,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23279.49,Other,"DRG Weight, with Charge Based Outlier",,70,,41490.484,Percent of Total Billed Charges,,,85,,50381.302,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28002.762,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40305.0416,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24394.707,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22426.677,Other,"DRG Weight, with Charge Based Outlier",,65,,38526.878,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26066,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16102.386,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17547,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17717,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17123,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17293,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17293,Other,CMS Methodology,,,"103% of Medicare, less IME",17462,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17759,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,DRG,,,,Inpatient,,,57025.21,14256.3025,8420,48471.4285,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27013.784,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18896.696,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21372.12,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23428.7368,Other,CMS Methodology,,65.6,,37408.53776,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18896.696,Other,"DRG Weight, with Charge Based Outlier",,70,,39917.647,Percent of Total Billed Charges,,,85,,48471.4285,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22730.7248,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38777.1428,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19801.9528,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18204.4408,Other,"DRG Weight, with Charge Based Outlier",,65,,37066.3865,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21159,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13070.8144,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14244,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14381,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13900,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14037,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14037,Other,CMS Methodology,,,"103% of Medicare, less IME",14175,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14416,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,DRG,,,,Inpatient,,,49461.65,12365.4125,5870,42042.4025,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32870.024,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22993.256,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26005.32,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28507.7848,Other,CMS Methodology,,65.6,,32446.8424,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22993.256,Other,"DRG Weight, with Charge Based Outlier",,70,,34623.155,Percent of Total Billed Charges,,,85,,42042.4025,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27658.4528,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33633.922,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24094.7608,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22150.9288,Other,"DRG Weight, with Charge Based Outlier",,65,,32150.0725,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25746,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15904.3984,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17331,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17499,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16913,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17080,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17080,Other,CMS Methodology,,,"103% of Medicare, less IME",17248,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17541,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,DRG,,,,Inpatient,,,67521.47,16880.3675,5870,57393.2495,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30833.479,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21568.651,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24394.095,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26741.5133,Other,CMS Methodology,,65.6,,44294.08432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21568.651,Other,"DRG Weight, with Charge Based Outlier",,70,,47265.029,Percent of Total Billed Charges,,,85,,57393.2495,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25944.8038,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45914.5996,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22601.9093,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20778.5123,Other,"DRG Weight, with Charge Based Outlier",,65,,43888.9555,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24151,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14919.0014,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16258,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16415,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15865,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16022,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16022,Other,CMS Methodology,,,"103% of Medicare, less IME",16179,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16454,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,DRG,,,,Inpatient,,,65115.35,16278.8375,8420,55348.0475,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,38429.698,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26882.362,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,30403.89,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,33329.6246,Other,CMS Methodology,,65.6,,42715.6696,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26882.362,Other,"DRG Weight, with Charge Based Outlier",,70,,45580.745,Percent of Total Billed Charges,,,85,,55348.0475,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,32336.6356,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44278.438,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,28170.1766,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25897.5626,Other,"DRG Weight, with Charge Based Outlier",,65,,42324.9775,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",30101,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18594.4868,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20263,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20459,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19773,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19969,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19969,Other,CMS Methodology,,,"103% of Medicare, less IME",20165,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20508,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,DRG,,,,Inpatient,,,47386.41,11846.6025,5870,40278.4485,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37260.327,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26064.363,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29478.735,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32315.4429,Other,CMS Methodology,,65.6,,31085.48496,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26064.363,Other,"DRG Weight, with Charge Based Outlier",,70,,33170.487,Percent of Total Billed Charges,,,85,,40278.4485,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31352.6694,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,32222.7588,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27312.9909,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25109.5299,Other,"DRG Weight, with Charge Based Outlier",,65,,30801.1665,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29185,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18028.6782,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19646,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19836,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19172,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19362,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19362,Other,CMS Methodology,,,"103% of Medicare, less IME",19551,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19884,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
SKIN ULCERS WITH MCC,592,DRG,,,,Inpatient,,,54108.38,13527.095,12670,45992.123,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,38596.751,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26999.219,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,30536.055,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,33474.5077,Other,CMS Methodology,,65.6,,35495.09728,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26999.219,Other,"DRG Weight, with Charge Based Outlier",,70,,37875.866,Percent of Total Billed Charges,,,85,,45992.123,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,32477.2022,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36793.6984,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,28292.6317,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26010.1387,Other,"DRG Weight, with Charge Based Outlier",,65,,35170.447,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",30232,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18675.3166,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20351,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20548,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19859,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20056,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20056,Other,CMS Methodology,,,"103% of Medicare, less IME",20253,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20597,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
SKIN ULCERS WITH CC,593,DRG,,,,Inpatient,,,30280.14,7570.035,8420,25738.119,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22950.079,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16054.051,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18157.095,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19904.3333,Other,CMS Methodology,,65.6,,19863.77184,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16054.051,Other,"DRG Weight, with Charge Based Outlier",,70,,21196.098,Percent of Total Billed Charges,,,85,,25738.119,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19311.3238,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20590.4952,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16823.1293,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15465.9323,Other,"DRG Weight, with Charge Based Outlier",,65,,19682.091,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17976,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11104.5614,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12101,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12218,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11809,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11926,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11926,Other,CMS Methodology,,,"103% of Medicare, less IME",12042,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12247,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
SKIN ULCERS WITHOUT CC/MCC,594,DRG,,,,Inpatient,,,17268.03,4317.0075,5870,15930.099,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15930.099,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11143.431,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12603.195,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13815.9873,Other,CMS Methodology,,65.6,,11327.82768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11143.431,Other,"DRG Weight, with Charge Based Outlier",,70,,12087.621,Percent of Total Billed Charges,,,85,,14677.8255,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13404.3678,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,11742.2604,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11677.2633,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10735.2063,Other,"DRG Weight, with Charge Based Outlier",,65,,11224.2195,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12478,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7707.8934,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8399,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8481,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8197,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8278,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8278,Other,CMS Methodology,,,"103% of Medicare, less IME",8359,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8501,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
MAJOR SKIN DISORDERS WITH MCC,595,DRG,,,,Inpatient,,,65611.28,16402.82,10970,55769.588,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39700.427,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27771.263,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31409.235,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34431.7129,Other,CMS Methodology,,65.6,,43040.99968,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27771.263,Other,"DRG Weight, with Charge Based Outlier",,70,,45927.896,Percent of Total Billed Charges,,,85,,55769.588,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33405.8894,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44615.6704,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29101.6609,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26753.8999,Other,"DRG Weight, with Charge Based Outlier",,65,,42647.332,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31096,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19209.3382,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20933,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21135,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20427,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20630,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20630,Other,CMS Methodology,,,"103% of Medicare, less IME",20832,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21186,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
MAJOR SKIN DISORDERS WITHOUT MCC,596,DRG,,,,Inpatient,,,41347.6,10336.9,7570,35145.46,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20292.247,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14194.843,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16054.335,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17599.2269,Other,CMS Methodology,,65.6,,27124.0256,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14194.843,Other,"DRG Weight, with Charge Based Outlier",,70,,28943.32,Percent of Total Billed Charges,,,85,,35145.46,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17074.8934,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28116.368,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14874.8549,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13674.8339,Other,"DRG Weight, with Charge Based Outlier",,65,,26875.94,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15894,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9818.5502,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10700,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10803,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10441,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10544,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10544,Other,CMS Methodology,,,"103% of Medicare, less IME",10648,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10829,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MALIGNANT BREAST DISORDERS WITH MCC,597,DRG,,,,Inpatient,,,41858.3,10464.575,8420,35579.555,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32973.259,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23065.471,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26086.995,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28597.3193,Other,CMS Methodology,,65.6,,27459.0448,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23065.471,Other,"DRG Weight, with Charge Based Outlier",,70,,29300.81,Percent of Total Billed Charges,,,85,,35579.555,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27745.3198,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28463.644,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24170.4353,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22220.4983,Other,"DRG Weight, with Charge Based Outlier",,65,,27207.895,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25827,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15954.3494,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17386,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17554,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16966,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17134,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17134,Other,CMS Methodology,,,"103% of Medicare, less IME",17302,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17596,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
MALIGNANT BREAST DISORDERS WITH CC,598,DRG,,,,Inpatient,,,36332.57,9083.1425,7570,30882.6845,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19911.216,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13928.304,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15752.88,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17268.7632,Other,CMS Methodology,,65.6,,23834.16592,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13928.304,Other,"DRG Weight, with Charge Based Outlier",,70,,25432.799,Percent of Total Billed Charges,,,85,,30882.6845,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16754.2752,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24706.1476,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14595.5472,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13418.0592,Other,"DRG Weight, with Charge Based Outlier",,65,,23616.1705,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15596,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9634.1856,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10499,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10600,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10245,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10346,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10346,Other,CMS Methodology,,,"103% of Medicare, less IME",10448,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10625,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,DRG,,,,Inpatient,,,41091.83,10272.9575,8687.8412,34928.0555,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17955.382,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12560.158,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14205.51,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15572.4914,Other,CMS Methodology,,65.6,,26956.24048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12560.158,Other,"DRG Weight, with Charge Based Outlier",,70,,28764.281,Percent of Total Billed Charges,,,85,,34928.0555,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15108.5404,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27942.4444,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13161.8594,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12100.0334,Other,"DRG Weight, with Charge Based Outlier",,65,,26709.6895,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14064,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8687.8412,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9467,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9559,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9239,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9330,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9330,Other,CMS Methodology,,,"103% of Medicare, less IME",9422,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9582,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CELLULITIS WITH MCC,602,DRG,,,,Inpatient,,,45931.98,11482.995,9270,39042.183,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27576.884,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19290.596,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21817.62,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23917.1068,Other,CMS Methodology,,65.6,,30131.37888,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19290.596,Other,"DRG Weight, with Charge Based Outlier",,70,,32152.386,Percent of Total Billed Charges,,,85,,39042.183,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23204.5448,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31233.7464,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20214.7228,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18583.9108,Other,"DRG Weight, with Charge Based Outlier",,65,,29855.787,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21600,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13343.2744,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14541,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14681,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14189,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14330,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14330,Other,CMS Methodology,,,"103% of Medicare, less IME",14470,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14716,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CELLULITIS WITHOUT MCC,603,DRG,,,,Inpatient,,,29422.02,7355.505,7570,25008.717,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16532.616,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11564.904,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13079.88,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14338.5432,Other,CMS Methodology,,65.6,,19300.84512,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11564.904,Other,"DRG Weight, with Charge Based Outlier",,70,,20595.414,Percent of Total Billed Charges,,,85,,25008.717,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13911.3552,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20006.9736,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12118.9272,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11141.2392,Other,"DRG Weight, with Charge Based Outlier",,65,,19124.313,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12949,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7999.4256,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8717,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8801,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8507,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8591,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8591,Other,CMS Methodology,,,"103% of Medicare, less IME",8675,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8822,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,DRG,,,,Inpatient,,,65898.78,16474.695,9270,56013.963,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27886.589,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19507.241,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22062.645,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24185.7103,Other,CMS Methodology,,65.6,,43229.59968,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19507.241,Other,"DRG Weight, with Charge Based Outlier",,70,,46129.146,Percent of Total Billed Charges,,,85,,56013.963,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23465.1458,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44811.1704,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20441.7463,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18792.6193,Other,"DRG Weight, with Charge Based Outlier",,65,,42834.207,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21843,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13493.1274,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14704,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14846,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14349,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14491,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14491,Other,CMS Methodology,,,"103% of Medicare, less IME",14633,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14881,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,DRG,,,,Inpatient,,,31313.45,7828.3625,7570,26616.4325,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17337.849,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12128.181,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13716.945,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15036.9123,Other,CMS Methodology,,65.6,,20541.6232,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12128.181,Other,"DRG Weight, with Charge Based Outlier",,70,,21919.415,Percent of Total Billed Charges,,,85,,26616.4325,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14588.9178,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21293.146,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12709.1883,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11683.8813,Other,"DRG Weight, with Charge Based Outlier",,65,,20353.7425,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13580,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8389.0434,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9142,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9230,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8921,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9009,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9009,Other,CMS Methodology,,,"103% of Medicare, less IME",9098,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9252,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MINOR SKIN DISORDERS WITH MCC,606,DRG,,,,Inpatient,,,58889.49,14722.3725,10970,50056.0665,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30225.331,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21143.239,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23912.955,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26214.0737,Other,CMS Methodology,,65.6,,38631.50544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21143.239,Other,"DRG Weight, with Charge Based Outlier",,70,,41222.643,Percent of Total Billed Charges,,,85,,50056.0665,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25433.0782,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40044.8532,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22156.1177,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20368.6847,Other,"DRG Weight, with Charge Based Outlier",,65,,38278.1685,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23674,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14624.7446,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15937,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16091,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15552,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15706,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15706,Other,CMS Methodology,,,"103% of Medicare, less IME",15860,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16129,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
MINOR SKIN DISORDERS WITHOUT MCC,607,DRG,,,,Inpatient,,,29236.73,7309.1825,7570,24851.2205,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16221.034,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11346.946,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12833.37,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14068.3118,Other,CMS Methodology,,65.6,,19179.29488,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11346.946,Other,"DRG Weight, with Charge Based Outlier",,70,,20465.711,Percent of Total Billed Charges,,,85,,24851.2205,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13649.1748,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19880.9764,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11890.5278,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10931.2658,Other,"DRG Weight, with Charge Based Outlier",,65,,19003.8745,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12705,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7848.6644,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8553,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8636,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8346,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8429,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8429,Other,CMS Methodology,,,"103% of Medicare, less IME",8512,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8656,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,DRG,,,,Inpatient,,,75120.9,18780.225,7570,63852.765,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42776.83,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29923.27,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33843.15,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,37099.841,Other,CMS Methodology,,65.6,,49279.3104,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29923.27,Other,"DRG Weight, with Charge Based Outlier",,70,,52584.63,Percent of Total Billed Charges,,,85,,63852.765,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35994.526,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,51082.212,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31356.761,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28827.071,Other,"DRG Weight, with Charge Based Outlier",,65,,48828.585,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33506,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20697.878,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22555,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22773,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22010,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22228,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22228,Other,CMS Methodology,,,"103% of Medicare, less IME",22446,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22827,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,DRG,,,,Inpatient,,,44555.53,11138.8825,5870,37872.2005,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26897.41,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18815.29,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21280.05,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23327.807,Other,CMS Methodology,,65.6,,29228.42768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18815.29,Other,"DRG Weight, with Charge Based Outlier",,70,,31188.871,Percent of Total Billed Charges,,,85,,37872.2005,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22632.802,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30297.7604,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19716.647,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18126.017,Other,"DRG Weight, with Charge Based Outlier",,65,,28961.0945,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21068,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13014.506,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14182,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14319,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13840,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13977,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13977,Other,CMS Methodology,,,"103% of Medicare, less IME",14114,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14354,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,DRG,,,,Inpatient,,,122983.01,30745.7525,14370,104535.5585,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,72546.05,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,50747.45,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,57395.25,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,62918.335,Other,CMS Methodology,,65.6,,80676.85456,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,50747.45,Other,"DRG Weight, with Charge Based Outlier",,70,,86088.107,Percent of Total Billed Charges,,,85,,104535.5585,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,61043.81,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,83628.4468,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,53178.535,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",48888.385,Other,"DRG Weight, with Charge Based Outlier",,65,,79938.9565,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",56823,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,35101.93,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",38251,Other,CMS Methodology,,,"104.5% of Medicare, less IME",38621,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",37328,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",37697,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",37697,Other,CMS Methodology,,,"103% of Medicare, less IME",38067,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",38713,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,DRG,,,,Inpatient,,,71150.59,17787.6475,10120,60478.0015,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36256.132,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25361.908,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28684.26,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31444.5164,Other,CMS Methodology,,65.6,,46674.78704,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25361.908,Other,"DRG Weight, with Charge Based Outlier",,70,,49805.413,Percent of Total Billed Charges,,,85,,60478.0015,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30507.6904,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48382.4012,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26576.8844,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24432.8084,Other,"DRG Weight, with Charge Based Outlier",,65,,46247.8835,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28398,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17542.7912,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19117,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19302,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18655,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18840,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18840,Other,CMS Methodology,,,"103% of Medicare, less IME",19024,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19348,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
O.R. PROCEDURES FOR OBESITY WITH MCC,619,DRG,,,,Inpatient,,,175278.44,43819.61,12670,148986.674,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,51176.405,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35798.945,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,40488.525,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,44384.6935,Other,CMS Methodology,,65.6,,114982.6566,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35798.945,Other,"DRG Weight, with Charge Based Outlier",,70,,122694.908,Percent of Total Billed Charges,,,85,,148986.674,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,47365.341,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,119189.3392,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,48505.9135,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",34487.4985,Other,"DRG Weight, with Charge Based Outlier",,65,,113930.986,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",40085,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24762.073,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",26984,Other,CMS Methodology,,,"104.5% of Medicare, less IME",27245,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",26332,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",26593,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",26593,Other,CMS Methodology,,,"103% of Medicare, less IME",26854,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",27310,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
O.R. PROCEDURES FOR OBESITY WITH CC,620,DRG,,,,Inpatient,,,46159.1,11539.775,5870,39235.235,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29975.69,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20968.61,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23715.45,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25997.563,Other,CMS Methodology,,65.6,,30280.3696,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20968.61,Other,"DRG Weight, with Charge Based Outlier",,70,,32311.37,Percent of Total Billed Charges,,,85,,39235.235,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25223.018,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31388.188,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21973.123,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20200.453,Other,"DRG Weight, with Charge Based Outlier",,65,,30003.415,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23479,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14503.954,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15805,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15958,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15424,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15576,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15576,Other,CMS Methodology,,,"103% of Medicare, less IME",15729,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15996,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,DRG,,,,Inpatient,,,43836.1,10959.025,5870,37260.685,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27437.986,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19193.434,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21707.73,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23796.6422,Other,CMS Methodology,,65.6,,28756.4816,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19193.434,Other,"DRG Weight, with Charge Based Outlier",,70,,30685.27,Percent of Total Billed Charges,,,85,,37260.685,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23087.6692,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29808.548,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20112.9062,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18490.3082,Other,"DRG Weight, with Charge Based Outlier",,65,,28493.465,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21491,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13276.0676,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14467,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14607,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14118,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14258,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14258,Other,CMS Methodology,,,"103% of Medicare, less IME",14397,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14642,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,DRG,,,,Inpatient,,,151896.33,37974.0825,18620,129111.8805,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,70237.34,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,49132.46,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,55568.7,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,60916.018,Other,CMS Methodology,,65.6,,99643.99248,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,49132.46,Other,"DRG Weight, with Charge Based Outlier",,70,,106327.431,Percent of Total Billed Charges,,,85,,129111.8805,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,59101.148,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,103289.5044,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,56982.178,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",47332.558,Other,"DRG Weight, with Charge Based Outlier",,65,,98732.6145,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",55015,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,33984.844,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",37034,Other,CMS Methodology,,,"104.5% of Medicare, less IME",37392,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",36140,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",36497,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",36497,Other,CMS Methodology,,,"103% of Medicare, less IME",36855,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",37481,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,18620,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,19300,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,19020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,18620,Other,AR Medicaid Methodology
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,DRG,,,,Inpatient,,,54573.28,13643.32,9270,46387.288,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35903.256,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25115.064,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28405.08,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31138.4712,Other,CMS Methodology,,65.6,,35800.07168,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25115.064,Other,"DRG Weight, with Charge Based Outlier",,70,,38201.296,Percent of Total Billed Charges,,,85,,46387.288,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30210.7632,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37109.8304,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26318.2152,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24195.0072,Other,"DRG Weight, with Charge Based Outlier",,65,,35472.632,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28122,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17372.0496,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18931,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19114,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18474,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18656,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18656,Other,CMS Methodology,,,"103% of Medicare, less IME",18839,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19159,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,DRG,,,,Inpatient,,,100755.56,25188.89,10970,85642.226,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,53815.467,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37645.023,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,42576.435,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,46673.5209,Other,CMS Methodology,,65.6,,66095.64736,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37645.023,Other,"DRG Weight, with Charge Based Outlier",,70,,70528.892,Percent of Total Billed Charges,,,85,,85642.226,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,45282.9774,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,68513.7808,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,39448.4289,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36265.9479,Other,"DRG Weight, with Charge Based Outlier",,65,,65491.114,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",42152,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26039.0022,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28375,Other,CMS Methodology,,,"104.5% of Medicare, less IME",28650,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",27690,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",27964,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",27964,Other,CMS Methodology,,,"103% of Medicare, less IME",28238,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",28718,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,DRG,,,,Inpatient,,,64143.33,16035.8325,7570,54521.8305,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28329.561,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19817.109,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22413.105,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24569.8947,Other,CMS Methodology,,65.6,,42078.02448,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19817.109,Other,"DRG Weight, with Charge Based Outlier",,70,,44900.331,Percent of Total Billed Charges,,,85,,54521.8305,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23837.8842,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,43617.4644,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20766.4587,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19091.1357,Other,"DRG Weight, with Charge Based Outlier",,65,,41693.1645,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22190,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13707.4626,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14937,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15082,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14577,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14721,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14721,Other,CMS Methodology,,,"103% of Medicare, less IME",14865,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15118,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,DRG,,,,Inpatient,,,48863.13,12215.7825,5870,41533.6605,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23779.713,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16634.397,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18813.465,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20623.8651,Other,CMS Methodology,,65.6,,32054.21328,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16634.397,Other,"DRG Weight, with Charge Based Outlier",,70,,34204.191,Percent of Total Billed Charges,,,85,,41533.6605,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20009.4186,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33226.9284,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17431.2771,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16025.0181,Other,"DRG Weight, with Charge Based Outlier",,65,,31761.0345,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18626,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11505.9858,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12538,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12660,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12236,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12357,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12357,Other,CMS Methodology,,,"103% of Medicare, less IME",12478,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12690,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,DRG,,,,Inpatient,,,121406.9,30351.725,14370,103195.865,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,74060.789,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51807.041,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,58593.645,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,64232.0503,Other,CMS Methodology,,65.6,,79642.9264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51807.041,Other,"DRG Weight, with Charge Based Outlier",,70,,84984.83,Percent of Total Billed Charges,,,85,,103195.865,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,62318.3858,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,82556.692,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,54288.8863,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",49909.1593,Other,"DRG Weight, with Charge Based Outlier",,65,,78914.485,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",58009,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,35834.8474,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",39050,Other,CMS Methodology,,,"104.5% of Medicare, less IME",39427,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",38107,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",38484,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",38484,Other,CMS Methodology,,,"103% of Medicare, less IME",38862,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",39522,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,DRG,,,,Inpatient,,,82110.34,20527.585,10120,69793.789,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42215.607,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29530.683,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33399.135,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36613.0989,Other,CMS Methodology,,65.6,,53864.38304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29530.683,Other,"DRG Weight, with Charge Based Outlier",,70,,57477.238,Percent of Total Billed Charges,,,85,,69793.789,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35522.2854,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,55835.0312,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30945.3669,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28448.8659,Other,"DRG Weight, with Charge Based Outlier",,65,,53371.721,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33066,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20426.3262,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22259,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22474,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21721,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21936,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21936,Other,CMS Methodology,,,"103% of Medicare, less IME",22152,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22528,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,DRG,,,,Inpatient,,,66563.05,16640.7625,12726.6066,56578.5925,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26302.401,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18399.069,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20809.305,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22811.7627,Other,CMS Methodology,,65.6,,43665.3608,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18399.069,Other,"DRG Weight, with Charge Based Outlier",,70,,46594.135,Percent of Total Billed Charges,,,85,,56578.5925,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,47950.1322,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45262.874,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,46760.4867,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17725.0437,Other,"DRG Weight, with Charge Based Outlier",,65,,43265.9825,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20602,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12726.6066,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13869,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14003,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13534,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13668,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13668,Other,CMS Methodology,,,"103% of Medicare, less IME",13802,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14036,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
DIABETES WITH MCC,637,DRG,,,,Inpatient,,,53753.25,13438.3125,8420,45690.2625,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27334.751,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19121.219,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21626.055,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23707.1077,Other,CMS Methodology,,65.6,,35262.132,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19121.219,Other,"DRG Weight, with Charge Based Outlier",,70,,37627.275,Percent of Total Billed Charges,,,85,,45690.2625,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23000.8022,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36552.21,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20037.2317,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18420.7387,Other,"DRG Weight, with Charge Based Outlier",,65,,34939.6125,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21410,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13226.1166,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14413,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14552,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14065,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14204,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14204,Other,CMS Methodology,,,"103% of Medicare, less IME",14343,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14587,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
DIABETES WITH CC,638,DRG,,,,Inpatient,,,32651.85,8162.9625,6720,27754.0725,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17215.844,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12042.836,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13620.42,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14931.0988,Other,CMS Methodology,,65.6,,21419.6136,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12042.836,Other,"DRG Weight, with Charge Based Outlier",,70,,22856.295,Percent of Total Billed Charges,,,85,,27754.0725,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14486.2568,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22203.258,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12619.7548,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11601.6628,Other,"DRG Weight, with Charge Based Outlier",,65,,21223.7025,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13485,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8330.0104,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9077,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9165,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8858,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8946,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8946,Other,CMS Methodology,,,"103% of Medicare, less IME",9034,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9187,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
DIABETES WITHOUT CC/MCC,639,DRG,,,,Inpatient,,,27093.7,6773.425,5690.7812,23029.645,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11761.282,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8227.258,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9305.01,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10200.4214,Other,CMS Methodology,,65.6,,17773.4672,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8227.258,Other,"DRG Weight, with Charge Based Outlier",,70,,18965.59,Percent of Total Billed Charges,,,85,,23029.645,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,9896.5204,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18423.716,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8621.3894,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7925.8634,Other,"DRG Weight, with Charge Based Outlier",,65,,17610.905,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9212,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5690.7812,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6201,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6261,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6052,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6112,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6112,Other,CMS Methodology,,,"103% of Medicare, less IME",6171,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6276,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,DRG,,,,Inpatient,,,46559.39,11639.8475,8420,39575.4815,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24926.56,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17436.64,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19720.8,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21618.512,Other,CMS Methodology,,65.6,,30542.95984,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17436.64,Other,"DRG Weight, with Charge Based Outlier",,70,,32591.573,Percent of Total Billed Charges,,,85,,39575.4815,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20974.432,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31660.3852,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18271.952,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16797.872,Other,"DRG Weight, with Charge Based Outlier",,65,,30263.6035,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19524,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12060.896,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13143,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13270,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12826,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12953,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12953,Other,CMS Methodology,,,"103% of Medicare, less IME",13080,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13302,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,DRG,,,,Inpatient,,,32238.11,8059.5275,7096.6748,27402.3935,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14666.878,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10259.782,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11603.79,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12720.4106,Other,CMS Methodology,,65.6,,21148.20016,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10259.782,Other,"DRG Weight, with Charge Based Outlier",,70,,22566.677,Percent of Total Billed Charges,,,85,,27402.3935,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12341.4316,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21921.9148,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10751.2826,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9883.9286,Other,"DRG Weight, with Charge Based Outlier",,65,,20954.7715,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11488,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7096.6748,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7733,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7808,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7547,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7621,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7621,Other,CMS Methodology,,,"103% of Medicare, less IME",7696,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7827,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
INBORN AND OTHER DISORDERS OF METABOLISM,642,DRG,,,,Inpatient,,,59078.11,14769.5275,10970,50216.3935,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23295.447,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16295.643,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18430.335,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20203.8669,Other,CMS Methodology,,65.6,,38755.24016,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16295.643,Other,"DRG Weight, with Charge Based Outlier",,70,,41354.677,Percent of Total Billed Charges,,,85,,50216.3935,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19601.9334,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40173.1148,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17076.2949,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15698.6739,Other,"DRG Weight, with Charge Based Outlier",,65,,38400.7715,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18247,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11271.6702,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12283,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12402,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11986,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12105,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12105,Other,CMS Methodology,,,"103% of Medicare, less IME",12224,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12431,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
ENDOCRINE DISORDERS WITH MCC,643,DRG,,,,Inpatient,,,59524.03,14881.0075,10120,50595.4255,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31107.521,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21760.349,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24610.905,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26979.1867,Other,CMS Methodology,,65.6,,39047.76368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21760.349,Other,"DRG Weight, with Charge Based Outlier",,70,,41666.821,Percent of Total Billed Charges,,,85,,50595.4255,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26175.3962,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40476.3404,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22802.7907,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20963.1877,Other,"DRG Weight, with Charge Based Outlier",,65,,38690.6195,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24365,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15051.5986,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16402,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16561,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16006,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16164,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16164,Other,CMS Methodology,,,"103% of Medicare, less IME",16323,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16600,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
ENDOCRINE DISORDERS WITH CC,644,DRG,,,,Inpatient,,,42654.84,10663.71,8420,36256.614,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19396.918,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13568.542,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15345.99,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16822.7186,Other,CMS Methodology,,65.6,,27981.57504,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13568.542,Other,"DRG Weight, with Charge Based Outlier",,70,,29858.388,Percent of Total Billed Charges,,,85,,36256.614,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16321.5196,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29005.2912,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14218.5506,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13071.4766,Other,"DRG Weight, with Charge Based Outlier",,65,,27725.646,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15193,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9385.3388,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10227,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10326,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9980,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10079,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10079,Other,CMS Methodology,,,"103% of Medicare, less IME",10178,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10351,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,DRG,,,,Inpatient,,,29052.3,7263.075,6720,24694.455,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14616.199,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10224.331,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11563.695,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12676.4573,Other,CMS Methodology,,65.6,,19058.3088,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10224.331,Other,"DRG Weight, with Charge Based Outlier",,70,,20336.61,Percent of Total Billed Charges,,,85,,24694.455,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12298.7878,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19755.564,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10714.1333,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9849.7763,Other,"DRG Weight, with Charge Based Outlier",,65,,18883.995,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11448,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7072.1534,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7707,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7781,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7521,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7595,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7595,Other,CMS Methodology,,,"103% of Medicare, less IME",7669,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7800,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MAJOR BLADDER PROCEDURES WITH MCC,653,DRG,,,,Inpatient,,,180531.29,45132.8225,14370,153451.5965,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,104635.242,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,73194.498,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,82782.81,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,90748.9134,Other,CMS Methodology,,65.6,,118428.5262,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,73194.498,Other,"DRG Weight, with Charge Based Outlier",,70,,126371.903,Percent of Total Billed Charges,,,85,,153451.5965,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,88045.2324,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,122761.2772,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,76700.9214,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",70513.1154,Other,"DRG Weight, with Charge Based Outlier",,65,,117345.3385,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",81957,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,50628.5172,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",55171,Other,CMS Methodology,,,"104.5% of Medicare, less IME",55704,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",53839,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",54372,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",54372,Other,CMS Methodology,,,"103% of Medicare, less IME",54905,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",55838,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
MAJOR BLADDER PROCEDURES WITH CC,654,DRG,,,,Inpatient,,,148936.53,37234.1325,10120,126596.0505,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,52970.817,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37054.173,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,41908.185,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,45940.9659,Other,CMS Methodology,,65.6,,97702.36368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,37054.173,Other,"DRG Weight, with Charge Based Outlier",,70,,104255.571,Percent of Total Billed Charges,,,85,,126596.0505,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,44572.2474,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,101276.8404,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,38829.2739,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",35696.7429,Other,"DRG Weight, with Charge Based Outlier",,65,,96808.7445,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",41490,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,25630.3122,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",27930,Other,CMS Methodology,,,"104.5% of Medicare, less IME",28200,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",27255,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",27525,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",27525,Other,CMS Methodology,,,"103% of Medicare, less IME",27795,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",28267,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,DRG,,,,Inpatient,,,116197.8,29049.45,8420,98768.13,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,38990.921,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27274.949,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,30847.905,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,33816.3667,Other,CMS Methodology,,65.6,,76225.7568,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27274.949,Other,"DRG Weight, with Charge Based Outlier",,70,,81338.46,Percent of Total Billed Charges,,,85,,98768.13,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,32808.8762,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,79014.504,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,28581.5707,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26275.7677,Other,"DRG Weight, with Charge Based Outlier",,65,,75528.57,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",30540,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18866.0386,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20559,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20757,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20062,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20261,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20261,Other,CMS Methodology,,,"103% of Medicare, less IME",20459,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20807,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,DRG,,,,Inpatient,,,135687.67,33921.9175,11820,115334.5195,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,61152.66,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42777.54,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,48381.3,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,53036.982,Other,CMS Methodology,,65.6,,89011.11152,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,42777.54,Other,"DRG Weight, with Charge Based Outlier",,70,,94981.369,Percent of Total Billed Charges,,,85,,115334.5195,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,51456.852,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,92267.6156,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,44826.822,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",41210.442,Other,"DRG Weight, with Charge Based Outlier",,65,,88196.9855,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",47899,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,29589.156,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",32244,Other,CMS Methodology,,,"104.5% of Medicare, less IME",32556,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",31465,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",31777,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",31777,Other,CMS Methodology,,,"103% of Medicare, less IME",32088,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",32633,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,DRG,,,,Inpatient,,,78607.25,19651.8125,7570,66816.1625,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34313.437,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24002.953,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27147.285,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29759.6399,Other,CMS Methodology,,65.6,,51566.356,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24002.953,Other,"DRG Weight, with Charge Based Outlier",,70,,55025.075,Percent of Total Billed Charges,,,85,,66816.1625,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28873.0114,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,53452.93,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25152.8279,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23123.6369,Other,"DRG Weight, with Charge Based Outlier",,65,,51094.7125,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26877,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16602.8042,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18092,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18267,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17655,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17830,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17830,Other,CMS Methodology,,,"103% of Medicare, less IME",18005,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18311,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,DRG,,,,Inpatient,,,71727.91,17931.9775,5870,60968.7235,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28230.08,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19747.52,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22334.4,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24483.616,Other,CMS Methodology,,65.6,,47053.50896,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19747.52,Other,"DRG Weight, with Charge Based Outlier",,70,,50209.537,Percent of Total Billed Charges,,,85,,60968.7235,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23754.176,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48774.9788,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20693.536,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19024.096,Other,"DRG Weight, with Charge Based Outlier",,65,,46623.1415,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22112,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13659.328,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14885,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15029,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14525,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14669,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14669,Other,CMS Methodology,,,"103% of Medicare, less IME",14813,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15065,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,DRG,,,,Inpatient,,,83118.58,20779.645,11820,70650.793,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,48507.311,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33931.859,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,38376.855,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,42069.8197,Other,CMS Methodology,,65.6,,54525.78848,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33931.859,Other,"DRG Weight, with Charge Based Outlier",,70,,58183.006,Percent of Total Billed Charges,,,85,,70650.793,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,40816.4342,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,56520.6344,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,35557.3837,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",32688.8107,Other,"DRG Weight, with Charge Based Outlier",,65,,54027.077,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",37994,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,23470.6126,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",25577,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25824,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",24959,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",25206,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",25206,Other,CMS Methodology,,,"103% of Medicare, less IME",25453,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25885,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,DRG,,,,Inpatient,,,44275.14,11068.785,7570,37633.869,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25151.8,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17594.2,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19899,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,21813.86,Other,CMS Methodology,,65.6,,29044.49184,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17594.2,Other,"DRG Weight, with Charge Based Outlier",,70,,30992.598,Percent of Total Billed Charges,,,85,,37633.869,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21163.96,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30107.0952,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18437.06,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16949.66,Other,"DRG Weight, with Charge Based Outlier",,65,,28778.841,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",19701,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12169.88,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13262,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13390,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12941,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13070,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13070,Other,CMS Methodology,,,"103% of Medicare, less IME",13198,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13422,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,DRG,,,,Inpatient,,,35040.83,8760.2075,5870,29784.7055,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19269.282,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13479.258,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15245.01,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16712.0214,Other,CMS Methodology,,65.6,,22986.78448,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13479.258,Other,"DRG Weight, with Charge Based Outlier",,70,,24528.581,Percent of Total Billed Charges,,,85,,29784.7055,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16214.1204,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23827.7644,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14124.9894,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12985.4634,Other,"DRG Weight, with Charge Based Outlier",,65,,22776.5395,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15093,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9323.5812,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10160,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10258,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9915,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10013,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10013,Other,CMS Methodology,,,"103% of Medicare, less IME",10111,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10283,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
MINOR BLADDER PROCEDURES WITH MCC,662,DRG,,,,Inpatient,,,167575.2,41893.8,19470,142438.92,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,58554.892,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40960.348,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,46326.06,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,50783.9684,Other,CMS Methodology,,65.6,,109929.3312,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40960.348,Other,"DRG Weight, with Charge Based Outlier",,70,,117302.64,Percent of Total Billed Charges,,,85,,142438.92,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,49270.9624,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,113951.136,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,64906.5764,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",39459.8204,Other,"DRG Weight, with Charge Based Outlier",,65,,108923.88,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",45864,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,28332.2072,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",30874,Other,CMS Methodology,,,"104.5% of Medicare, less IME",31173,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",30129,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",30427,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",30427,Other,CMS Methodology,,,"103% of Medicare, less IME",30725,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",31247,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,19470,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,20192.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,19895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,19470,Other,AR Medicaid Methodology
MINOR BLADDER PROCEDURES WITH CC,663,DRG,,,,Inpatient,,,49731.83,12432.9575,7570,42272.0555,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28669.298,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20054.762,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22681.89,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24864.5446,Other,CMS Methodology,,65.6,,32624.08048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20054.762,Other,"DRG Weight, with Charge Based Outlier",,70,,34812.281,Percent of Total Billed Charges,,,85,,42272.0555,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24123.7556,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33817.6444,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21015.4966,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19320.0826,Other,"DRG Weight, with Charge Based Outlier",,65,,32325.6895,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22456,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13871.8468,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15117,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15263,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14751,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14897,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14897,Other,CMS Methodology,,,"103% of Medicare, less IME",15043,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15299,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,DRG,,,,Inpatient,,,42270.96,10567.74,5020,35930.316,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20267.846,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14177.774,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16035.03,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17578.0642,Other,CMS Methodology,,65.6,,27729.74976,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14177.774,Other,"DRG Weight, with Charge Based Outlier",,70,,29589.672,Percent of Total Billed Charges,,,85,,35930.316,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17054.3612,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28744.2528,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14856.9682,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13658.3902,Other,"DRG Weight, with Charge Based Outlier",,65,,27476.124,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15875,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9806.7436,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10687,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10790,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10429,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10532,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10532,Other,CMS Methodology,,,"103% of Medicare, less IME",10635,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10816,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
PROSTATECTOMY WITH MCC,665,DRG,,,,Inpatient,,,95828.1,23957.025,12670,81453.885,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,64448.672,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45083.168,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,50988.96,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,55895.5744,Other,CMS Methodology,,65.6,,62863.2336,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45083.168,Other,"DRG Weight, with Charge Based Outlier",,70,,67079.67,Percent of Total Billed Charges,,,85,,81453.885,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,54230.2784,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,65163.108,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,47242.9024,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",43431.6064,Other,"DRG Weight, with Charge Based Outlier",,65,,62288.265,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",50480,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31183.9552,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",33982,Other,CMS Methodology,,,"104.5% of Medicare, less IME",34310,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33161,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",33489,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",33489,Other,CMS Methodology,,,"103% of Medicare, less IME",33818,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",34392,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
PROSTATECTOMY WITH CC,666,DRG,,,,Inpatient,,,59740.53,14935.1325,9270,50779.4505,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30919.821,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21629.049,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24462.405,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26816.3967,Other,CMS Methodology,,65.6,,39189.78768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21629.049,Other,"DRG Weight, with Charge Based Outlier",,70,,41818.371,Percent of Total Billed Charges,,,85,,50779.4505,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26017.4562,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40623.5604,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22665.2007,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20836.6977,Other,"DRG Weight, with Charge Based Outlier",,65,,38831.3445,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24218,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14960.7786,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16303,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16461,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15909,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16067,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16067,Other,CMS Methodology,,,"103% of Medicare, less IME",16224,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16500,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
TRANSURETHRAL PROCEDURES WITH MCC,668,DRG,,,,Inpatient,,,120344.18,30086.045,16070,102292.553,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,54738.951,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38291.019,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,43307.055,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,47474.4477,Other,CMS Methodology,,65.6,,78945.78208,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38291.019,Other,"DRG Weight, with Charge Based Outlier",,70,,84240.926,Percent of Total Billed Charges,,,85,,102292.553,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,46060.0422,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,81834.0424,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,40125.3717,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36888.2787,Other,"DRG Weight, with Charge Based Outlier",,65,,78223.717,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",42875,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26485.8366,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28862,Other,CMS Methodology,,,"104.5% of Medicare, less IME",29141,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",28165,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",28444,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",28444,Other,CMS Methodology,,,"103% of Medicare, less IME",28723,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",29211,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,16622.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,16395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology
TRANSURETHRAL PROCEDURES WITH CC,669,DRG,,,,Inpatient,,,62206.23,15551.5575,9270,52875.2955,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29046.575,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20318.675,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22980.375,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25191.7525,Other,CMS Methodology,,65.6,,40807.28688,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20318.675,Other,"DRG Weight, with Charge Based Outlier",,70,,43544.361,Percent of Total Billed Charges,,,85,,52875.2955,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24441.215,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42300.2364,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21292.0525,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19574.3275,Other,"DRG Weight, with Charge Based Outlier",,65,,40434.0495,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22751,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14054.395,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15315,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15463,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14945,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15093,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15093,Other,CMS Methodology,,,"103% of Medicare, less IME",15241,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15500,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,DRG,,,,Inpatient,,,28137.01,7034.2525,6720,23916.4585,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17938.489,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12548.341,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14192.145,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15557.8403,Other,CMS Methodology,,65.6,,18457.87856,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12548.341,Other,"DRG Weight, with Charge Based Outlier",,70,,19695.907,Percent of Total Billed Charges,,,85,,23916.4585,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15094.3258,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19133.1668,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13149.4763,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12088.6493,Other,"DRG Weight, with Charge Based Outlier",,65,,18289.0565,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14051,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8679.6674,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9458,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9550,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9230,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9321,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9321,Other,CMS Methodology,,,"103% of Medicare, less IME",9413,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9573,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
URETHRAL PROCEDURES WITH CC/MCC,671,DRG,,,,Inpatient,,,44693.65,11173.4125,6720,37989.6025,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32353.849,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22632.181,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25596.945,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28060.1123,Other,CMS Methodology,,65.6,,29319.0344,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22632.181,Other,"DRG Weight, with Charge Based Outlier",,70,,31285.555,Percent of Total Billed Charges,,,85,,37989.6025,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27224.1178,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30391.682,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23716.3883,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21803.0813,Other,"DRG Weight, with Charge Based Outlier",,65,,29050.8725,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25342,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15654.6434,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17059,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17224,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16647,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16812,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16812,Other,CMS Methodology,,,"103% of Medicare, less IME",16977,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17265,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,DRG,,,,Inpatient,,,116256.07,29064.0175,13520,98817.6595,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,78638.792,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,55009.448,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,62215.56,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,68202.4984,Other,CMS Methodology,,65.6,,76263.98192,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,55009.448,Other,"DRG Weight, with Charge Based Outlier",,70,,81379.249,Percent of Total Billed Charges,,,85,,98817.6595,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,66170.5424,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,79054.1276,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,57644.7064,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",52994.2504,Other,"DRG Weight, with Charge Based Outlier",,65,,75566.4455,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",61595,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,38049.9472,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",41464,Other,CMS Methodology,,,"104.5% of Medicare, less IME",41865,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",40462,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",40863,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",40863,Other,CMS Methodology,,,"103% of Medicare, less IME",41264,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",41965,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,DRG,,,,Inpatient,,,67577.04,16894.26,10970,57440.484,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,43328.668,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30309.292,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,34279.74,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,37578.4436,Other,CMS Methodology,,65.6,,44330.53824,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30309.292,Other,"DRG Weight, with Charge Based Outlier",,70,,47303.928,Percent of Total Billed Charges,,,85,,57440.484,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,36458.8696,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45952.3872,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31761.2756,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",29198.9516,Other,"DRG Weight, with Charge Based Outlier",,65,,43925.076,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33938,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20964.8888,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22846,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23067,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22294,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22515,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22515,Other,CMS Methodology,,,"103% of Medicare, less IME",22736,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",23122,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,DRG,,,,Inpatient,,,56517.77,14129.4425,7570,48040.1045,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29380.681,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20552.389,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23244.705,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25481.5187,Other,CMS Methodology,,65.6,,37075.65712,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20552.389,Other,"DRG Weight, with Charge Based Outlier",,70,,39562.439,Percent of Total Billed Charges,,,85,,48040.1045,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24722.3482,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38432.0836,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21536.9627,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19799.4797,Other,"DRG Weight, with Charge Based Outlier",,65,,36736.5505,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23013,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14216.0546,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15492,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15641,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15117,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15267,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15267,Other,CMS Methodology,,,"103% of Medicare, less IME",15417,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15679,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
RENAL FAILURE WITH MCC,682,DRG,,,,Inpatient,,,52707.8,13176.95,9270,44801.63,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28190.663,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19719.947,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22303.215,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24449.4301,Other,CMS Methodology,,65.6,,34576.3168,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19719.947,Other,"DRG Weight, with Charge Based Outlier",,70,,36895.46,Percent of Total Billed Charges,,,85,,44801.63,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23721.0086,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35841.304,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20664.6421,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18997.5331,Other,"DRG Weight, with Charge Based Outlier",,65,,34260.07,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22081,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13640.2558,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14864,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15008,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14505,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14649,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14649,Other,CMS Methodology,,,"103% of Medicare, less IME",14792,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15044,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
RENAL FAILURE WITH CC,683,DRG,,,,Inpatient,,,34375.83,8593.9575,7570,29219.4555,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16684.653,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11671.257,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13200.165,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14470.4031,Other,CMS Methodology,,65.6,,22550.54448,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11671.257,Other,"DRG Weight, with Charge Based Outlier",,70,,24063.081,Percent of Total Billed Charges,,,85,,29219.4555,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14039.2866,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23375.5644,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12230.3751,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11243.6961,Other,"DRG Weight, with Charge Based Outlier",,65,,22344.2895,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13069,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8072.9898,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8797,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8882,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8585,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8670,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8670,Other,CMS Methodology,,,"103% of Medicare, less IME",8755,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8904,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
RENAL FAILURE WITHOUT CC/MCC,684,DRG,,,,Inpatient,,,25486.07,6371.5175,5516.4068,21663.1595,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11400.898,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7975.162,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9019.89,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,9887.8646,Other,CMS Methodology,,65.6,,16718.86192,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7975.162,Other,"DRG Weight, with Charge Based Outlier",,70,,17840.249,Percent of Total Billed Charges,,,85,,21663.1595,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,9593.2756,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,17330.5276,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8357.2166,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7683.0026,Other,"DRG Weight, with Charge Based Outlier",,65,,16565.9455,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",8930,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5516.4068,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6011,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6069,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5866,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5924,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5924,Other,CMS Methodology,,,"103% of Medicare, less IME",5982,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6084,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,DRG,,,,Inpatient,,,72960.67,18240.1675,9270,62016.5695,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35394.589,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24759.241,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28002.645,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30697.3103,Other,CMS Methodology,,65.6,,47862.19952,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24759.241,Other,"DRG Weight, with Charge Based Outlier",,70,,51072.469,Percent of Total Billed Charges,,,85,,62016.5695,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29782.7458,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,49613.2556,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25945.3463,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23852.2193,Other,"DRG Weight, with Charge Based Outlier",,65,,47424.4355,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27723,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17125.9274,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18663,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18843,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18212,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18392,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18392,Other,CMS Methodology,,,"103% of Medicare, less IME",18572,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18888,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,DRG,,,,Inpatient,,,34174.44,8543.61,7570,29048.274,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19759.179,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13821.951,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15632.595,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17136.9033,Other,CMS Methodology,,65.6,,22418.43264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13821.951,Other,"DRG Weight, with Charge Based Outlier",,70,,23922.108,Percent of Total Billed Charges,,,85,,29048.274,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16626.3438,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23238.6192,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14484.0993,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13315.6023,Other,"DRG Weight, with Charge Based Outlier",,65,,22213.386,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15477,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9560.6214,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10418,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10519,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10167,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10267,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10267,Other,CMS Methodology,,,"103% of Medicare, less IME",10368,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10544,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,DRG,,,,Inpatient,,,80413.58,20103.395,5020,68351.543,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13593.234,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9508.746,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10754.37,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11789.2518,Other,CMS Methodology,,65.6,,52751.30848,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9508.746,Other,"DRG Weight, with Charge Based Outlier",,70,,56289.506,Percent of Total Billed Charges,,,85,,68351.543,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11438.0148,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,54681.2344,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9964.2678,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9160.4058,Other,"DRG Weight, with Charge Based Outlier",,65,,52268.827,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10647,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6577.1844,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7167,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7237,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6994,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7063,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7063,Other,CMS Methodology,,,"103% of Medicare, less IME",7133,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7254,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,DRG,,,,Inpatient,,,42234.09,10558.5225,8420,35898.9765,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21966.531,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15366.039,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17378.955,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19051.3137,Other,CMS Methodology,,65.6,,27705.56304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15366.039,Other,"DRG Weight, with Charge Based Outlier",,70,,29563.863,Percent of Total Billed Charges,,,85,,35898.9765,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18483.7182,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28719.1812,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16102.1577,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14803.1247,Other,"DRG Weight, with Charge Based Outlier",,65,,27452.1585,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17206,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10628.6646,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11582,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11694,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11303,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11414,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11414,Other,CMS Methodology,,,"103% of Medicare, less IME",11526,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11722,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,DRG,,,,Inpatient,,,28470.03,7117.5075,6720,24199.5255,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15064.802,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10538.138,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11918.61,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13065.5254,Other,CMS Methodology,,65.6,,18676.33968,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10538.138,Other,"DRG Weight, with Charge Based Outlier",,70,,19929.021,Percent of Total Billed Charges,,,85,,24199.5255,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12676.2644,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19359.6204,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11042.9734,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10152.0874,Other,"DRG Weight, with Charge Based Outlier",,65,,18505.5195,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11800,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7289.2132,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7943,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8020,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7751,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7828,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7828,Other,CMS Methodology,,,"103% of Medicare, less IME",7905,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8039,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
URINARY STONES WITH MCC,693,DRG,,,,Inpatient,,,65344.5,16336.125,9270,55542.825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27599.408,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19306.352,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21835.44,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23936.6416,Other,CMS Methodology,,65.6,,42865.992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19306.352,Other,"DRG Weight, with Charge Based Outlier",,70,,45741.15,Percent of Total Billed Charges,,,85,,55542.825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23223.4976,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44434.26,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20231.2336,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18599.0896,Other,"DRG Weight, with Charge Based Outlier",,65,,42473.925,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21618,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13354.1728,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14552,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14693,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14201,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14341,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14341,Other,CMS Methodology,,,"103% of Medicare, less IME",14482,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14728,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
URINARY STONES WITHOUT MCC,694,DRG,,,,Inpatient,,,26284.77,6571.1925,5870,22342.0545,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14666.878,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10259.782,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11603.79,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12720.4106,Other,CMS Methodology,,65.6,,17242.80912,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10259.782,Other,"DRG Weight, with Charge Based Outlier",,70,,18399.339,Percent of Total Billed Charges,,,85,,22342.0545,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12341.4316,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,17873.6436,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10751.2826,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9883.9286,Other,"DRG Weight, with Charge Based Outlier",,65,,17085.1005,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11488,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7096.6748,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7733,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7808,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7547,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7621,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7621,Other,CMS Methodology,,,"103% of Medicare, less IME",7696,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7827,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,DRG,,,,Inpatient,,,22439.21,5609.8025,7570,21168.806,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21168.806,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14808.014,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16747.83,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18359.4562,Other,CMS Methodology,,65.6,,14720.12176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14808.014,Other,"DRG Weight, with Charge Based Outlier",,70,,15707.447,Percent of Total Billed Charges,,,85,,19073.3285,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17812.4732,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,15258.6628,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15517.4002,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14265.5422,Other,"DRG Weight, with Charge Based Outlier",,65,,14585.4865,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16581,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10242.6796,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11162,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11270,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10892,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11000,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11000,Other,CMS Methodology,,,"103% of Medicare, less IME",11108,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11297,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,DRG,,,,Inpatient,,,26656.24,6664.06,6282.9276,22657.804,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12985.086,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9083.334,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10273.23,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11261.8122,Other,CMS Methodology,,65.6,,17486.49344,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9083.334,Other,"DRG Weight, with Charge Based Outlier",,70,,18659.368,Percent of Total Billed Charges,,,85,,22657.804,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10926.2892,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18126.2432,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9518.4762,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8750.5782,Other,"DRG Weight, with Charge Based Outlier",,65,,17326.556,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10171,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6282.9276,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6847,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6913,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6681,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6747,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6747,Other,CMS Methodology,,,"103% of Medicare, less IME",6814,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6929,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,DRG,,,,Inpatient,,,57003.97,14250.9925,9270,48453.3745,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31550.493,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22070.217,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24961.365,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27363.3711,Other,CMS Methodology,,65.6,,37394.60432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22070.217,Other,"DRG Weight, with Charge Based Outlier",,70,,39902.779,Percent of Total Billed Charges,,,85,,48453.3745,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26548.1346,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38762.6996,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23127.5031,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21261.7041,Other,"DRG Weight, with Charge Based Outlier",,65,,37052.5805,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24712,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15265.9338,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16636,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16796,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16234,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16395,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16395,Other,CMS Methodology,,,"103% of Medicare, less IME",16555,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16837,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,DRG,,,,Inpatient,,,35526.62,8881.655,7570,30197.627,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19143.523,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13391.287,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15145.515,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16602.9521,Other,CMS Methodology,,65.6,,23305.46272,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13391.287,Other,"DRG Weight, with Charge Based Outlier",,70,,24868.634,Percent of Total Billed Charges,,,85,,30197.627,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16108.3006,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24158.1016,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14032.8041,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12900.7151,Other,"DRG Weight, with Charge Based Outlier",,65,,23092.303,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14994,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9262.7318,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10094,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10191,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9850,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9948,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9948,Other,CMS Methodology,,,"103% of Medicare, less IME",10045,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10216,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,DRG,,,,Inpatient,,,18851.71,4712.9275,5870,16023.9535,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13030.134,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9114.846,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10308.87,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11300.8818,Other,CMS Methodology,,65.6,,12366.72176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9114.846,Other,"DRG Weight, with Charge Based Outlier",,70,,13196.197,Percent of Total Billed Charges,,,85,,16023.9535,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10964.1948,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,12819.1628,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9551.4978,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8780.9358,Other,"DRG Weight, with Charge Based Outlier",,65,,12253.6115,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10206,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6304.7244,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6870,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6937,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6704,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6771,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6771,Other,CMS Methodology,,,"103% of Medicare, less IME",6837,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6953,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,DRG,,,,Inpatient,,,96093.07,24023.2675,9270,81679.1095,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36425.062,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25480.078,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28817.91,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31591.0274,Other,CMS Methodology,,65.6,,63037.05392,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25480.078,Other,"DRG Weight, with Charge Based Outlier",,70,,67265.149,Percent of Total Billed Charges,,,85,,81679.1095,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30649.8364,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,65343.2876,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26700.7154,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24546.6494,Other,"DRG Weight, with Charge Based Outlier",,65,,62460.4955,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28531,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17624.5292,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19206,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19391,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18742,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18928,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18928,Other,CMS Methodology,,,"103% of Medicare, less IME",19113,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19438,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,DRG,,,,Inpatient,,,76983.38,19245.845,5870,65435.873,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27826.525,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19465.225,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22015.125,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24133.6175,Other,CMS Methodology,,65.6,,50501.09728,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19465.225,Other,"DRG Weight, with Charge Based Outlier",,70,,53888.366,Percent of Total Billed Charges,,,85,,65435.873,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23414.605,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52348.6984,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20397.7175,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18752.1425,Other,"DRG Weight, with Charge Based Outlier",,65,,50039.197,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21796,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13464.065,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14672,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14814,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14318,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14459,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14459,Other,CMS Methodology,,,"103% of Medicare, less IME",14601,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14849,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
PENIS PROCEDURES WITH CC/MCC,709,DRG,,,,Inpatient,,,82816.1,20704.025,8420,70393.685,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42178.067,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29504.423,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33369.435,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36580.5409,Other,CMS Methodology,,65.6,,54327.3616,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29504.423,Other,"DRG Weight, with Charge Based Outlier",,70,,57971.27,Percent of Total Billed Charges,,,85,,70393.685,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35490.6974,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,56314.948,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30917.8489,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28423.5679,Other,"DRG Weight, with Charge Based Outlier",,65,,53830.465,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33037,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20408.1622,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22239,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22454,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21702,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21917,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21917,Other,CMS Methodology,,,"103% of Medicare, less IME",22132,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22508,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
PENIS PROCEDURES WITHOUT CC/MCC,710,DRG,,,,Inpatient,,,25017.29,6254.3225,5020,28181.278,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28181.278,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19713.382,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22295.79,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24441.2906,Other,CMS Methodology,,65.6,,16411.34224,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19713.382,Other,"DRG Weight, with Charge Based Outlier",,70,,17512.103,Percent of Total Billed Charges,,,85,,21264.6965,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23713.1116,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,17011.7572,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20657.7626,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18991.2086,Other,"DRG Weight, with Charge Based Outlier",,65,,16261.2385,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22073,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13635.7148,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14859,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15003,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14500,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14644,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14644,Other,CMS Methodology,,,"103% of Medicare, less IME",14787,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15039,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
TESTES PROCEDURES WITH CC/MCC,711,DRG,,,,Inpatient,,,64917.64,16229.41,9270,55179.994,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35805.652,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25046.788,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28327.86,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31053.8204,Other,CMS Methodology,,65.6,,42585.97184,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25046.788,Other,"DRG Weight, with Charge Based Outlier",,70,,45442.348,Percent of Total Billed Charges,,,85,,55179.994,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30128.6344,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44143.9952,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26246.6684,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24129.2324,Other,"DRG Weight, with Charge Based Outlier",,65,,42196.466,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28045,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17324.8232,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18879,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19062,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18423,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18606,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18606,Other,CMS Methodology,,,"103% of Medicare, less IME",18788,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19107,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
TESTES PROCEDURES WITHOUT CC/MCC,712,DRG,,,,Inpatient,,,49209.28,12302.32,7570,41827.888,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16632.097,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11634.493,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13158.585,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14424.8219,Other,CMS Methodology,,65.6,,32281.28768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11634.493,Other,"DRG Weight, with Charge Based Outlier",,70,,34446.496,Percent of Total Billed Charges,,,85,,41827.888,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13995.0634,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33462.3104,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12191.8499,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11208.2789,Other,"DRG Weight, with Charge Based Outlier",,65,,31986.032,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13027,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8047.5602,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8770,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8854,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8558,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8643,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8643,Other,CMS Methodology,,,"103% of Medicare, less IME",8727,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8876,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,DRG,,,,Inpatient,,,45912.74,11478.185,7570,39025.829,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27141.42,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18985.98,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21473.1,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23539.434,Other,CMS Methodology,,65.6,,30118.75744,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18985.98,Other,"DRG Weight, with Charge Based Outlier",,70,,32138.918,Percent of Total Billed Charges,,,85,,39025.829,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22838.124,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31220.6632,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19895.514,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18290.454,Other,"DRG Weight, with Charge Based Outlier",,65,,29843.281,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21259,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13132.572,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14311,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14449,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13965,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14103,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14103,Other,CMS Methodology,,,"103% of Medicare, less IME",14242,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14484,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,DRG,,,,Inpatient,,,26771.25,6692.8125,5870,22755.5625,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17638.169,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12338.261,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13954.545,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15297.3763,Other,CMS Methodology,,65.6,,17561.94,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12338.261,Other,"DRG Weight, with Charge Based Outlier",,70,,18739.875,Percent of Total Billed Charges,,,85,,22755.5625,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14841.6218,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18204.45,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12929.3323,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11886.2653,Other,"DRG Weight, with Charge Based Outlier",,65,,17401.3125,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13815,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8534.3554,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9300,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9390,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9075,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9165,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9165,Other,CMS Methodology,,,"103% of Medicare, less IME",9255,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9412,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,DRG,,,,Inpatient,,,118372.99,29593.2475,15220,100617.0415,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42388.291,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29651.479,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33535.755,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36762.8657,Other,CMS Methodology,,65.6,,77652.68144,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29651.479,Other,"DRG Weight, with Charge Based Outlier",,70,,82861.093,Percent of Total Billed Charges,,,85,,100617.0415,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35667.5902,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,80493.6332,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,36567.9497,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28565.2367,Other,"DRG Weight, with Charge Based Outlier",,65,,76942.4435,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33201,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20509.8806,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22350,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22566,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21810,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22026,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22026,Other,CMS Methodology,,,"103% of Medicare, less IME",22242,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22620,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,DRG,,,,Inpatient,,,71836.69,17959.1725,7570,61061.1865,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26640.261,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18635.409,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21076.605,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23104.7847,Other,CMS Methodology,,65.6,,47124.86864,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18635.409,Other,"DRG Weight, with Charge Based Outlier",,70,,50285.683,Percent of Total Billed Charges,,,85,,61061.1865,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22416.4242,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48848.9492,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19528.1487,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17952.7257,Other,"DRG Weight, with Charge Based Outlier",,65,,46693.8485,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20866,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12890.0826,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14047,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14182,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13707,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13843,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13843,Other,CMS Methodology,,,"103% of Medicare, less IME",13979,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14216,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,DRG,,,,Inpatient,,,60720.92,15180.23,9270,51612.782,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34827.735,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24362.715,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27554.175,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30205.6845,Other,CMS Methodology,,65.6,,39832.92352,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24362.715,Other,"DRG Weight, with Charge Based Outlier",,70,,42504.644,Percent of Total Billed Charges,,,85,,51612.782,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29305.767,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,41290.2256,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25529.8245,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23470.2195,Other,"DRG Weight, with Charge Based Outlier",,65,,39468.598,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27279,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16851.651,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18364,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18541,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17920,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18098,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18098,Other,CMS Methodology,,,"103% of Medicare, less IME",18275,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18585,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,DRG,,,,Inpatient,,,34119.26,8529.815,5870,29001.371,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23122.763,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16174.847,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18293.715,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20054.1001,Other,CMS Methodology,,65.6,,22382.23456,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16174.847,Other,"DRG Weight, with Charge Based Outlier",,70,,23883.482,Percent of Total Billed Charges,,,85,,29001.371,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19456.6286,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23201.0968,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16949.7121,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15582.3031,Other,"DRG Weight, with Charge Based Outlier",,65,,22177.519,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18111,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11188.1158,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12192,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12310,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11897,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12015,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12015,Other,CMS Methodology,,,"103% of Medicare, less IME",12133,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12339,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,DRG,,,,Inpatient,,,32895.18,8223.795,7570,32451.453,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32451.453,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22700.457,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25674.165,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28144.7631,Other,CMS Methodology,,65.6,,21579.23808,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22700.457,Other,"DRG Weight, with Charge Based Outlier",,70,,23026.626,Percent of Total Billed Charges,,,85,,27960.903,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27306.2466,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22368.7224,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23787.9351,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21868.8561,Other,"DRG Weight, with Charge Based Outlier",,65,,21381.867,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25418,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15701.8698,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17111,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17276,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16697,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16863,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16863,Other,CMS Methodology,,,"103% of Medicare, less IME",17028,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17317,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,DRG,,,,Inpatient,,,32847.16,8211.79,9270,27920.086,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21076.833,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14743.677,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16675.065,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18279.6891,Other,CMS Methodology,,65.6,,21547.73696,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14743.677,Other,"DRG Weight, with Charge Based Outlier",,70,,22993.012,Percent of Total Billed Charges,,,85,,27920.086,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17735.0826,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22336.0688,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15449.9811,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14203.5621,Other,"DRG Weight, with Charge Based Outlier",,65,,21350.654,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16509,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10198.1778,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11113,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11221,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10845,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10952,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10952,Other,CMS Methodology,,,"103% of Medicare, less IME",11060,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11247,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,DRG,,,,Inpatient,,,23282.9,5820.725,6720,23699.002,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23699.002,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16577.938,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18749.61,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20553.8654,Other,CMS Methodology,,65.6,,15273.5824,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16577.938,Other,"DRG Weight, with Charge Based Outlier",,70,,16298.03,Percent of Total Billed Charges,,,85,,19790.465,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19941.5044,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,15832.372,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17372.1134,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15970.6274,Other,"DRG Weight, with Charge Based Outlier",,65,,15133.885,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18563,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11466.9332,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12496,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12617,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12194,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12315,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12315,Other,CMS Methodology,,,"103% of Medicare, less IME",12435,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12647,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,DRG,,,,Inpatient,,,25589.83,6397.4575,5870,21751.3555,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13972.388,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9773.972,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11054.34,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12118.0876,Other,CMS Methodology,,65.6,,16786.92848,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9773.972,Other,"DRG Weight, with Charge Based Outlier",,70,,17912.881,Percent of Total Billed Charges,,,85,,21751.3555,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11757.0536,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,17401.0844,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10242.1996,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9415.9156,Other,"DRG Weight, with Charge Based Outlier",,65,,16633.3895,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10944,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6760.6408,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7367,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7438,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7189,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7260,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7260,Other,CMS Methodology,,,"103% of Medicare, less IME",7332,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7456,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,DRG,,,,Inpatient,,,56402.66,14100.665,10120,47942.261,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27580.638,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19293.222,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21820.59,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23920.3626,Other,CMS Methodology,,65.6,,37000.14496,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19293.222,Other,"DRG Weight, with Charge Based Outlier",,70,,39481.862,Percent of Total Billed Charges,,,85,,47942.261,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23207.7036,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38353.8088,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20217.4746,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18586.4406,Other,"DRG Weight, with Charge Based Outlier",,65,,36661.729,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21603,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13345.0908,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14542,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14683,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14191,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14332,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14332,Other,CMS Methodology,,,"103% of Medicare, less IME",14472,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14718,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,DRG,,,,Inpatient,,,28858.93,7214.7325,7420.9022,24530.0905,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15336.967,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10728.523,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12133.935,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13301.5709,Other,CMS Methodology,,65.6,,18931.45808,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10728.523,Other,"DRG Weight, with Charge Based Outlier",,70,,20201.251,Percent of Total Billed Charges,,,85,,24530.0905,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12905.2774,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19624.0724,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11242.4789,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10335.4979,Other,"DRG Weight, with Charge Based Outlier",,65,,18758.3045,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12013,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7420.9022,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8087,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8165,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7891,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7970,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7970,Other,CMS Methodology,,,"103% of Medicare, less IME",8048,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8184,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,DRG,,,,Inpatient,,,27325.1,6831.275,5511.8658,23226.335,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11391.513,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7968.597,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9012.465,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,9879.7251,Other,CMS Methodology,,65.6,,17925.2656,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7968.597,Other,"DRG Weight, with Charge Based Outlier",,70,,19127.57,Percent of Total Billed Charges,,,85,,23226.335,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,9585.3786,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18581.068,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8350.3371,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7676.6781,Other,"DRG Weight, with Charge Based Outlier",,65,,17761.315,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",8923,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5511.8658,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6006,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6064,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5861,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5919,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5919,Other,CMS Methodology,,,"103% of Medicare, less IME",5977,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6079,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,DRG,,,,Inpatient,,,151142.45,37785.6125,15220,128471.0825,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39469.556,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27609.764,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31226.58,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34231.4812,Other,CMS Methodology,,65.6,,99149.4472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27609.764,Other,"DRG Weight, with Charge Based Outlier",,70,,105799.715,Percent of Total Billed Charges,,,85,,128471.0825,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,46120.6232,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,102776.866,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,56412.4252,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26598.3172,Other,"DRG Weight, with Charge Based Outlier",,65,,98242.5925,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",30915,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19097.6296,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20811,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21012,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20308,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20510,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20510,Other,CMS Methodology,,,"103% of Medicare, less IME",20711,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21063,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,DRG,,,,Inpatient,,,112191.41,28047.8525,13520,95362.6985,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,73908.752,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51700.688,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,58473.36,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,64100.1904,Other,CMS Methodology,,65.6,,73597.56496,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51700.688,Other,"DRG Weight, with Charge Based Outlier",,70,,78533.987,Percent of Total Billed Charges,,,85,,95362.6985,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,62190.4544,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,76290.1588,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,54177.4384,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",49806.7024,Other,"DRG Weight, with Charge Based Outlier",,65,,72924.4165,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",57890,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,35761.2832,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",38970,Other,CMS Methodology,,,"104.5% of Medicare, less IME",39347,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",38029,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",38405,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",38405,Other,CMS Methodology,,,"103% of Medicare, less IME",38782,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",39441,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,DRG,,,,Inpatient,,,71334.7,17833.675,8420,60634.495,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37509.968,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26238.992,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29676.24,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32531.9536,Other,CMS Methodology,,65.6,,46795.5632,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26238.992,Other,"DRG Weight, with Charge Based Outlier",,70,,49934.29,Percent of Total Billed Charges,,,85,,60634.495,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31562.7296,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48507.596,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27495.9856,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25277.7616,Other,"DRG Weight, with Charge Based Outlier",,65,,46367.555,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29380,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18149.4688,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19778,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19969,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19300,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19491,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19491,Other,CMS Methodology,,,"103% of Medicare, less IME",19682,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20017,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,DRG,,,,Inpatient,,,67575.25,16893.8125,7570,57438.9625,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28472.213,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19916.897,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22525.965,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24693.6151,Other,CMS Methodology,,65.6,,44329.364,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19916.897,Other,"DRG Weight, with Charge Based Outlier",,70,,47302.675,Percent of Total Billed Charges,,,85,,57438.9625,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23957.9186,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45951.17,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20871.0271,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19187.2681,Other,"DRG Weight, with Charge Based Outlier",,65,,43923.9125,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22301,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13776.4858,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15013,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15158,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14650,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14795,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14795,Other,CMS Methodology,,,"103% of Medicare, less IME",14940,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15194,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,DRG,,,,Inpatient,,,260772.28,65193.07,14370,221656.438,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,87739.78164,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,52269.217,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,80801.30136,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,64805.0711,Other,CMS Methodology,,65.6,,171066.6157,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,52269.217,Other,"DRG Weight, with Charge Based Outlier",,70,,182540.596,Percent of Total Billed Charges,,,85,,221656.438,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,62874.3346,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,177325.1504,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,54773.2031,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",91270.298,Other,"DRG Weight, with Charge Based Outlier",,65,,169501.982,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",58527,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,36154.5338,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",39399,Other,CMS Methodology,,,"104.5% of Medicare, less IME",39779,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",38447,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",38828,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",38828,Other,CMS Methodology,,,"103% of Medicare, less IME",39208,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",39874,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,DRG,,,,Inpatient,,,81962.43,20490.6075,9270,69668.0655,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34129.491,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23874.279,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27001.755,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29600.1057,Other,CMS Methodology,,65.6,,53767.35408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23874.279,Other,"DRG Weight, with Charge Based Outlier",,70,,57373.701,Percent of Total Billed Charges,,,85,,69668.0655,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28718.2302,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,55734.4524,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25017.9897,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22999.6767,Other,"DRG Weight, with Charge Based Outlier",,65,,53275.5795,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26732,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16513.8006,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17996,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18169,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17561,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17735,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17735,Other,CMS Methodology,,,"103% of Medicare, less IME",17909,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18213,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,DRG,,,,Inpatient,,,63619.2,15904.8,6720,54076.32,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25782.472,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18035.368,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20397.96,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22360.8344,Other,CMS Methodology,,65.6,,41734.1952,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18035.368,Other,"DRG Weight, with Charge Based Outlier",,70,,44533.44,Percent of Total Billed Charges,,,85,,54076.32,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21694.6384,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,43261.056,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18899.3624,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17374.6664,Other,"DRG Weight, with Charge Based Outlier",,65,,41352.48,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20195,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12475.0352,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13594,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13726,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13266,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13397,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13397,Other,CMS Methodology,,,"103% of Medicare, less IME",13529,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13759,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,DRG,,,,Inpatient,,,65944.19,16486.0475,7570,56052.5615,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34287.159,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23984.571,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27126.495,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29736.8493,Other,CMS Methodology,,65.6,,43259.38864,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23984.571,Other,"DRG Weight, with Charge Based Outlier",,70,,46160.933,Percent of Total Billed Charges,,,85,,56052.5615,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28850.8998,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44842.0492,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25133.5653,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23105.9283,Other,"DRG Weight, with Charge Based Outlier",,65,,42863.7235,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26856,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16590.0894,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18079,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18253,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17642,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17817,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17817,Other,CMS Methodology,,,"103% of Medicare, less IME",17991,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18297,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,DRG,,,,Inpatient,,,43837.54,10959.385,6720,37261.909,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22499.599,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15738.931,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17800.695,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19513.6373,Other,CMS Methodology,,65.6,,28757.42624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15738.931,Other,"DRG Weight, with Charge Based Outlier",,70,,30686.278,Percent of Total Billed Charges,,,85,,37261.909,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18932.2678,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29809.5272,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16492.9133,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15162.3563,Other,"DRG Weight, with Charge Based Outlier",,65,,28494.401,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17623,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10886.5934,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11863,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11978,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11577,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11691,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11691,Other,CMS Methodology,,,"103% of Medicare, less IME",11806,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12007,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,DRG,,,,Inpatient,,,93952.2,23488.05,12670,79859.37,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36676.58,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25656.02,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29016.9,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31809.166,Other,CMS Methodology,,65.6,,61632.6432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25656.02,Other,"DRG Weight, with Charge Based Outlier",,70,,65766.54,Percent of Total Billed Charges,,,85,,79859.37,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30861.476,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,63887.496,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26885.086,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24716.146,Other,"DRG Weight, with Charge Based Outlier",,65,,61068.93,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28728,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17746.228,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19339,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19525,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18871,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19058,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19058,Other,CMS Methodology,,,"103% of Medicare, less IME",19245,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19572,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,DRG,,,,Inpatient,,,29193.56,7298.39,5870,24814.526,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19235.496,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13455.624,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15218.28,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16682.7192,Other,CMS Methodology,,65.6,,19150.97536,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13455.624,Other,"DRG Weight, with Charge Based Outlier",,70,,20435.492,Percent of Total Billed Charges,,,85,,24814.526,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16185.6912,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19851.6208,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14100.2232,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12962.6952,Other,"DRG Weight, with Charge Based Outlier",,65,,18975.814,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15067,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9307.2336,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10142,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10240,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9897,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9995,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9995,Other,CMS Methodology,,,"103% of Medicare, less IME",10093,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10265,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,DRG,,,,Inpatient,,,42197,10549.25,7570,35867.45,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31432.242,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21987.498,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24867.81,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27260.8134,Other,CMS Methodology,,65.6,,27681.232,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21987.498,Other,"DRG Weight, with Charge Based Outlier",,70,,29537.9,Percent of Total Billed Charges,,,85,,35867.45,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26448.6324,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28693.96,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23040.8214,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21182.0154,Other,"DRG Weight, with Charge Based Outlier",,65,,27428.05,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24620,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15208.7172,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16573,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16733,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16173,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16333,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16333,Other,CMS Methodology,,,"103% of Medicare, less IME",16493,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16773,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,DRG,,,,Inpatient,,,41477.79,10369.4475,5020,35256.1215,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17929.104,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12541.776,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14184.72,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15549.7008,Other,CMS Methodology,,65.6,,27209.43024,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12541.776,Other,"DRG Weight, with Charge Based Outlier",,70,,29034.453,Percent of Total Billed Charges,,,85,,35256.1215,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15086.4288,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,28204.8972,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13142.5968,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12082.3248,Other,"DRG Weight, with Charge Based Outlier",,65,,26960.5635,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14043,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8675.1264,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9454,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9545,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9225,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9316,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9316,Other,CMS Methodology,,,"103% of Medicare, less IME",9408,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9568,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,DRG,,,,Inpatient,,,50313.34,12578.335,5020,42766.339,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25570.371,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17886.999,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20230.155,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22176.8817,Other,CMS Methodology,,65.6,,33005.55104,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17886.999,Other,"DRG Weight, with Charge Based Outlier",,70,,35219.338,Percent of Total Billed Charges,,,85,,42766.339,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21516.1662,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34213.0712,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18743.8857,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17231.7327,Other,"DRG Weight, with Charge Based Outlier",,65,,32703.671,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20028,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12372.4086,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13483,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13613,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13157,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13287,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13287,Other,CMS Methodology,,,"103% of Medicare, less IME",13417,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13645,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,DRG,,,,Inpatient,,,102447.19,25611.7975,11820,87080.1115,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,48588.022,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33988.318,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,38440.71,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,42139.8194,Other,CMS Methodology,,65.6,,67205.35664,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33988.318,Other,"DRG Weight, with Charge Based Outlier",,70,,71713.033,Percent of Total Billed Charges,,,85,,87080.1115,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,40884.3484,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,69664.0892,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,35616.5474,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",32743.2014,Other,"DRG Weight, with Charge Based Outlier",,65,,66590.6735,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",38057,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,23509.6652,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",25619,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25867,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",25000,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",25248,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",25248,Other,CMS Methodology,,,"103% of Medicare, less IME",25495,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25928,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,DRG,,,,Inpatient,,,110661.25,27665.3125,14370,94062.0625,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33960.561,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23756.109,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26868.105,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29453.5947,Other,CMS Methodology,,65.6,,72593.78,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23756.109,Other,"DRG Weight, with Charge Based Outlier",,70,,77462.875,Percent of Total Billed Charges,,,85,,94062.0625,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28576.0842,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,75249.65,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30390.1587,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22885.8357,Other,"DRG Weight, with Charge Based Outlier",,65,,71929.8125,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26600,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16432.0626,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17906,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18079,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17474,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17647,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17647,Other,CMS Methodology,,,"103% of Medicare, less IME",17820,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18123,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,DRG,,,,Inpatient,,,39250.58,9812.645,8420,33362.993,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20836.577,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14575.613,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16484.985,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18071.3179,Other,CMS Methodology,,65.6,,25748.38048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14575.613,Other,"DRG Weight, with Charge Based Outlier",,70,,27475.406,Percent of Total Billed Charges,,,85,,33362.993,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17532.9194,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26690.3944,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15273.8659,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14041.6549,Other,"DRG Weight, with Charge Based Outlier",,65,,25512.877,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16321,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10081.9282,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10987,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11093,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10721,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10827,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10827,Other,CMS Methodology,,,"103% of Medicare, less IME",10933,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11119,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,DRG,,,,Inpatient,,,54147.54,13536.885,8420,46025.409,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26565.181,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18582.889,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21017.205,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23039.6687,Other,CMS Methodology,,65.6,,35520.78624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18582.889,Other,"DRG Weight, with Charge Based Outlier",,70,,37903.278,Percent of Total Billed Charges,,,85,,46025.409,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22353.2482,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36820.3272,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19473.1127,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17902.1297,Other,"DRG Weight, with Charge Based Outlier",,65,,35195.901,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20808,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12853.7546,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14007,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14142,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13669,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13804,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13804,Other,CMS Methodology,,,"103% of Medicare, less IME",13939,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14176,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,DRG,,,,Inpatient,,,28045.69,7011.4225,7570,23838.8365,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19132.261,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13383.409,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15136.605,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16593.1847,Other,CMS Methodology,,65.6,,18397.97264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13383.409,Other,"DRG Weight, with Charge Based Outlier",,70,,19631.983,Percent of Total Billed Charges,,,85,,23838.8365,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16098.8242,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19071.0692,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14024.5487,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12893.1257,Other,"DRG Weight, with Charge Based Outlier",,65,,18229.6985,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14986,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9257.2826,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10088,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10185,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9844,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9942,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9942,Other,CMS Methodology,,,"103% of Medicare, less IME",10039,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10210,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,DRG,,,,Inpatient,,,27142.71,6785.6775,5812.48,23071.3035,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12012.8,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8403.2,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9504,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10418.56,Other,CMS Methodology,,65.6,,17805.61776,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8403.2,Other,"DRG Weight, with Charge Based Outlier",,70,,18999.897,Percent of Total Billed Charges,,,85,,23071.3035,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10108.16,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18457.0428,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8805.76,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8095.36,Other,"DRG Weight, with Charge Based Outlier",,65,,17642.7615,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9409,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5812.48,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6334,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6395,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6181,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6242,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6242,Other,CMS Methodology,,,"103% of Medicare, less IME",6303,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6411,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,DRG,,,,Inpatient,,,28898.92,7224.73,6720,24564.082,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18499.712,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12940.928,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14636.16,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16044.5824,Other,CMS Methodology,,65.6,,18957.69152,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12940.928,Other,"DRG Weight, with Charge Based Outlier",,70,,20229.244,Percent of Total Billed Charges,,,85,,24564.082,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15566.5664,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19651.2656,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13560.8704,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12466.8544,Other,"DRG Weight, with Charge Based Outlier",,65,,18784.298,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14490,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8951.2192,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9754,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9849,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9519,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9613,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9613,Other,CMS Methodology,,,"103% of Medicare, less IME",9707,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9872,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,DRG,,,,Inpatient,,,13567.1,3391.775,5020,11898.303,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11898.303,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8323.107,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9413.415,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10319.2581,Other,CMS Methodology,,65.6,,8900.0176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8323.107,Other,"DRG Weight, with Charge Based Outlier",,70,,9496.97,Percent of Total Billed Charges,,,85,,11532.035,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10011.8166,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,9225.628,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8721.8301,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8018.2011,Other,"DRG Weight, with Charge Based Outlier",,65,,8818.615,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9320,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5757.0798,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6274,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6334,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6122,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6183,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6183,Other,CMS Methodology,,,"103% of Medicare, less IME",6243,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6349,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5020,Other,AR Medicaid Methodology
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,DRG,,,,Inpatient,,,35519.73,8879.9325,6720,30191.7705,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18980.224,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13277.056,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15016.32,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16461.3248,Other,CMS Methodology,,65.6,,23300.94288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13277.056,Other,"DRG Weight, with Charge Based Outlier",,70,,24863.811,Percent of Total Billed Charges,,,85,,30191.7705,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15970.8928,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24153.4164,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13913.1008,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12790.6688,Other,"DRG Weight, with Charge Based Outlier",,65,,23087.8245,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14867,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9183.7184,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10008,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10104,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9766,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9863,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9863,Other,CMS Methodology,,,"103% of Medicare, less IME",9959,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10129,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,DRG,,,,Inpatient,,,80403.65,20100.9125,7570,68343.1025,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25833.151,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18070.819,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20438.055,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22404.7877,Other,CMS Methodology,,65.6,,52744.7944,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18070.819,Other,"DRG Weight, with Charge Based Outlier",,70,,56282.555,Percent of Total Billed Charges,,,85,,68343.1025,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21737.2822,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,54674.482,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18936.5117,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17408.8187,Other,"DRG Weight, with Charge Based Outlier",,65,,52262.3725,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20234,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12499.5566,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13621,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13753,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13292,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13424,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13424,Other,CMS Methodology,,,"103% of Medicare, less IME",13555,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13786,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,DRG,,,,Inpatient,,,41164.37,10291.0925,5870,34989.7145,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20196.52,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14127.88,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15978.6,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17516.204,Other,CMS Methodology,,65.6,,27003.82672,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14127.88,Other,"DRG Weight, with Charge Based Outlier",,70,,28815.059,Percent of Total Billed Charges,,,85,,34989.7145,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16994.344,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27991.7716,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14804.684,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13610.324,Other,"DRG Weight, with Charge Based Outlier",,65,,26756.8405,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15819,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9772.232,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10649,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10752,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10392,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10495,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10495,Other,CMS Methodology,,,"103% of Medicare, less IME",10598,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10778,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,DRG,,,,Inpatient,,,26480.62,6620.155,6480.007,22508.527,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13392.395,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9368.255,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10595.475,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11615.0665,Other,CMS Methodology,,65.6,,17371.28672,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9368.255,Other,"DRG Weight, with Charge Based Outlier",,70,,18536.434,Percent of Total Billed Charges,,,85,,22508.527,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11269.019,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18006.8216,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9817.0465,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9025.0615,Other,"DRG Weight, with Charge Based Outlier",,65,,17212.403,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10490,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6480.007,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7061,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7130,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6891,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6959,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6959,Other,CMS Methodology,,,"103% of Medicare, less IME",7027,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7147,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
ABORTION WITHOUT D&C,779,DRG,,,,Inpatient,,,37673.07,9418.2675,5870,32022.1095,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17546.196,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12273.924,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13881.78,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15217.6092,Other,CMS Methodology,,65.6,,24713.53392,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12273.924,Other,"DRG Weight, with Charge Based Outlier",,70,,26371.149,Percent of Total Billed Charges,,,85,,32022.1095,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14764.2312,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25617.6876,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12861.9132,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11824.2852,Other,"DRG Weight, with Charge Based Outlier",,65,,24487.4955,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13743,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8489.8536,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9252,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9341,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9028,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9118,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9118,Other,CMS Methodology,,,"103% of Medicare, less IME",9207,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9363,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,DRG,,,,Inpatient,,,83384.17,20846.0425,9270,70876.5445,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34576.217,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24186.773,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27355.185,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29987.5459,Other,CMS Methodology,,65.6,,54700.01552,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24186.773,Other,"DRG Weight, with Charge Based Outlier",,70,,58368.919,Percent of Total Billed Charges,,,85,,70876.5445,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29094.1274,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,56701.2356,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25345.4539,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23300.7229,Other,"DRG Weight, with Charge Based Outlier",,65,,54199.7105,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27082,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16729.9522,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18231,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18407,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17791,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17967,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17967,Other,CMS Methodology,,,"103% of Medicare, less IME",18143,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18451,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CESAREAN SECTION WITH STERILIZATION WITH CC,784,DRG,,,,Inpatient,,,36058.1,9014.525,6720,30649.385,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20327.91,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14219.79,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16082.55,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17630.157,Other,CMS Methodology,,65.6,,23654.1136,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14219.79,Other,"DRG Weight, with Charge Based Outlier",,70,,25240.67,Percent of Total Billed Charges,,,85,,30649.385,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17104.902,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24519.508,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14900.997,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13698.867,Other,"DRG Weight, with Charge Based Outlier",,65,,23437.765,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15922,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9835.806,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10718,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10822,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10459,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10563,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10563,Other,CMS Methodology,,,"103% of Medicare, less IME",10667,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10848,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,DRG,,,,Inpatient,,,33999.51,8499.8775,6720,28899.5835,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16395.595,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11469.055,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12971.475,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14219.7065,Other,CMS Methodology,,65.6,,22303.67856,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11469.055,Other,"DRG Weight, with Charge Based Outlier",,70,,23799.657,Percent of Total Billed Charges,,,85,,28899.5835,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13796.059,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23119.6668,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12018.4865,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11048.9015,Other,"DRG Weight, with Charge Based Outlier",,65,,22099.6815,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12842,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7933.127,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8645,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8728,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8436,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8520,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8520,Other,CMS Methodology,,,"103% of Medicare, less IME",8603,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8749,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,DRG,,,,Inpatient,,,70198.86,17549.715,10120,59669.031,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30330.443,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21216.767,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23996.115,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26305.2361,Other,CMS Methodology,,65.6,,46050.45216,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21216.767,Other,"DRG Weight, with Charge Based Outlier",,70,,49139.202,Percent of Total Billed Charges,,,85,,59669.031,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25521.5246,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47735.2248,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22233.1681,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20439.5191,Other,"DRG Weight, with Charge Based Outlier",,65,,45629.259,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23757,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14675.6038,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15992,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16147,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15606,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15761,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15761,Other,CMS Methodology,,,"103% of Medicare, less IME",15915,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16186,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,DRG,,,,Inpatient,,,37637.26,9409.315,7570,31991.671,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19929.986,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13941.434,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15767.73,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17285.0422,Other,CMS Methodology,,65.6,,24690.04256,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13941.434,Other,"DRG Weight, with Charge Based Outlier",,70,,26346.082,Percent of Total Billed Charges,,,85,,31991.671,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16770.0692,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25593.3368,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14609.3062,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13430.7082,Other,"DRG Weight, with Charge Based Outlier",,65,,24464.219,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15610,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9643.2676,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10509,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10610,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10255,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10356,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10356,Other,CMS Methodology,,,"103% of Medicare, less IME",10458,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10635,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,DRG,,,,Inpatient,,,30569.03,7642.2575,6720,25983.6755,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16981.219,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11878.711,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13434.795,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14727.6113,Other,CMS Methodology,,65.6,,20053.28368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11878.711,Other,"DRG Weight, with Charge Based Outlier",,70,,21398.321,Percent of Total Billed Charges,,,85,,25983.6755,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14288.8318,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20786.9404,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12447.7673,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11443.5503,Other,"DRG Weight, with Charge Based Outlier",,65,,19869.8695,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13301,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8216.4854,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8954,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9040,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8737,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8824,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8824,Other,CMS Methodology,,,"103% of Medicare, less IME",8910,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9062,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,DRG,,,,Inpatient,,,69222.59,17305.6475,7570,58839.2015,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33834.802,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23668.138,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26768.61,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29344.5254,Other,CMS Methodology,,65.6,,45410.01904,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23668.138,Other,"DRG Weight, with Charge Based Outlier",,70,,48455.813,Percent of Total Billed Charges,,,85,,58839.2015,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28470.2644,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47071.3612,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24801.9734,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22801.0874,Other,"DRG Weight, with Charge Based Outlier",,65,,44994.6835,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26502,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16371.2132,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17840,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18012,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17409,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17582,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17582,Other,CMS Methodology,,,"103% of Medicare, less IME",17754,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18056,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,DRG,,,,Inpatient,,,417843.33,104460.8325,33920,355166.8305,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,189472.5283,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,137192.556,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,178605.2652,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,96775.3992,Other,CMS Methodology,,65.6,,274105.2245,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,137192.556,Other,"DRG Weight, with Charge Based Outlier",,70,,292490.331,Percent of Total Billed Charges,,,85,,355166.8305,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,93892.1712,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,284133.4644,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,153242.5032,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",146245.1655,Other,"DRG Weight, with Charge Based Outlier",,65,,271598.1645,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",87400,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,101300.5392,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",58835,Other,CMS Methodology,,,"104.5% of Medicare, less IME",59403,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",57414,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",57982,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",57982,Other,CMS Methodology,,,"103% of Medicare, less IME",58551,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",59546,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,33920,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,35365,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,34770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,33920,Other,AR Medicaid Methodology
PREMATURITY WITH MAJOR PROBLEMS,791,DRG,,,,Inpatient,,,176964.23,44241.0575,17770,150419.5955,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,76204.323,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53306.487,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,60289.515,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,66091.1121,Other,CMS Methodology,,65.6,,116088.5349,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53306.487,Other,"DRG Weight, with Charge Based Outlier",,70,,123874.961,Percent of Total Billed Charges,,,85,,150419.5955,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,64122.0606,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,120335.6764,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,55860.1641,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",51353.6751,Other,"DRG Weight, with Charge Based Outlier",,65,,115026.7495,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",59688,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,36872.0118,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",40180,Other,CMS Methodology,,,"104.5% of Medicare, less IME",40569,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",39210,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",39598,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",39598,Other,CMS Methodology,,,"103% of Medicare, less IME",39986,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",40666,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,17770,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,18407.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,18145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,17770,Other,AR Medicaid Methodology
PREMATURITY WITHOUT MAJOR PROBLEMS,792,DRG,,,,Inpatient,,,48423.73,12105.9325,8420,45980.869,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,45980.869,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32164.561,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,36378.045,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,39878.6663,Other,CMS Methodology,,65.6,,31765.96688,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32164.561,Other,"DRG Weight, with Charge Based Outlier",,70,,33896.611,Percent of Total Billed Charges,,,85,,41160.1705,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,38690.5618,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,32928.1364,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,33705.4223,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",30986.2553,Other,"DRG Weight, with Charge Based Outlier",,65,,31475.4245,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",36015,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22248.1754,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",24244,Other,CMS Methodology,,,"104.5% of Medicare, less IME",24479,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23659,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23893,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23893,Other,CMS Methodology,,,"103% of Medicare, less IME",24127,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24537,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,DRG,,,,Inpatient,,,69807.68,17451.92,9270,78280.285,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,78280.285,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,54758.665,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,61931.925,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,67891.5695,Other,CMS Methodology,,65.6,,45793.83808,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,54758.665,Other,"DRG Weight, with Charge Based Outlier",,70,,48865.376,Percent of Total Billed Charges,,,85,,59336.528,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,65868.877,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47469.2224,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,57381.9095,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",52752.6545,Other,"DRG Weight, with Charge Based Outlier",,65,,45374.992,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",61314,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,37876.481,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",41275,Other,CMS Methodology,,,"104.5% of Medicare, less IME",41674,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",40278,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",40677,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",40677,Other,CMS Methodology,,,"103% of Medicare, less IME",41076,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",41773,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,DRG,,,,Inpatient,,,22534.03,5633.5075,5870,27708.274,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27708.274,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19382.506,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21921.57,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24031.0598,Other,CMS Methodology,,65.6,,14782.32368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19382.506,Other,"DRG Weight, with Charge Based Outlier",,70,,15773.821,Percent of Total Billed Charges,,,85,,19153.9255,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23315.1028,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,15323.1404,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20311.0358,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18672.4538,Other,"DRG Weight, with Charge Based Outlier",,65,,14647.1195,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21703,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13406.8484,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14610,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14751,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14257,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14398,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14398,Other,CMS Methodology,,,"103% of Medicare, less IME",14539,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14786,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
NORMAL NEWBORN,795,DRG,,,,Inpatient,,,15221.57,3805.3925,1814.5836,12938.3345,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,3750.246,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,2623.374,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,2967.03,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,3252.5442,Other,CMS Methodology,,65.6,,9985.34992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,2623.374,Other,"DRG Weight, with Charge Based Outlier",,70,,10655.099,Percent of Total Billed Charges,,,85,,12938.3345,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,3155.6412,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,10350.6676,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,2749.0482,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",2527.2702,Other,"DRG Weight, with Charge Based Outlier",,65,,9894.0205,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",2937,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,1814.5836,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",1977,Other,CMS Methodology,,,"104.5% of Medicare, less IME",1997,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",1930,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",1949,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",1949,Other,CMS Methodology,,,"103% of Medicare, less IME",1968,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",2001,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,DRG,,,,Inpatient,,,134564.48,33641.12,9636.002,114379.808,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19914.97,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13930.93,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15755.85,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17272.019,Other,CMS Methodology,,65.6,,88274.29888,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13930.93,Other,"DRG Weight, with Charge Based Outlier",,70,,94195.136,Percent of Total Billed Charges,,,85,,114379.808,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33969.434,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,91503.8464,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,36582.299,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13420.589,Other,"DRG Weight, with Charge Based Outlier",,65,,87466.912,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15599,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9636.002,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10501,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10602,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10247,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10348,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10348,Other,CMS Methodology,,,"103% of Medicare, less IME",10450,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10627,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,DRG,,,,Inpatient,,,38106.25,9526.5625,5870,32390.3125,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18173.114,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12712.466,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14377.77,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15761.3278,Other,CMS Methodology,,65.6,,24997.7,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12712.466,Other,"DRG Weight, with Charge Based Outlier",,70,,26674.375,Percent of Total Billed Charges,,,85,,32390.3125,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15291.7508,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,25912.25,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13321.4638,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12246.7618,Other,"DRG Weight, with Charge Based Outlier",,65,,24769.0625,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14234,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8793.1924,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9582,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9675,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9351,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9443,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9443,Other,CMS Methodology,,,"103% of Medicare, less IME",9536,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9698,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,DRG,,,,Inpatient,,,34200.24,8550.06,5870,29070.204,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18173.114,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12712.466,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14377.77,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15761.3278,Other,CMS Methodology,,65.6,,22435.35744,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12712.466,Other,"DRG Weight, with Charge Based Outlier",,70,,23940.168,Percent of Total Billed Charges,,,85,,29070.204,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15291.7508,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23256.1632,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13321.4638,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12246.7618,Other,"DRG Weight, with Charge Based Outlier",,65,,22230.156,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14234,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8793.1924,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9582,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9675,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9351,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9443,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9443,Other,CMS Methodology,,,"103% of Medicare, less IME",9536,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9698,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
SPLENIC PROCEDURES WITH MCC,799,DRG,,,,Inpatient,,,223378.36,55844.59,14370,189871.606,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,89247.596,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,62430.524,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,75952.57332,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,77403.3892,Other,CMS Methodology,,65.6,,146536.2042,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,62430.524,Other,"DRG Weight, with Charge Based Outlier",,70,,156364.852,Percent of Total Billed Charges,,,85,,189871.606,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,75097.3112,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,151897.2848,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,65421.2932,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",78182.426,Other,"DRG Weight, with Charge Based Outlier",,65,,145195.934,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",69905,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,43183.0936,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",47058,Other,CMS Methodology,,,"104.5% of Medicare, less IME",47512,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",45921,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",46376,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",46376,Other,CMS Methodology,,,"103% of Medicare, less IME",46830,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",47626,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
SPLENIC PROCEDURES WITH CC,800,DRG,,,,Inpatient,,,75944.07,18986.0175,8420,64552.4595,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,54692.026,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38258.194,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,43269.93,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,47433.7502,Other,CMS Methodology,,65.6,,49819.30992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,38258.194,Other,"DRG Weight, with Charge Based Outlier",,70,,53160.849,Percent of Total Billed Charges,,,85,,64552.4595,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,46020.5572,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,51641.9676,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,40090.9742,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",36856.6562,Other,"DRG Weight, with Charge Based Outlier",,65,,49363.6455,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",42838,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,26463.1316,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",28838,Other,CMS Methodology,,,"104.5% of Medicare, less IME",29116,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",28141,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",28420,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",28420,Other,CMS Methodology,,,"103% of Medicare, less IME",28698,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",29186,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
SPLENIC PROCEDURES WITHOUT CC/MCC,801,DRG,,,,Inpatient,,,66837.64,16709.41,7570,56811.994,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30814.709,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21555.521,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24379.245,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26725.2343,Other,CMS Methodology,,65.6,,43845.49184,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21555.521,Other,"DRG Weight, with Charge Based Outlier",,70,,46786.348,Percent of Total Billed Charges,,,85,,56811.994,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25929.0098,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45449.5952,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22588.1503,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20765.8633,Other,"DRG Weight, with Charge Based Outlier",,65,,43444.466,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24136,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14909.9194,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16248,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16405,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15855,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16012,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16012,Other,CMS Methodology,,,"103% of Medicare, less IME",16169,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16444,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,DRG,,,,Inpatient,,,82275.42,20568.855,10120,69934.107,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,67286.696,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47068.424,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,53234.28,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,58356.9592,Other,CMS Methodology,,65.6,,53972.67552,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,47068.424,Other,"DRG Weight, with Charge Based Outlier",,70,,57592.794,Percent of Total Billed Charges,,,85,,69934.107,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,56618.3312,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,55947.2856,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,49323.2632,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",45344.1352,Other,"DRG Weight, with Charge Based Outlier",,65,,53479.023,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",52703,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,32557.1536,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",35478,Other,CMS Methodology,,,"104.5% of Medicare, less IME",35821,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",34621,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34964,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34964,Other,CMS Methodology,,,"103% of Medicare, less IME",35307,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35907,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,DRG,,,,Inpatient,,,71815.33,17953.8325,10120,61043.0305,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33410.6,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23371.4,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26433,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28976.62,Other,CMS Methodology,,65.6,,47110.85648,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23371.4,Other,"DRG Weight, with Charge Based Outlier",,70,,50270.731,Percent of Total Billed Charges,,,85,,61043.0305,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28113.32,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,48834.4244,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24491.02,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22515.22,Other,"DRG Weight, with Charge Based Outlier",,65,,46679.9645,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26169,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16165.96,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17616,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17787,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17191,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17361,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17361,Other,CMS Methodology,,,"103% of Medicare, less IME",17531,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17829,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,DRG,,,,Inpatient,,,38770.25,9692.5625,5870,32954.7125,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20752.112,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14516.528,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16418.16,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17998.0624,Other,CMS Methodology,,65.6,,25433.284,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14516.528,Other,"DRG Weight, with Charge Based Outlier",,70,,27139.175,Percent of Total Billed Charges,,,85,,32954.7125,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17461.8464,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26363.77,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15211.9504,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13984.7344,Other,"DRG Weight, with Charge Based Outlier",,65,,25200.6625,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16254,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10041.0592,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10942,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11048,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10678,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10783,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10783,Other,CMS Methodology,,,"103% of Medicare, less IME",10889,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11074,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,DRG,,,,Inpatient,,,40197.63,10049.4075,7570,34167.9855,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18732.46,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13103.74,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14820.3,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16246.442,Other,CMS Methodology,,65.6,,26369.64528,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13103.74,Other,"DRG Weight, with Charge Based Outlier",,70,,28138.341,Percent of Total Billed Charges,,,85,,34167.9855,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15762.412,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27334.3884,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13731.482,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12623.702,Other,"DRG Weight, with Charge Based Outlier",,65,,26128.4595,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14672,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9063.836,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9877,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9973,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9639,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9734,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9734,Other,CMS Methodology,,,"103% of Medicare, less IME",9829,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9996,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,DRG,,,,Inpatient,,,27876.67,6969.1675,6571.7352,23695.1695,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13581.972,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9500.868,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10745.46,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11779.4844,Other,CMS Methodology,,65.6,,18287.09552,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9500.868,Other,"DRG Weight, with Charge Based Outlier",,70,,19513.669,Percent of Total Billed Charges,,,85,,23695.1695,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11428.5384,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18956.1356,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9956.0124,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9152.8164,Other,"DRG Weight, with Charge Based Outlier",,65,,18119.8355,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10638,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6571.7352,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7161,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7231,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6988,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7058,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7058,Other,CMS Methodology,,,"103% of Medicare, less IME",7127,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7248,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,DRG,,,,Inpatient,,,24899.22,6224.805,5787.9586,21164.337,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11962.121,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8367.749,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9463.905,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10374.6067,Other,CMS Methodology,,65.6,,16333.88832,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8367.749,Other,"DRG Weight, with Charge Based Outlier",,70,,17429.454,Percent of Total Billed Charges,,,85,,21164.337,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10065.5162,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,16931.4696,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8768.6107,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8061.2077,Other,"DRG Weight, with Charge Based Outlier",,65,,16184.493,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9370,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5787.9586,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6307,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6368,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6155,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6216,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6216,Other,CMS Methodology,,,"103% of Medicare, less IME",6277,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6383,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,DRG,,,,Inpatient,,,97355.69,24338.9225,11820,82752.3365,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,42988.931,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30071.639,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,34010.955,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,37283.7937,Other,CMS Methodology,,65.6,,63865.33264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30071.639,Other,"DRG Weight, with Charge Based Outlier",,70,,68148.983,Percent of Total Billed Charges,,,85,,82752.3365,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,36172.9982,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,66201.8692,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,31512.2377,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28970.0047,Other,"DRG Weight, with Charge Based Outlier",,65,,63281.1985,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",33672,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20800.5046,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22667,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22886,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22119,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",22338,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",22338,Other,CMS Methodology,,,"103% of Medicare, less IME",22557,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22941,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,DRG,,,,Inpatient,,,57907.38,14476.845,9270,49221.273,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23246.645,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16261.505,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18391.725,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20161.5415,Other,CMS Methodology,,65.6,,37987.24128,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16261.505,Other,"DRG Weight, with Charge Based Outlier",,70,,40535.166,Percent of Total Billed Charges,,,85,,49221.273,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19560.869,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,39377.0184,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17040.5215,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15665.7865,Other,"DRG Weight, with Charge Based Outlier",,65,,37639.797,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18208,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11248.057,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12257,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12376,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11961,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12080,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12080,Other,CMS Methodology,,,"103% of Medicare, less IME",12198,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12405,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,DRG,,,,Inpatient,,,35470.18,8867.545,7570,30149.653,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17865.286,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12497.134,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14134.23,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15494.3522,Other,CMS Methodology,,65.6,,23268.43808,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12497.134,Other,"DRG Weight, with Charge Based Outlier",,70,,24829.126,Percent of Total Billed Charges,,,85,,30149.653,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15032.7292,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24119.7224,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13095.8162,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12039.3182,Other,"DRG Weight, with Charge Based Outlier",,65,,23055.617,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13993,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8644.2476,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9420,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9511,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9192,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9283,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9283,Other,CMS Methodology,,,"103% of Medicare, less IME",9374,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9534,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
RED BLOOD CELL DISORDERS WITH MCC,811,DRG,,,,Inpatient,,,55357.38,13839.345,9270,47053.773,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26407.513,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18472.597,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20892.465,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22902.9251,Other,CMS Methodology,,65.6,,36314.44128,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18472.597,Other,"DRG Weight, with Charge Based Outlier",,70,,38750.166,Percent of Total Billed Charges,,,85,,47053.773,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22220.5786,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37643.0184,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19357.5371,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17795.8781,Other,"DRG Weight, with Charge Based Outlier",,65,,35982.297,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20684,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12777.4658,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13924,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14058,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13588,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13722,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13722,Other,CMS Methodology,,,"103% of Medicare, less IME",13857,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14092,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
RED BLOOD CELL DISORDERS WITHOUT MCC,812,DRG,,,,Inpatient,,,36070.78,9017.695,7570,30660.163,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17322.833,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12117.677,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13705.065,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15023.8891,Other,CMS Methodology,,65.6,,23662.43168,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12117.677,Other,"DRG Weight, with Charge Based Outlier",,70,,25249.546,Percent of Total Billed Charges,,,85,,30660.163,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14576.2826,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24528.1304,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12698.1811,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11673.7621,Other,"DRG Weight, with Charge Based Outlier",,65,,23446.007,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13568,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8381.7778,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9134,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9222,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8913,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9001,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9001,Other,CMS Methodology,,,"103% of Medicare, less IME",9090,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9244,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
COAGULATION DISORDERS,813,DRG,,,,Inpatient,,,75130.25,18782.5625,10120,63860.7125,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29055.96,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20325.24,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22987.8,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25199.892,Other,CMS Methodology,,65.6,,49285.444,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20325.24,Other,"DRG Weight, with Charge Based Outlier",,70,,52591.175,Percent of Total Billed Charges,,,85,,63860.7125,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24449.112,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,51088.57,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21298.932,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19580.652,Other,"DRG Weight, with Charge Based Outlier",,65,,48834.6625,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22759,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14058.936,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15320,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15468,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14950,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15098,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15098,Other,CMS Methodology,,,"103% of Medicare, less IME",15246,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15505,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,DRG,,,,Inpatient,,,89156.69,22289.1725,10970,75783.1865,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39238.685,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27448.265,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31043.925,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34031.2495,Other,CMS Methodology,,65.6,,58486.78864,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27448.265,Other,"DRG Weight, with Charge Based Outlier",,70,,62409.683,Percent of Total Billed Charges,,,85,,75783.1865,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33017.357,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,60626.5492,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,28763.1895,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26442.7345,Other,"DRG Weight, with Charge Based Outlier",,65,,57951.8485,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",30734,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18985.921,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20689,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20889,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20190,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20390,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20390,Other,CMS Methodology,,,"103% of Medicare, less IME",20589,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20939,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,DRG,,,,Inpatient,,,46422.2,11605.55,8420,39458.87,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19072.197,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13341.393,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15089.085,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16541.0919,Other,CMS Methodology,,65.6,,30452.9632,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13341.393,Other,"DRG Weight, with Charge Based Outlier",,70,,32495.54,Percent of Total Billed Charges,,,85,,39458.87,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16048.2834,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31567.096,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13980.5199,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12852.6489,Other,"DRG Weight, with Charge Based Outlier",,65,,30174.43,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14939,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9228.2202,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10056,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10153,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9813,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9910,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9910,Other,CMS Methodology,,,"103% of Medicare, less IME",10008,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10178,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,DRG,,,,Inpatient,,,34573.73,8643.4325,5988.6708,29387.6705,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12376.938,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8657.922,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9792.09,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10734.3726,Other,CMS Methodology,,65.6,,22680.36688,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8657.922,Other,"DRG Weight, with Charge Based Outlier",,70,,24201.611,Percent of Total Billed Charges,,,85,,29387.6705,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10414.5636,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23510.1364,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9072.6846,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8340.7506,Other,"DRG Weight, with Charge Based Outlier",,65,,22472.9245,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9694,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5988.6708,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6526,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6589,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6368,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6431,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6431,Other,CMS Methodology,,,"103% of Medicare, less IME",6494,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6605,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,DRG,,,,Inpatient,,,67920.49,16980.1225,7570,57732.4165,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,41029.343,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28700.867,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,32460.615,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,35584.2661,Other,CMS Methodology,,65.6,,44555.84144,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28700.867,Other,"DRG Weight, with Charge Based Outlier",,70,,47544.343,Percent of Total Billed Charges,,,85,,57732.4165,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,34524.1046,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,46185.9332,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30075.7981,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27649.4491,Other,"DRG Weight, with Charge Based Outlier",,65,,44148.3185,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",32137,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19852.3438,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21634,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21843,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21111,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21320,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21320,Other,CMS Methodology,,,"103% of Medicare, less IME",21529,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21895,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,DRG,,,,Inpatient,,,56394.16,14098.54,7570,47935.036,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18571.038,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12990.822,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14692.59,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16106.4426,Other,CMS Methodology,,65.6,,36994.56896,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12990.822,Other,"DRG Weight, with Charge Based Outlier",,70,,39475.912,Percent of Total Billed Charges,,,85,,47935.036,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15626.5836,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38348.0288,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13613.1546,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12514.9206,Other,"DRG Weight, with Charge Based Outlier",,65,,36656.204,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14546,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8985.7308,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9792,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9887,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9555,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9650,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9650,Other,CMS Methodology,,,"103% of Medicare, less IME",9745,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9910,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,DRG,,,,Inpatient,,,40016.6,10004.15,5870,34014.11,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12677.258,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8868.002,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10029.69,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10994.8366,Other,CMS Methodology,,65.6,,26250.8896,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8868.002,Other,"DRG Weight, with Charge Based Outlier",,70,,28011.62,Percent of Total Billed Charges,,,85,,34014.11,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10667.2676,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27211.288,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9292.8286,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8543.1346,Other,"DRG Weight, with Charge Based Outlier",,65,,26010.79,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9930,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6133.9828,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6684,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6749,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6523,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6587,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6587,Other,CMS Methodology,,,"103% of Medicare, less IME",6652,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6765,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,DRG,,,,Inpatient,,,153135.6,38283.9,13520,130165.26,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,109284.571,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,76446.799,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,86461.155,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,94781.2217,Other,CMS Methodology,,65.6,,100456.9536,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,76446.799,Other,"DRG Weight, with Charge Based Outlier",,70,,107194.92,Percent of Total Billed Charges,,,85,,130165.26,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,91957.4062,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,104132.208,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,80109.0257,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",73646.2727,Other,"DRG Weight, with Charge Based Outlier",,65,,99538.14,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",85599,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,52878.1286,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",57623,Other,CMS Methodology,,,"104.5% of Medicare, less IME",58179,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",56231,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",56788,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",56788,Other,CMS Methodology,,,"103% of Medicare, less IME",57344,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",58319,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,DRG,,,,Inpatient,,,80565.5,20141.375,7570,68480.675,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,41902.148,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29311.412,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,33151.14,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,36341.2396,Other,CMS Methodology,,65.6,,52850.968,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,29311.412,Other,"DRG Weight, with Charge Based Outlier",,70,,56395.85,Percent of Total Billed Charges,,,85,,68480.675,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,35258.5256,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,54784.54,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30715.5916,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",28237.6276,Other,"DRG Weight, with Charge Based Outlier",,65,,52367.575,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",32821,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,20274.6568,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",22094,Other,CMS Methodology,,,"104.5% of Medicare, less IME",22307,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21560,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21774,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21774,Other,CMS Methodology,,,"103% of Medicare, less IME",21987,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22361,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,DRG,,,,Inpatient,,,53355.12,13338.78,6720,45351.852,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21467.249,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15016.781,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16983.945,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18618.2923,Other,CMS Methodology,,65.6,,35000.95872,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15016.781,Other,"DRG Weight, with Charge Based Outlier",,70,,37348.584,Percent of Total Billed Charges,,,85,,45351.852,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18063.5978,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36281.4816,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15736.1683,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14466.6613,Other,"DRG Weight, with Charge Based Outlier",,65,,34680.828,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16815,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10387.0834,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11319,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11428,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11046,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11155,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11155,Other,CMS Methodology,,,"103% of Medicare, less IME",11264,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11456,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,DRG,,,,Inpatient,,,157148.4,39287.1,17770,133576.14,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,87834.215,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,61441.835,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,69490.575,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,76177.5805,Other,CMS Methodology,,65.6,,103089.3504,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,61441.835,Other,"DRG Weight, with Charge Based Outlier",,70,,110003.88,Percent of Total Billed Charges,,,85,,133576.14,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,73908.023,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,106860.912,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,64385.2405,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",59190.9955,Other,"DRG Weight, with Charge Based Outlier",,65,,102146.46,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",68798,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,42499.219,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",46312,Other,CMS Methodology,,,"104.5% of Medicare, less IME",46760,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",45194,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",45641,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",45641,Other,CMS Methodology,,,"103% of Medicare, less IME",46089,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",46872,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,17770,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,18407.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,18145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,17770,Other,AR Medicaid Methodology
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,DRG,,,,Inpatient,,,101924.13,25481.0325,11820,86635.5105,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,41282.738,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28878.122,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,32661.09,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,35804.0326,Other,CMS Methodology,,65.6,,66862.22928,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28878.122,Other,"DRG Weight, with Charge Based Outlier",,70,,71346.891,Percent of Total Billed Charges,,,85,,86635.5105,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,34737.3236,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,69308.4084,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30261.5446,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27820.2106,Other,"DRG Weight, with Charge Based Outlier",,65,,66250.6845,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",32335,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19974.9508,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21767,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21978,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21241,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21452,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21452,Other,CMS Methodology,,,"103% of Medicare, less IME",21662,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22030,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,DRG,,,,Inpatient,,,50237.13,12559.2825,7570,42701.5605,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23102.116,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16160.404,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18277.38,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20036.1932,Other,CMS Methodology,,65.6,,32955.55728,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16160.404,Other,"DRG Weight, with Charge Based Outlier",,70,,35165.991,Percent of Total Billed Charges,,,85,,42701.5605,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19439.2552,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,34161.2484,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16934.5772,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15568.3892,Other,"DRG Weight, with Charge Based Outlier",,65,,32654.1345,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18095,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11178.1256,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12181,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12299,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11887,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12005,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12005,Other,CMS Methodology,,,"103% of Medicare, less IME",12122,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12328,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,DRG,,,,Inpatient,,,178860.76,44715.19,15220,152031.646,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,89636.135,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,62702.315,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,70916.175,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,77740.3645,Other,CMS Methodology,,65.6,,117332.6586,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,62702.315,Other,"DRG Weight, with Charge Based Outlier",,70,,125202.532,Percent of Total Billed Charges,,,85,,152031.646,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,75424.247,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,121625.3168,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,65706.1045,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",60405.2995,Other,"DRG Weight, with Charge Based Outlier",,65,,116259.494,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",70209,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,43371.091,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",47263,Other,CMS Methodology,,,"104.5% of Medicare, less IME",47719,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",46121,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",46578,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",46578,Other,CMS Methodology,,,"103% of Medicare, less IME",47034,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",47833,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,DRG,,,,Inpatient,,,93375.27,23343.8175,8420,79368.9795,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,44295.323,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30985.487,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,35044.515,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,38416.8121,Other,CMS Methodology,,65.6,,61254.17712,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,30985.487,Other,"DRG Weight, with Charge Based Outlier",,70,,65362.689,Percent of Total Billed Charges,,,85,,79368.9795,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,37272.2606,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,63495.1836,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,32469.8641,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",29850.3751,Other,"DRG Weight, with Charge Based Outlier",,65,,60693.9255,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",34695,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,21432.6118,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",23356,Other,CMS Methodology,,,"104.5% of Medicare, less IME",23581,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",22792,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23017,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23017,Other,CMS Methodology,,,"103% of Medicare, less IME",23243,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",23638,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,DRG,,,,Inpatient,,,58134.48,14533.62,6720,49414.308,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30086.433,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21046.077,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23803.065,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26093.6091,Other,CMS Methodology,,65.6,,38136.21888,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21046.077,Other,"DRG Weight, with Charge Based Outlier",,70,,40694.136,Percent of Total Billed Charges,,,85,,49414.308,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25316.2026,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,39531.4464,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22054.3011,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20275.0821,Other,"DRG Weight, with Charge Based Outlier",,65,,37787.412,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23566,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14557.5378,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15864,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16017,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15481,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15634,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15634,Other,CMS Methodology,,,"103% of Medicare, less IME",15787,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16055,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,DRG,,,,Inpatient,,,105080.43,26270.1075,12670,89318.3655,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,57882.926,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40490.294,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,45794.43,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,50201.1802,Other,CMS Methodology,,65.6,,68932.76208,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,40490.294,Other,"DRG Weight, with Charge Based Outlier",,70,,73556.301,Percent of Total Billed Charges,,,85,,89318.3655,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,48705.5372,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,71454.6924,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,42430.0042,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",39006.9862,Other,"DRG Weight, with Charge Based Outlier",,65,,68302.2795,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",45338,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,28007.0716,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",30520,Other,CMS Methodology,,,"104.5% of Medicare, less IME",30815,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",29783,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",30078,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",30078,Other,CMS Methodology,,,"103% of Medicare, less IME",30373,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",30889,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,DRG,,,,Inpatient,,,58995.01,14748.7525,8420,50145.7585,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21604.27,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15112.63,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17092.35,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18737.129,Other,CMS Methodology,,65.6,,38700.72656,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15112.63,Other,"DRG Weight, with Charge Based Outlier",,70,,41296.507,Percent of Total Billed Charges,,,85,,50145.7585,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18178.894,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40116.6068,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15836.609,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14558.999,Other,"DRG Weight, with Charge Based Outlier",,65,,38346.7565,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16922,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10453.382,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11391,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11501,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11116,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11226,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11226,Other,CMS Methodology,,,"103% of Medicare, less IME",11336,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11529,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,DRG,,,,Inpatient,,,40020.84,10005.21,6787.8868,34017.714,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14028.698,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9813.362,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11098.89,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12166.9246,Other,CMS Methodology,,65.6,,26253.67104,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9813.362,Other,"DRG Weight, with Charge Based Outlier",,70,,28014.588,Percent of Total Billed Charges,,,85,,34017.714,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,11804.4356,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27214.1712,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10283.4766,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9453.8626,Other,"DRG Weight, with Charge Based Outlier",,65,,26013.546,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10988,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6787.8868,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7397,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7468,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7218,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7290,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7290,Other,CMS Methodology,,,"103% of Medicare, less IME",7361,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7486,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,DRG,,,,Inpatient,,,33953.29,8488.3225,4720.8236,28860.2965,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,9756.646,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,6824.974,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,7719.03,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,8461.8242,Other,CMS Methodology,,65.6,,22273.35824,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,6824.974,Other,"DRG Weight, with Charge Based Outlier",,70,,23767.303,Percent of Total Billed Charges,,,85,,28860.2965,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,8209.7212,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23088.2372,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,7151.9282,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",6574.9502,Other,"DRG Weight, with Charge Based Outlier",,65,,22069.6385,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",7642,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,4720.8236,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",5144,Other,CMS Methodology,,,"104.5% of Medicare, less IME",5194,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5020,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5070,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5070,Other,CMS Methodology,,,"103% of Medicare, less IME",5120,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",5207,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
ACUTE LEUKEMIA WITH MCC,834,DRG,,,,Inpatient,,,278148.94,69537.235,28820,236426.599,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,123942.2702,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,75833.025,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,111358.9418,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,89978.9167,Other,CMS Methodology,,65.6,,182465.7046,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,75833.025,Other,"DRG Weight, with Charge Based Outlier",,70,,194704.258,Percent of Total Billed Charges,,,85,,236426.599,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,87298.1762,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,189141.2792,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,125514.1207,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",97352.129,Other,"DRG Weight, with Charge Based Outlier",,65,,180796.811,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",81262,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,52806.5994,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",54703,Other,CMS Methodology,,,"104.5% of Medicare, less IME",55232,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",53382,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",53910,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",53910,Other,CMS Methodology,,,"103% of Medicare, less IME",54439,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",55364,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,28820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,30010,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,29520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,28820,Other,AR Medicaid Methodology
ACUTE LEUKEMIA WITH CC,835,DRG,,,,Inpatient,,,101407.79,25351.9475,14370,86196.6215,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40090.843,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28044.367,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31718.115,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34770.3161,Other,CMS Methodology,,65.6,,66523.51024,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28044.367,Other,"DRG Weight, with Charge Based Outlier",,70,,70985.453,Percent of Total Billed Charges,,,85,,86196.6215,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33734.4046,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,68957.2972,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,34883.8481,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27016.9991,Other,"DRG Weight, with Charge Based Outlier",,65,,65915.0635,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31402,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19398.2438,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21139,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21343,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20628,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20832,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20832,Other,CMS Methodology,,,"103% of Medicare, less IME",21037,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21394,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
ACUTE LEUKEMIA WITHOUT CC/MCC,836,DRG,,,,Inpatient,,,76616.78,19154.195,11283.4768,65124.263,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23319.848,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16312.712,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18449.64,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20225.0296,Other,CMS Methodology,,65.6,,50260.60768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16312.712,Other,"DRG Weight, with Charge Based Outlier",,70,,53631.746,Percent of Total Billed Charges,,,85,,65124.263,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23925.4656,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52099.4104,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,28086.1816,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15715.1176,Other,"DRG Weight, with Charge Based Outlier",,65,,49800.907,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18266,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11283.4768,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12296,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12415,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11999,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12118,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12118,Other,CMS Methodology,,,"103% of Medicare, less IME",12236,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12444,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,DRG,,,,Inpatient,,,195606.98,48901.745,22020,166265.933,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,93985.144,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,65744.536,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,74356.92,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,81512.2088,Other,CMS Methodology,,65.6,,128318.1789,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,65744.536,Other,"DRG Weight, with Charge Based Outlier",,70,,136924.886,Percent of Total Billed Charges,,,85,,166265.933,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,79083.7168,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,133012.7464,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,74390.0648,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",68462.443,Other,"DRG Weight, with Charge Based Outlier",,65,,127144.537,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",73615,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,45475.3904,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",49556,Other,CMS Methodology,,,"104.5% of Medicare, less IME",50034,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",48359,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",48837,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",48837,Other,CMS Methodology,,,"103% of Medicare, less IME",49316,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",50154,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,22020,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,22870,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,22520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,22020,Other,AR Medicaid Methodology
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,DRG,,,,Inpatient,,,82989.47,20747.3675,11820,70541.0495,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,38069.314,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26630.266,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,30118.77,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,33017.0678,Other,CMS Methodology,,65.6,,54441.09232,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26630.266,Other,"DRG Weight, with Charge Based Outlier",,70,,58092.629,Percent of Total Billed Charges,,,85,,70541.0495,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,32033.3908,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,56432.8396,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27906.0038,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25654.7018,Other,"DRG Weight, with Charge Based Outlier",,65,,53943.1555,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29818,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18420.1124,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20073,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20267,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19588,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19782,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19782,Other,CMS Methodology,,,"103% of Medicare, less IME",19976,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20315,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,DRG,,,,Inpatient,,,48649.9,12162.475,9270,41352.415,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,25722.408,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17993.352,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20350.44,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22308.7416,Other,CMS Methodology,,65.6,,31914.3344,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,17993.352,Other,"DRG Weight, with Charge Based Outlier",,70,,34054.93,Percent of Total Billed Charges,,,85,,41352.415,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,21644.0976,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33081.932,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,18855.3336,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17334.1896,Other,"DRG Weight, with Charge Based Outlier",,65,,31622.435,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20147,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12445.9728,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13563,Other,CMS Methodology,,,"104.5% of Medicare, less IME",13694,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13235,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13366,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13366,Other,CMS Methodology,,,"103% of Medicare, less IME",13497,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",13726,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,DRG,,,,Inpatient,,,117465.5,29366.375,13520,99845.675,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,59857.53,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,41871.57,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,47356.65,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,51913.731,Other,CMS Methodology,,65.6,,77057.368,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,41871.57,Other,"DRG Weight, with Charge Based Outlier",,70,,82225.85,Percent of Total Billed Charges,,,85,,99845.675,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,50367.066,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,79876.54,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,43877.451,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",40337.661,Other,"DRG Weight, with Charge Based Outlier",,65,,76352.575,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",46884,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,28962.498,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",31561,Other,CMS Methodology,,,"104.5% of Medicare, less IME",31866,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",30799,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",31104,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",31104,Other,CMS Methodology,,,"103% of Medicare, less IME",31409,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",31942,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,DRG,,,,Inpatient,,,67519.02,16879.755,9270,57391.167,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,29431.36,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20587.84,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,23284.8,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,25525.472,Other,CMS Methodology,,65.6,,44292.47712,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20587.84,Other,"DRG Weight, with Charge Based Outlier",,70,,47263.314,Percent of Total Billed Charges,,,85,,57391.167,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24764.992,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45912.9336,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21574.112,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19833.632,Other,"DRG Weight, with Charge Based Outlier",,65,,43887.363,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23053,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14240.576,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15518,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15668,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15143,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15293,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15293,Other,CMS Methodology,,,"103% of Medicare, less IME",15443,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15706,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,DRG,,,,Inpatient,,,32783,8195.75,7570,27865.55,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19744.163,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13811.447,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15620.715,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17123.8801,Other,CMS Methodology,,65.6,,21505.648,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13811.447,Other,"DRG Weight, with Charge Based Outlier",,70,,22948.1,Percent of Total Billed Charges,,,85,,27865.55,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16613.7086,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22292.44,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14473.0921,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13305.4831,Other,"DRG Weight, with Charge Based Outlier",,65,,21308.95,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15465,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9553.3558,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10411,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10511,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10159,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10260,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10260,Other,CMS Methodology,,,"103% of Medicare, less IME",10360,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10536,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,DRG,,,,Inpatient,,,82099.05,20524.7625,11820,69784.1925,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35537.241,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24859.029,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28115.505,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30821.0307,Other,CMS Methodology,,65.6,,53856.9768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24859.029,Other,"DRG Weight, with Charge Based Outlier",,70,,57469.335,Percent of Total Billed Charges,,,85,,69784.1925,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29902.7802,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,55827.354,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26049.9147,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23948.3517,Other,"DRG Weight, with Charge Based Outlier",,65,,53364.3825,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27835,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17194.9506,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18738,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18919,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18285,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18466,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18466,Other,CMS Methodology,,,"103% of Medicare, less IME",18647,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18964,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,DRG,,,,Inpatient,,,48557.49,12139.3725,8420,41273.8665,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22433.904,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15692.976,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17748.72,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19456.6608,Other,CMS Methodology,,65.6,,31853.71344,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15692.976,Other,"DRG Weight, with Charge Based Outlier",,70,,33990.243,Percent of Total Billed Charges,,,85,,41273.8665,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18876.9888,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33019.0932,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16444.7568,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15118.0848,Other,"DRG Weight, with Charge Based Outlier",,65,,31562.3685,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17572,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10854.8064,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11829,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11943,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11543,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11657,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11657,Other,CMS Methodology,,,"103% of Medicare, less IME",11772,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11972,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,DRG,,,,Inpatient,,,55318,13829.5,7599.8176,47020.3,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15706.736,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10987.184,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12426.48,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13622.2672,Other,CMS Methodology,,65.6,,36288.608,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10987.184,Other,"DRG Weight, with Charge Based Outlier",,70,,38722.6,Percent of Total Billed Charges,,,85,,47020.3,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13216.4192,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,37616.24,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11513.5312,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10584.6832,Other,"DRG Weight, with Charge Based Outlier",,65,,35956.7,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12303,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7599.8176,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8282,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8362,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8082,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8162,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8162,Other,CMS Methodology,,,"103% of Medicare, less IME",8242,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8382,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,DRG,,,,Inpatient,,,84661.45,21165.3625,12670,71962.2325,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,47934.826,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33531.394,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,37923.93,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,41573.3102,Other,CMS Methodology,,65.6,,55537.9112,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,33531.394,Other,"DRG Weight, with Charge Based Outlier",,70,,59263.015,Percent of Total Billed Charges,,,85,,71962.2325,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,40334.7172,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,57569.786,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,35137.7342,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",32303.0162,Other,"DRG Weight, with Charge Based Outlier",,65,,55029.9425,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",37546,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,23193.6116,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",25275,Other,CMS Methodology,,,"104.5% of Medicare, less IME",25519,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",24664,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",24908,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",24908,Other,CMS Methodology,,,"103% of Medicare, less IME",25153,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",25580,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,DRG,,,,Inpatient,,,42890.49,10722.6225,9270,36456.9165,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23851.039,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16684.291,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18869.895,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20685.7253,Other,CMS Methodology,,65.6,,28136.16144,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16684.291,Other,"DRG Weight, with Charge Based Outlier",,70,,30023.343,Percent of Total Billed Charges,,,85,,36456.9165,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20069.4358,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29165.5332,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17483.5613,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16073.0843,Other,"DRG Weight, with Charge Based Outlier",,65,,27878.8185,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18682,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11540.4974,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12576,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12697,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12272,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12394,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12394,Other,CMS Methodology,,,"103% of Medicare, less IME",12515,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12728,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,DRG,,,,Inpatient,,,23443.2,5860.8,7437.2498,19926.72,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,15370.753,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10752.157,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,12160.665,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,13330.8731,Other,CMS Methodology,,65.6,,15378.7392,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10752.157,Other,"DRG Weight, with Charge Based Outlier",,70,,16410.24,Percent of Total Billed Charges,,,85,,19926.72,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12933.7066,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,15941.376,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,11267.2451,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10358.2661,Other,"DRG Weight, with Charge Based Outlier",,65,,15238.08,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12039,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7437.2498,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8105,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8183,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7909,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7987,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7987,Other,CMS Methodology,,,"103% of Medicare, less IME",8065,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8202,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,DRG,,,,Inpatient,,,176860.76,44215.19,15220,150331.646,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,93874.401,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,65667.069,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,74269.305,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,81416.1627,Other,CMS Methodology,,65.6,,116020.6586,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,65667.069,Other,"DRG Weight, with Charge Based Outlier",,70,,123802.532,Percent of Total Billed Charges,,,85,,150331.646,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,78990.5322,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,120265.3168,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,68812.8867,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",63261.4437,Other,"DRG Weight, with Charge Based Outlier",,65,,114959.494,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",73529,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,45421.8066,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",49497,Other,CMS Methodology,,,"104.5% of Medicare, less IME",49976,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",48302,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",48780,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",48780,Other,CMS Methodology,,,"103% of Medicare, less IME",49258,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",50095,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,DRG,,,,Inpatient,,,67951.48,16987.87,9270,57758.758,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37504.337,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26235.053,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29671.785,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32527.0699,Other,CMS Methodology,,65.6,,44576.17088,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26235.053,Other,"DRG Weight, with Charge Based Outlier",,70,,47566.036,Percent of Total Billed Charges,,,85,,57758.758,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31557.9914,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,46207.0064,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27491.8579,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25273.9669,Other,"DRG Weight, with Charge Based Outlier",,65,,44168.462,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29376,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18146.7442,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19775,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19966,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19297,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19488,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19488,Other,CMS Methodology,,,"103% of Medicare, less IME",19679,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20014,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,DRG,,,,Inpatient,,,62638.76,15659.69,9270,53242.946,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30512.512,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21344.128,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24140.16,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26463.1424,Other,CMS Methodology,,65.6,,41091.02656,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21344.128,Other,"DRG Weight, with Charge Based Outlier",,70,,43847.132,Percent of Total Billed Charges,,,85,,53242.946,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25674.7264,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,42594.3568,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22366.6304,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20562.2144,Other,"DRG Weight, with Charge Based Outlier",,65,,40715.194,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23899,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14763.6992,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16088,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16244,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15700,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15855,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15855,Other,CMS Methodology,,,"103% of Medicare, less IME",16011,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16283,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,DRG,,,,Inpatient,,,140261.47,35065.3675,15220,119222.2495,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,84682.732,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,59237.308,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,66997.26,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,73444.3364,Other,CMS Methodology,,65.6,,92011.52432,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,59237.308,Other,"DRG Weight, with Charge Based Outlier",,70,,98183.029,Percent of Total Billed Charges,,,85,,119222.2495,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,71256.2104,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,95377.7996,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,62075.1044,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",57067.2284,Other,"DRG Weight, with Charge Based Outlier",,65,,91169.9555,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",66329,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,40974.3512,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",44651,Other,CMS Methodology,,,"104.5% of Medicare, less IME",45082,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",43572,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",44004,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",44004,Other,CMS Methodology,,,"103% of Medicare, less IME",44435,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",45190,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,15730,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,15520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,15220,Other,AR Medicaid Methodology
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,DRG,,,,Inpatient,,,73177.37,18294.3425,10120,62200.7645,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40897.953,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28608.957,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,32356.665,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,35470.3131,Other,CMS Methodology,,65.6,,48004.35472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28608.957,Other,"DRG Weight, with Charge Based Outlier",,70,,51224.159,Percent of Total Billed Charges,,,85,,62200.7645,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,34413.5466,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,49760.6116,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29979.4851,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27560.9061,Other,"DRG Weight, with Charge Based Outlier",,65,,47565.2905,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",32034,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19788.7698,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21564,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21773,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21043,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21252,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21252,Other,CMS Methodology,,,"103% of Medicare, less IME",21460,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21825,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,DRG,,,,Inpatient,,,43802.4,10950.6,7570,37232.04,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24183.268,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16916.692,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19132.74,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20973.8636,Other,CMS Methodology,,65.6,,28734.3744,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16916.692,Other,"DRG Weight, with Charge Based Outlier",,70,,30661.68,Percent of Total Billed Charges,,,85,,37232.04,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20348.9896,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,29785.632,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17727.0956,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16296.9716,Other,"DRG Weight, with Charge Based Outlier",,65,,28471.56,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18942,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11701.2488,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12751,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12874,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12443,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12566,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12566,Other,CMS Methodology,,,"103% of Medicare, less IME",12690,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12905,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,DRG,,,,Inpatient,,,57589.87,14397.4675,10120,48951.3895,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34512.399,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24142.131,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27304.695,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29932.1973,Other,CMS Methodology,,65.6,,37778.95472,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24142.131,Other,"DRG Weight, with Charge Based Outlier",,70,,40312.909,Percent of Total Billed Charges,,,85,,48951.3895,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29040.4278,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,39161.1116,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25298.6733,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23257.7163,Other,"DRG Weight, with Charge Based Outlier",,65,,37433.4155,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27032,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16699.0734,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18197,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18373,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17758,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17934,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17934,Other,CMS Methodology,,,"103% of Medicare, less IME",18109,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18417,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,DRG,,,,Inpatient,,,34437.9,8609.475,8420,29272.215,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18768.123,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13128.687,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14848.515,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16277.3721,Other,CMS Methodology,,65.6,,22591.2624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13128.687,Other,"DRG Weight, with Charge Based Outlier",,70,,24106.53,Percent of Total Billed Charges,,,85,,29272.215,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15792.4206,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23417.772,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13757.6241,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12647.7351,Other,"DRG Weight, with Charge Based Outlier",,65,,22384.635,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14700,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9081.0918,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9896,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9992,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9657,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9752,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9752,Other,CMS Methodology,,,"103% of Medicare, less IME",9848,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10015,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
FEVER AND INFLAMMATORY CONDITIONS,864,DRG,,,,Inpatient,,,30484.81,7621.2025,7570,25912.0885,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16855.46,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11790.74,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13335.3,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14618.542,Other,CMS Methodology,,65.6,,19998.03536,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11790.74,Other,"DRG Weight, with Charge Based Outlier",,70,,21339.367,Percent of Total Billed Charges,,,85,,25912.0885,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14183.012,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20729.6708,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12355.582,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11358.802,Other,"DRG Weight, with Charge Based Outlier",,65,,19815.1265,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13202,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8155.636,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8887,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8973,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8673,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8759,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8759,Other,CMS Methodology,,,"103% of Medicare, less IME",8844,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8995,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
VIRAL ILLNESS WITH MCC,865,DRG,,,,Inpatient,,,57267.83,14316.9575,7570,48677.6555,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27225.885,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19045.065,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21539.925,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23612.6895,Other,CMS Methodology,,65.6,,37567.69648,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19045.065,Other,"DRG Weight, with Charge Based Outlier",,70,,40087.481,Percent of Total Billed Charges,,,85,,48677.6555,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22909.197,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,38942.1244,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19957.4295,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18347.3745,Other,"DRG Weight, with Charge Based Outlier",,65,,37224.0895,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21325,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13173.441,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14355,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14494,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14009,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14147,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14147,Other,CMS Methodology,,,"103% of Medicare, less IME",14286,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14529,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
VIRAL ILLNESS WITHOUT MCC,866,DRG,,,,Inpatient,,,29697.18,7424.295,6720,25242.603,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16607.696,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11617.424,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13139.28,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14403.6592,Other,CMS Methodology,,65.6,,19481.35008,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11617.424,Other,"DRG Weight, with Charge Based Outlier",,70,,20788.026,Percent of Total Billed Charges,,,85,,25242.603,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13974.5312,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20194.0824,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12173.9632,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11191.8352,Other,"DRG Weight, with Charge Based Outlier",,65,,19303.167,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13008,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8035.7536,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8757,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8841,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8545,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8630,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8630,Other,CMS Methodology,,,"103% of Medicare, less IME",8714,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8863,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,DRG,,,,Inpatient,,,66252.67,16563.1675,9270,56314.7695,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40248.511,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28154.659,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31842.855,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34907.0597,Other,CMS Methodology,,65.6,,43461.75152,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28154.659,Other,"DRG Weight, with Charge Based Outlier",,70,,46376.869,Percent of Total Billed Charges,,,85,,56314.7695,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33867.0742,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45051.8156,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29503.4237,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27123.2507,Other,"DRG Weight, with Charge Based Outlier",,65,,43064.2355,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31525,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19474.5326,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21222,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21427,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20709,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20914,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20914,Other,CMS Methodology,,,"103% of Medicare, less IME",21119,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21478,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,DRG,,,,Inpatient,,,57359.73,14339.9325,9270,48755.7705,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19710.377,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13787.813,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15593.985,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17094.5779,Other,CMS Methodology,,65.6,,37627.98288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13787.813,Other,"DRG Weight, with Charge Based Outlier",,70,,40151.811,Percent of Total Billed Charges,,,85,,48755.7705,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16585.2794,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,39004.6164,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14448.3259,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13282.7149,Other,"DRG Weight, with Charge Based Outlier",,65,,37283.8245,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15438,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9537.0082,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10393,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10493,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10142,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10242,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10242,Other,CMS Methodology,,,"103% of Medicare, less IME",10343,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10518,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,DRG,,,,Inpatient,,,140191.3,35047.825,6535.4072,119162.605,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,13506.892,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9448.348,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10686.06,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11714.3684,Other,CMS Methodology,,65.6,,91965.4928,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9448.348,Other,"DRG Weight, with Charge Based Outlier",,70,,98133.91,Percent of Total Billed Charges,,,85,,119162.605,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,32880.3624,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,95330.084,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,37380.9764,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",9102.2204,Other,"DRG Weight, with Charge Based Outlier",,65,,91124.345,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10579,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6535.4072,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7122,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7191,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6950,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7019,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7019,Other,CMS Methodology,,,"103% of Medicare, less IME",7087,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7208,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,DRG,,,,Inpatient,,,242740.62,60685.155,16920,206329.527,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,136144.7181,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,91338.845,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,117109.1259,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,113244.8635,Other,CMS Methodology,,65.6,,159237.8467,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,91338.845,Other,"DRG Weight, with Charge Based Outlier",,70,,169918.434,Percent of Total Billed Charges,,,85,,206329.527,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,109870.961,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,165063.6216,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,95714.4835,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",84959.217,Other,"DRG Weight, with Charge Based Outlier",,65,,157781.403,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",102274,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,63178.933,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",68848,Other,CMS Methodology,,,"104.5% of Medicare, less IME",69513,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",67185,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",67850,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",67850,Other,CMS Methodology,,,"103% of Medicare, less IME",68515,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",69679,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,17515,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,17270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16920,Other,AR Medicaid Methodology
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,DRG,,,,Inpatient,,,75053.17,18763.2925,10120,63795.1945,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36828.617,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25762.373,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29137.185,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31941.0259,Other,CMS Methodology,,65.6,,49234.87952,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25762.373,Other,"DRG Weight, with Charge Based Outlier",,70,,52537.219,Percent of Total Billed Charges,,,85,,63795.1945,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30989.4074,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,51036.1556,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26996.5339,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24818.6029,Other,"DRG Weight, with Charge Based Outlier",,65,,48784.5605,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28847,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17819.7922,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19419,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19606,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18950,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19137,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19137,Other,CMS Methodology,,,"103% of Medicare, less IME",19325,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19653,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,DRG,,,,Inpatient,,,35445.5,8861.375,7570,30128.675,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19351.87,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13537.03,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15310.35,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16783.649,Other,CMS Methodology,,65.6,,23252.248,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13537.03,Other,"DRG Weight, with Charge Based Outlier",,70,,24811.85,Percent of Total Billed Charges,,,85,,30128.675,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16283.614,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24102.94,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14185.529,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13041.119,Other,"DRG Weight, with Charge Based Outlier",,65,,23039.575,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15158,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9363.542,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10204,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10302,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9957,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10056,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10056,Other,CMS Methodology,,,"103% of Medicare, less IME",10154,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10327,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,DRG,,,,Inpatient,,,100576.25,25144.0625,12670,85489.8125,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,73758.592,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51595.648,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,58354.56,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,63969.9584,Other,CMS Methodology,,65.6,,65978.02,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,51595.648,Other,"DRG Weight, with Charge Based Outlier",,70,,70403.375,Percent of Total Billed Charges,,,85,,85489.8125,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,62064.1024,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,68391.85,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,54067.3664,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,21717,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",49705.5104,Other,"DRG Weight, with Charge Based Outlier",,65,,65374.5625,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",57773,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,35688.6272,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",38891,Other,CMS Methodology,,,"104.5% of Medicare, less IME",39267,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",37951,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",38327,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",38327,Other,CMS Methodology,,,"103% of Medicare, less IME",38703,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",39361,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,DRG,,,,Inpatient,,,27555.5,6888.875,7239,23422.175,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17992.922,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12586.418,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14235.21,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15605.0494,Other,CMS Methodology,,65.6,,18076.408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12586.418,Other,"DRG Weight, with Charge Based Outlier",,70,,19288.85,Percent of Total Billed Charges,,,85,,23422.175,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15140.1284,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18737.74,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13189.3774,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,7239,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12125.3314,Other,"DRG Weight, with Charge Based Outlier",,65,,17911.075,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14093,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8706.0052,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9487,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9579,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9258,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9350,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9350,Other,CMS Methodology,,,"103% of Medicare, less IME",9441,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9602,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
DEPRESSIVE NEUROSES,881,DRG,,,,Inpatient,,,26608.13,6652.0325,7239,22616.9105,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17157.657,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12002.133,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13574.385,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14880.6339,Other,CMS Methodology,,65.6,,17454.93328,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12002.133,Other,"DRG Weight, with Charge Based Outlier",,70,,18625.691,Percent of Total Billed Charges,,,85,,22616.9105,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14437.2954,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18093.5284,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12577.1019,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,7239,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11562.4509,Other,"DRG Weight, with Charge Based Outlier",,65,,17295.2845,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13439,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8301.8562,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9047,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9134,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8828,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8916,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8916,Other,CMS Methodology,,,"103% of Medicare, less IME",9003,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9156,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
NEUROSES EXCEPT DEPRESSIVE,882,DRG,,,,Inpatient,,,27426.15,6856.5375,7239,23312.2275,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18056.74,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12631.06,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14285.7,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,15660.398,Other,CMS Methodology,,65.6,,17991.5544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12631.06,Other,"DRG Weight, with Charge Based Outlier",,70,,19198.305,Percent of Total Billed Charges,,,85,,23312.2275,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15193.828,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18649.782,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13236.158,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,7239,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12168.338,Other,"DRG Weight, with Charge Based Outlier",,65,,17826.9975,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14143,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8736.884,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9521,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9613,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9291,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9383,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9383,Other,CMS Methodology,,,"103% of Medicare, less IME",9475,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9636,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,DRG,,,,Inpatient,,,27823.17,6955.7925,7239,34797.703,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34797.703,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24341.707,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27530.415,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30179.6381,Other,CMS Methodology,,65.6,,18251.99952,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24341.707,Other,"DRG Weight, with Charge Based Outlier",,70,,19476.219,Percent of Total Billed Charges,,,85,,23649.6945,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29280.4966,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18919.7556,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25507.8101,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,7239,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23449.9811,Other,"DRG Weight, with Charge Based Outlier",,65,,18085.0605,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27256,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16837.1198,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18348,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18525,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17905,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18082,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18082,Other,CMS Methodology,,,"103% of Medicare, less IME",18259,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18569,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,DRG,,,,Inpatient,,,59839.67,14959.9175,12670,50863.7195,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31349.654,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21929.726,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24802.47,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27189.1858,Other,CMS Methodology,,65.6,,39254.82352,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21929.726,Other,"DRG Weight, with Charge Based Outlier",,70,,41887.769,Percent of Total Billed Charges,,,85,,50863.7195,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26379.1388,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40690.9756,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22980.2818,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,21717,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21126.3598,Other,"DRG Weight, with Charge Based Outlier",,65,,38895.7855,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24555,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15168.7564,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16530,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16689,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16131,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16290,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16290,Other,CMS Methodology,,,"103% of Medicare, less IME",16450,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16729,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
PSYCHOSES,885,DRG,,,,Inpatient,,,45960.04,11490.01,10970,39066.034,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26458.192,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18508.048,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20932.56,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22946.8784,Other,CMS Methodology,,65.6,,30149.78624,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18508.048,Other,"DRG Weight, with Charge Based Outlier",,70,,32172.028,Percent of Total Billed Charges,,,85,,39066.034,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22263.2224,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31252.8272,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19394.6864,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,16891,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17830.0304,Other,"DRG Weight, with Charge Based Outlier",,65,,29874.026,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20724,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12801.9872,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13951,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14085,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13614,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13748,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13748,Other,CMS Methodology,,,"103% of Medicare, less IME",13883,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14119,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,DRG,,,,Inpatient,,,68241.26,17060.315,12670,58005.071,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33720.305,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23588.045,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26678.025,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29245.2235,Other,CMS Methodology,,65.6,,44766.26656,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23588.045,Other,"DRG Weight, with Charge Based Outlier",,70,,47768.882,Percent of Total Billed Charges,,,85,,58005.071,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28373.921,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,46404.0568,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24718.0435,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,21717,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22723.9285,Other,"DRG Weight, with Charge Based Outlier",,65,,44356.819,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26412,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16315.813,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17780,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17952,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17350,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17522,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17522,Other,CMS Methodology,,,"103% of Medicare, less IME",17694,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17994,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
OTHER MENTAL DISORDER DIAGNOSES,887,DRG,,,,Inpatient,,,59451,14862.75,10802.1308,50533.35,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22325.038,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15616.822,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17662.59,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19362.2426,Other,CMS Methodology,,65.6,,38999.856,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15616.822,Other,"DRG Weight, with Charge Based Outlier",,70,,41615.7,Percent of Total Billed Charges,,,85,,50533.35,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18785.3836,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40426.68,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16364.9546,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,16891,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15044.7206,Other,"DRG Weight, with Charge Based Outlier",,65,,38643.15,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17486,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10802.1308,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11771,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11885,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11487,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11601,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11601,Other,CMS Methodology,,,"103% of Medicare, less IME",11714,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11914,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,DRG,,,,Inpatient,,,15317.6,3829.4,2413,13019.96,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11714.357,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8194.433,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9267.885,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10159.7239,Other,CMS Methodology,,65.6,,10048.3456,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8194.433,Other,"DRG Weight, with Charge Based Outlier",,70,,10722.32,Percent of Total Billed Charges,,,85,,13019.96,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,9857.0354,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,10415.968,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,8586.9919,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,2413,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7894.2409,Other,"DRG Weight, with Charge Based Outlier",,65,,9956.44,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9175,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5668.0762,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6177,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6236,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6027,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6087,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6087,Other,CMS Methodology,,,"103% of Medicare, less IME",6147,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6251,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,DRG,,,,Inpatient,,,26179.33,6544.8325,7239,26339.941,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26339.941,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18425.329,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,20839.005,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,22844.3207,Other,CMS Methodology,,65.6,,17173.64048,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18425.329,Other,"DRG Weight, with Charge Based Outlier",,70,,18325.531,Percent of Total Billed Charges,,,85,,22252.4305,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22163.7202,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,17801.9444,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19308.0047,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,7239,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17750.3417,Other,"DRG Weight, with Charge Based Outlier",,65,,17016.5645,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20631,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12744.7706,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",13888,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14022,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13553,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13687,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13687,Other,CMS Methodology,,,"103% of Medicare, less IME",13821,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14056,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,DRG,,,,Inpatient,,,51946.32,12986.58,8420,44154.372,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,33425.616,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23381.904,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,26444.88,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28989.6432,Other,CMS Methodology,,65.6,,34076.78592,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23381.904,Other,"DRG Weight, with Charge Based Outlier",,70,,36362.424,Percent of Total Billed Charges,,,85,,44154.372,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28125.9552,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35323.4976,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24502.0272,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,9652,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",22525.3392,Other,"DRG Weight, with Charge Based Outlier",,65,,33765.108,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26181,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16173.2256,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17624,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17795,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17199,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17369,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17369,Other,CMS Methodology,,,"103% of Medicare, less IME",17539,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17837,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,DRG,,,,Inpatient,,,27423.81,6855.9525,7239,23310.2385,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16558.894,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11583.286,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13100.67,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14361.3338,Other,CMS Methodology,,65.6,,17990.01936,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11583.286,Other,"DRG Weight, with Charge Based Outlier",,70,,19196.667,Percent of Total Billed Charges,,,85,,23310.2385,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13933.4668,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,18648.1908,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12138.1898,Other,"DRG Weight, with Length of Stay Based Outlier",2413,,,7239,Per diem,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11158.9478,Other,"DRG Weight, with Charge Based Outlier",,65,,17825.4765,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",12970,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8012.1404,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8731,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8815,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8520,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8604,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8604,Other,CMS Methodology,,,"103% of Medicare, less IME",8689,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8836,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,DRG,,,,Inpatient,,,130867.23,32716.8075,12670,111237.1455,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,83160.485,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,58172.465,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,65792.925,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,72124.1095,Other,CMS Methodology,,65.6,,85848.90288,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,58172.465,Other,"DRG Weight, with Charge Based Outlier",,70,,91607.061,Percent of Total Billed Charges,,,85,,111237.1455,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,69975.317,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,88989.7164,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,60959.2495,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",56041.3945,Other,"DRG Weight, with Charge Based Outlier",,65,,85063.6995,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",65137,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,40237.801,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",43848,Other,CMS Methodology,,,"104.5% of Medicare, less IME",44272,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",42789,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",43213,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",43213,Other,CMS Methodology,,,"103% of Medicare, less IME",43636,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",44378,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,DRG,,,,Inpatient,,,70072.71,17518.1775,8420,59561.8035,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,35617.952,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24915.488,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,28179.36,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,30891.0304,Other,CMS Methodology,,65.6,,45967.69776,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,24915.488,Other,"DRG Weight, with Charge Based Outlier",,70,,49050.897,Percent of Total Billed Charges,,,85,,59561.8035,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,29970.6944,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47649.4428,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26109.0784,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24002.7424,Other,"DRG Weight, with Charge Based Outlier",,65,,45547.2615,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",27898,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17234.0032,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18780,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18962,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18327,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",18508,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",18508,Other,CMS Methodology,,,"103% of Medicare, less IME",18690,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19007,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,DRG,,,,Inpatient,,,33008.29,8252.0725,5870,28057.0465,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,22882.507,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16006.783,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18103.635,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,19845.7289,Other,CMS Methodology,,65.6,,21653.43824,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16006.783,Other,"DRG Weight, with Charge Based Outlier",,70,,23105.803,Percent of Total Billed Charges,,,85,,28057.0465,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,19254.4654,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22445.6372,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,16773.5969,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",15420.3959,Other,"DRG Weight, with Charge Based Outlier",,65,,21455.3885,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",17923,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11071.8662,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12065,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12182,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11774,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11890,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11890,Other,CMS Methodology,,,"103% of Medicare, less IME",12007,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12211,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,DRG,,,,Inpatient,,,76719.3,19179.825,8420,72472.847,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,72472.847,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,50696.243,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,57337.335,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,62854.8469,Other,CMS Methodology,,65.6,,50327.8608,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,50696.243,Other,"DRG Weight, with Charge Based Outlier",,70,,53703.51,Percent of Total Billed Charges,,,85,,65211.405,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,60982.2134,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,52169.124,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,53124.8749,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",48839.0539,Other,"DRG Weight, with Charge Based Outlier",,65,,49867.545,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",56765,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,35066.5102,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",38213,Other,CMS Methodology,,,"104.5% of Medicare, less IME",38582,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",37290,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",37659,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",37659,Other,CMS Methodology,,,"103% of Medicare, less IME",38028,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",38674,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,DRG,,,,Inpatient,,,40661.4,10165.35,9270,34562.19,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30936.714,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21640.866,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24475.77,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26831.0478,Other,CMS Methodology,,65.6,,26673.8784,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21640.866,Other,"DRG Weight, with Charge Based Outlier",,70,,28462.98,Percent of Total Billed Charges,,,85,,34562.19,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26031.6708,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,27649.752,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22677.5838,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20848.0818,Other,"DRG Weight, with Charge Based Outlier",,65,,26429.91,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24232,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14968.9524,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16312,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16470,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15918,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16076,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16076,Other,CMS Methodology,,,"103% of Medicare, less IME",16233,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16509,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
HAND PROCEDURES FOR INJURIES,906,DRG,,,,Inpatient,,,85499.58,21374.895,8420,72674.643,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40965.525,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28656.225,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,32410.125,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,35528.9175,Other,CMS Methodology,,65.6,,56087.72448,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28656.225,Other,"DRG Weight, with Charge Based Outlier",,70,,59849.706,Percent of Total Billed Charges,,,85,,72674.643,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,34470.405,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,58139.7144,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30029.0175,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27606.4425,Other,"DRG Weight, with Charge Based Outlier",,65,,55574.727,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",32087,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19821.465,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21600,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21809,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21078,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21287,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21287,Other,CMS Methodology,,,"103% of Medicare, less IME",21496,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21861,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,DRG,,,,Inpatient,,,158182.61,39545.6525,12670,134455.2185,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,74774.049,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,52305.981,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,59157.945,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,64850.6523,Other,CMS Methodology,,65.6,,103767.7922,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,52305.981,Other,"DRG Weight, with Charge Based Outlier",,70,,110727.827,Percent of Total Billed Charges,,,85,,134455.2185,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,62918.5578,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,107564.1748,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,54811.7283,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",50389.8213,Other,"DRG Weight, with Charge Based Outlier",,65,,102818.6965,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",58568,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,36179.9634,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",39426,Other,CMS Methodology,,,"104.5% of Medicare, less IME",39807,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",38474,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",38855,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",38855,Other,CMS Methodology,,,"103% of Medicare, less IME",39236,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",39902,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,DRG,,,,Inpatient,,,73492.43,18373.1075,8420,62468.5655,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,37860.967,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26484.523,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29953.935,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,32836.3709,Other,CMS Methodology,,65.6,,48211.03408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,26484.523,Other,"DRG Weight, with Charge Based Outlier",,70,,51444.701,Percent of Total Billed Charges,,,85,,62468.5655,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,31858.0774,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,49974.8524,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,27753.2789,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",25514.2979,Other,"DRG Weight, with Charge Based Outlier",,65,,47770.0795,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",29655,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,18319.3022,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19963,Other,CMS Methodology,,,"104.5% of Medicare, less IME",20156,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",19481,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19674,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19674,Other,CMS Methodology,,,"103% of Medicare, less IME",19867,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",20204,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,DRG,,,,Inpatient,,,44810.52,11202.63,5870,38088.942,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,23805.991,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16652.779,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,18834.255,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20646.6557,Other,CMS Methodology,,65.6,,29395.70112,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16652.779,Other,"DRG Weight, with Charge Based Outlier",,70,,31367.364,Percent of Total Billed Charges,,,85,,38088.942,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20031.5302,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30471.1536,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17450.5397,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16042.7267,Other,"DRG Weight, with Charge Based Outlier",,65,,29126.838,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18646,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11518.7006,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12552,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12673,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12249,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12370,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12370,Other,CMS Methodology,,,"103% of Medicare, less IME",12492,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12704,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
TRAUMATIC INJURY WITH MCC,913,DRG,,,,Inpatient,,,38928.28,9732.07,7570,33089.038,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30375.491,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21248.279,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24031.755,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26344.3057,Other,CMS Methodology,,65.6,,25536.95168,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21248.279,Other,"DRG Weight, with Charge Based Outlier",,70,,27249.796,Percent of Total Billed Charges,,,85,,33089.038,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25559.4302,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,26471.2304,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22266.1897,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20469.8767,Other,"DRG Weight, with Charge Based Outlier",,65,,25303.382,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",23792,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14697.4006,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16016,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16171,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15629,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15784,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15784,Other,CMS Methodology,,,"103% of Medicare, less IME",15939,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16210,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
TRAUMATIC INJURY WITHOUT MCC,914,DRG,,,,Inpatient,,,35156.6,8789.15,7570,29883.11,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17200.828,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12032.332,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13608.54,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14918.0756,Other,CMS Methodology,,65.6,,23062.7296,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,12032.332,Other,"DRG Weight, with Charge Based Outlier",,70,,24609.62,Percent of Total Billed Charges,,,85,,29883.11,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14473.6216,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,23906.488,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12608.7476,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11591.5436,Other,"DRG Weight, with Charge Based Outlier",,65,,22851.79,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13473,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8322.7448,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9070,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9157,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8850,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8938,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8938,Other,CMS Methodology,,,"103% of Medicare, less IME",9026,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9179,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
ALLERGIC REACTIONS WITH MCC,915,DRG,,,,Inpatient,,,64933.31,16233.3275,8420,55193.3135,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32620.383,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22818.627,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25807.815,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,28291.2741,Other,CMS Methodology,,65.6,,42596.25136,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22818.627,Other,"DRG Weight, with Charge Based Outlier",,70,,45453.317,Percent of Total Billed Charges,,,85,,55193.3135,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27448.3926,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,44154.6508,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23911.7661,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21982.6971,Other,"DRG Weight, with Charge Based Outlier",,65,,42206.6515,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25550,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15783.6078,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",17200,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17366,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16784,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16951,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16951,Other,CMS Methodology,,,"103% of Medicare, less IME",17117,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17408,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
ALLERGIC REACTIONS WITHOUT MCC,916,DRG,,,,Inpatient,,,30145.6,7536.4,5870,25623.76,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12465.157,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8719.633,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,9861.885,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,10810.8839,Other,CMS Methodology,,65.6,,19775.5136,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,8719.633,Other,"DRG Weight, with Charge Based Outlier",,70,,21101.92,Percent of Total Billed Charges,,,85,,25623.76,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10488.7954,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20499.008,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9137.3519,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8400.2009,Other,"DRG Weight, with Charge Based Outlier",,65,,19594.64,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",9764,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6031.3562,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6573,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6636,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6414,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6477,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6477,Other,CMS Methodology,,,"103% of Medicare, less IME",6541,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6652,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,DRG,,,,Inpatient,,,66331.96,16582.99,9270,56382.166,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,30777.169,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21529.261,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24349.545,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,26692.6763,Other,CMS Methodology,,65.6,,43513.76576,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21529.261,Other,"DRG Weight, with Charge Based Outlier",,70,,46432.372,Percent of Total Billed Charges,,,85,,56382.166,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,25897.4218,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45105.7328,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22560.6323,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",20740.5653,Other,"DRG Weight, with Charge Based Outlier",,65,,43115.774,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24107,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,14891.7554,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16228,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16385,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",15836,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",15993,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",15993,Other,CMS Methodology,,,"103% of Medicare, less IME",16150,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16424,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,DRG,,,,Inpatient,,,31937.26,7984.315,7570,27146.671,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,16603.942,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11614.798,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13136.31,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14400.4034,Other,CMS Methodology,,65.6,,20950.84256,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11614.798,Other,"DRG Weight, with Charge Based Outlier",,70,,22356.082,Percent of Total Billed Charges,,,85,,27146.671,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,13971.3724,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21717.3368,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12171.2114,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11189.3054,Other,"DRG Weight, with Charge Based Outlier",,65,,20759.219,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13005,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8033.9372,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",8755,Other,CMS Methodology,,,"104.5% of Medicare, less IME",8839,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8543,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8628,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8628,Other,CMS Methodology,,,"103% of Medicare, less IME",8712,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",8861,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
COMPLICATIONS OF TREATMENT WITH MCC,919,DRG,,,,Inpatient,,,52799.67,13199.9175,9270,44879.7195,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,34228.972,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23943.868,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,27080.46,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,29686.3844,Other,CMS Methodology,,65.6,,34636.58352,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,23943.868,Other,"DRG Weight, with Charge Based Outlier",,70,,36959.769,Percent of Total Billed Charges,,,85,,44879.7195,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,28801.9384,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,35903.7756,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,25090.9124,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",23066.7164,Other,"DRG Weight, with Charge Based Outlier",,65,,34319.7855,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",26810,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,16561.9352,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",18048,Other,CMS Methodology,,,"104.5% of Medicare, less IME",18222,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",17612,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",17786,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",17786,Other,CMS Methodology,,,"103% of Medicare, less IME",17961,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",18266,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
COMPLICATIONS OF TREATMENT WITH CC,920,DRG,,,,Inpatient,,,36480.83,9120.2075,7570,31008.7055,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19068.443,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13338.767,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15086.115,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16537.8361,Other,CMS Methodology,,65.6,,23931.42448,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13338.767,Other,"DRG Weight, with Charge Based Outlier",,70,,25536.581,Percent of Total Billed Charges,,,85,,31008.7055,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16045.1246,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,24806.9644,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13977.7681,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12850.1191,Other,"DRG Weight, with Charge Based Outlier",,65,,23712.5395,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14936,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9226.4038,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10054,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10151,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9811,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9909,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9909,Other,CMS Methodology,,,"103% of Medicare, less IME",10006,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10176,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,DRG,,,,Inpatient,,,19659.01,4914.7525,5870,16710.1585,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,12908.129,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9029.501,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,10212.345,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,11195.0683,Other,CMS Methodology,,65.6,,12896.31056,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,9029.501,Other,"DRG Weight, with Charge Based Outlier",,70,,13761.307,Percent of Total Billed Charges,,,85,,16710.1585,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,10861.5338,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,13368.1268,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,9462.0643,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",8698.7173,Other,"DRG Weight, with Charge Based Outlier",,65,,12778.3565,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",10110,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,6245.6914,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",6806,Other,CMS Methodology,,,"104.5% of Medicare, less IME",6872,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",6642,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",6707,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",6707,Other,CMS Methodology,,,"103% of Medicare, less IME",6773,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",6888,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,DRG,,,,Inpatient,,,60025.32,15006.33,8420,51021.522,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31710.038,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22181.822,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25087.59,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27501.7426,Other,CMS Methodology,,65.6,,39376.60992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22181.822,Other,"DRG Weight, with Charge Based Outlier",,70,,42017.724,Percent of Total Billed Charges,,,85,,51021.522,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26682.3836,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40817.2176,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23244.4546,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21369.2206,Other,"DRG Weight, with Charge Based Outlier",,65,,39016.458,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24837,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15343.1308,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16720,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16881,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16316,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16477,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16477,Other,CMS Methodology,,,"103% of Medicare, less IME",16639,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16922,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,DRG,,,,Inpatient,,,29211.71,7302.9275,7570,24829.9535,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,19143.523,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13391.287,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,15145.515,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16602.9521,Other,CMS Methodology,,65.6,,19162.88176,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13391.287,Other,"DRG Weight, with Charge Based Outlier",,70,,20448.197,Percent of Total Billed Charges,,,85,,24829.9535,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,16108.3006,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,19863.9628,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14032.8041,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12900.7151,Other,"DRG Weight, with Charge Based Outlier",,65,,18987.6115,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14994,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9262.7318,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10094,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10191,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9850,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9948,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9948,Other,CMS Methodology,,,"103% of Medicare, less IME",10045,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10216,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,DRG,,,,Inpatient,,,15436.55,3859.1375,6720,40276.666,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,40276.666,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28174.354,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31865.13,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34931.4782,Other,CMS Methodology,,65.6,,10126.3768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28174.354,Other,"DRG Weight, with Charge Based Outlier",,70,,10805.585,Percent of Total Billed Charges,,,85,,13121.0675,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33890.7652,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,10496.854,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29524.0622,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27142.2242,Other,"DRG Weight, with Charge Based Outlier",,65,,10033.7575,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31547,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19488.1556,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21237,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21442,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20724,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20929,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20929,Other,CMS Methodology,,,"103% of Medicare, less IME",21134,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21493,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
NON-EXTENSIVE BURNS,935,DRG,,,,Inpatient,,,45191.59,11297.8975,7570,41226.428,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,41226.428,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28838.732,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,32616.54,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,35755.1956,Other,CMS Methodology,,65.6,,29645.68304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,28838.732,Other,"DRG Weight, with Charge Based Outlier",,70,,31634.113,Percent of Total Billed Charges,,,85,,38412.8515,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,34689.9416,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30730.2812,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,30220.2676,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",27782.2636,Other,"DRG Weight, with Charge Based Outlier",,65,,29374.5335,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",32291,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19947.7048,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",21738,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21948,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",21212,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",21422,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",21422,Other,CMS Methodology,,,"103% of Medicare, less IME",21633,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",22000,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,DRG,,,,Inpatient,,,117883.85,29470.9625,16070,100201.2725,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,59575.98,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,41674.62,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,47133.9,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,51669.546,Other,CMS Methodology,,65.6,,77331.8056,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,41674.62,Other,"DRG Weight, with Charge Based Outlier",,70,,82518.695,Percent of Total Billed Charges,,,85,,100201.2725,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,50130.156,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,80161.018,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,49167.066,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",40147.926,Other,"DRG Weight, with Charge Based Outlier",,65,,76624.5025,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",46664,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,28826.268,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",31413,Other,CMS Methodology,,,"104.5% of Medicare, less IME",31716,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",30654,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",30957,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",30957,Other,CMS Methodology,,,"103% of Medicare, less IME",31261,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",31792,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,16622.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,16395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,DRG,,,,Inpatient,,,67416.57,16854.1425,6720,57304.0845,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,39630.978,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27722.682,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,31354.29,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,34371.4806,Other,CMS Methodology,,65.6,,44225.26992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,27722.682,Other,"DRG Weight, with Charge Based Outlier",,70,,47191.599,Percent of Total Billed Charges,,,85,,57304.0845,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,33347.4516,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,45843.2676,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,29050.7526,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",26707.0986,Other,"DRG Weight, with Charge Based Outlier",,65,,43820.7705,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",31042,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,19175.7348,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",20896,Other,CMS Methodology,,,"104.5% of Medicare, less IME",21098,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",20392,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",20593,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",20593,Other,CMS Methodology,,,"103% of Medicare, less IME",20795,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",21149,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,DRG,,,,Inpatient,,,53017.8,13254.45,5870,45065.13,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,36682.211,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25659.959,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,29021.355,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,31814.0497,Other,CMS Methodology,,65.6,,34779.6768,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,25659.959,Other,"DRG Weight, with Charge Based Outlier",,70,,37112.46,Percent of Total Billed Charges,,,85,,45065.13,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,30866.2142,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,36052.104,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,26889.2137,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",24719.9407,Other,"DRG Weight, with Charge Based Outlier",,65,,34461.57,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",28732,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,17748.9526,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",19341,Other,CMS Methodology,,,"104.5% of Medicare, less IME",19528,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",18874,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",19061,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",19061,Other,CMS Methodology,,,"103% of Medicare, less IME",19248,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",19575,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,5912.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,5895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,5870,Other,AR Medicaid Methodology
REHABILITATION WITH CC/MCC,945,DRG,,,,Inpatient,,,58443.7,14610.925,12670,49677.145,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28652.405,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20042.945,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22668.525,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24849.8935,Other,CMS Methodology,,65.6,,38339.0672,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,20042.945,Other,"DRG Weight, with Charge Based Outlier",,70,,40910.59,Percent of Total Billed Charges,,,85,,49677.145,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,24109.541,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,39741.716,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,21003.1135,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",19308.6985,Other,"DRG Weight, with Charge Based Outlier",,65,,37988.405,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22442,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13863.673,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",15108,Other,CMS Methodology,,,"104.5% of Medicare, less IME",15254,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14743,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14889,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14889,Other,CMS Methodology,,,"103% of Medicare, less IME",15035,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15290,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
REHABILITATION WITHOUT CC/MCC,946,DRG,,,,Inpatient,,,45538.24,11384.56,10140.053,38707.504,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20956.705,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14659.645,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16580.025,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18175.5035,Other,CMS Methodology,,65.6,,29873.08544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14659.645,Other,"DRG Weight, with Charge Based Outlier",,70,,31876.768,Percent of Total Billed Charges,,,85,,38707.504,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17634.001,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,30966.0032,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15361.9235,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14122.6085,Other,"DRG Weight, with Charge Based Outlier",,65,,29599.856,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16415,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10140.053,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11050,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11157,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10783,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10890,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10890,Other,CMS Methodology,,,"103% of Medicare, less IME",10996,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11183,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
SIGNS AND SYMPTOMS WITH MCC,947,DRG,,,,Inpatient,,,59656.35,14914.0875,11681.2684,50707.8975,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,24141.974,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16887.806,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,19100.07,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,20938.0498,Other,CMS Methodology,,65.6,,39134.5656,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,16887.806,Other,"DRG Weight, with Charge Based Outlier",,70,,41759.445,Percent of Total Billed Charges,,,85,,50707.8975,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,20314.2428,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,40566.318,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,17696.8258,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",16269.1438,Other,"DRG Weight, with Charge Based Outlier",,65,,38776.6275,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",18910,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,11681.2684,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",12729,Other,CMS Methodology,,,"104.5% of Medicare, less IME",12852,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",12422,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",12545,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",12545,Other,CMS Methodology,,,"103% of Medicare, less IME",12668,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",12883,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,12160,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12020,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,11820,Other,AR Medicaid Methodology
SIGNS AND SYMPTOMS WITHOUT MCC,948,DRG,,,,Inpatient,,,32033.76,8008.44,7215.649,27228.696,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,14912.765,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10431.785,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,11798.325,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,12933.6655,Other,CMS Methodology,,65.6,,21014.14656,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,10431.785,Other,"DRG Weight, with Charge Based Outlier",,70,,22423.632,Percent of Total Billed Charges,,,85,,27228.696,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,12548.333,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,21782.9568,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,10931.5255,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",10049.6305,Other,"DRG Weight, with Charge Based Outlier",,65,,20821.944,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",11681,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,7215.649,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",7863,Other,CMS Methodology,,,"104.5% of Medicare, less IME",7939,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",7673,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",7749,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",7749,Other,CMS Methodology,,,"103% of Medicare, less IME",7825,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",7958,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
AFTERCARE WITH CC/MCC,949,DRG,,,,Inpatient,,,46047.75,11511.9375,9799.478,39140.5875,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,20252.83,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14167.27,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,16023.15,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,17565.041,Other,CMS Methodology,,65.6,,30207.324,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,14167.27,Other,"DRG Weight, with Charge Based Outlier",,70,,32233.425,Percent of Total Billed Charges,,,85,,39140.5875,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17041.726,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,31312.47,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,14845.961,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",13648.271,Other,"DRG Weight, with Charge Based Outlier",,65,,29931.0375,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",15863,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9799.478,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",10679,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10782,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",10421,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",10524,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",10524,Other,CMS Methodology,,,"103% of Medicare, less IME",10627,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10808,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
AFTERCARE WITHOUT CC/MCC,950,DRG,,,,Inpatient,,,58037.58,14509.395,5322.9602,49331.943,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,11001.097,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7695.493,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,8703.585,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,9541.1219,Other,CMS Methodology,,65.6,,38072.65248,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7695.493,Other,"DRG Weight, with Charge Based Outlier",,70,,40626.306,Percent of Total Billed Charges,,,85,,49331.943,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,17862.8634,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,39465.5544,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,24552.1499,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7413.5789,Other,"DRG Weight, with Charge Based Outlier",,65,,37724.427,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",8617,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5322.9602,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",5801,Other,CMS Methodology,,,"104.5% of Medicare, less IME",5857,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5660,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5716,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5716,Other,CMS Methodology,,,"103% of Medicare, less IME",5773,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",5871,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
OTHER FACTORS INFLUENCING HEALTH STATUS,951,DRG,,,,Inpatient,,,30379.38,7594.845,5149.494,25822.473,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,10642.59,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7444.71,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,8419.95,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,9230.193,Other,CMS Methodology,,65.6,,19928.87328,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,7444.71,Other,"DRG Weight, with Charge Based Outlier",,70,,21265.566,Percent of Total Billed Charges,,,85,,25822.473,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,8955.198,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20657.9784,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,7801.353,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",7171.983,Other,"DRG Weight, with Charge Based Outlier",,65,,19746.597,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",8336,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,5149.494,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",5612,Other,CMS Methodology,,,"104.5% of Medicare, less IME",5666,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",5476,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",5530,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",5530,Other,CMS Methodology,,,"103% of Medicare, less IME",5584,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",5679,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,DRG,,,,Inpatient,,,186627.56,46656.89,12670,158633.426,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,128167.191,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,89655.579,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,101400.255,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,111157.8957,Other,CMS Methodology,,65.6,,122427.6794,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,89655.579,Other,"DRG Weight, with Charge Based Outlier",,70,,130639.292,Percent of Total Billed Charges,,,85,,158633.426,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,107846.1702,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,126906.7408,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,93950.5797,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",65319.646,Other,"DRG Weight, with Charge Based Outlier",,65,,121307.914,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",100389,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,62014.6206,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",67579,Other,CMS Methodology,,,"104.5% of Medicare, less IME",68232,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",65947,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",66600,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",66600,Other,CMS Methodology,,,"103% of Medicare, less IME",67252,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",68395,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,DRG,,,,Inpatient,,,173506.76,43376.69,12670,147480.746,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,71746.448,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,50188.112,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,56762.64,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,62224.8496,Other,CMS Methodology,,65.6,,113820.4346,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,50188.112,Other,"DRG Weight, with Charge Based Outlier",,70,,121454.732,Percent of Total Billed Charges,,,85,,147480.746,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,60370.9856,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,117984.5968,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,52592.4016,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",48349.5376,Other,"DRG Weight, with Charge Based Outlier",,65,,112779.394,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",56197,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,34715.0368,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",37830,Other,CMS Methodology,,,"104.5% of Medicare, less IME",38195,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",36916,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",37282,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",37282,Other,CMS Methodology,,,"103% of Medicare, less IME",37647,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",38287,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13052.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,12895,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,12670,Other,AR Medicaid Methodology
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,DRG,,,,Inpatient,,,253194.74,63298.685,16070,215215.529,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,149991.7986,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,98004.946,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,129216.9214,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,121509.7118,Other,CMS Methodology,,65.6,,166095.7494,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,98004.946,Other,"DRG Weight, with Charge Based Outlier",,70,,177236.318,Percent of Total Billed Charges,,,85,,215215.529,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,117889.5748,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,172172.4232,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,102699.9278,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",88618.159,Other,"DRG Weight, with Charge Based Outlier",,65,,164576.581,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",109738,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,67789.8644,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",73872,Other,CMS Methodology,,,"104.5% of Medicare, less IME",74586,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",72088,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",72802,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",72802,Other,CMS Methodology,,,"103% of Medicare, less IME",73515,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",74765,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,16622.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,16395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,16070,Other,AR Medicaid Methodology
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,DRG,,,,Inpatient,,,134662.82,33665.705,10120,114463.397,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,77140.946,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53961.674,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,61030.53,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,66903.4342,Other,CMS Methodology,,65.6,,88338.80992,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,53961.674,Other,"DRG Weight, with Charge Based Outlier",,70,,94263.974,Percent of Total Billed Charges,,,85,,114463.397,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,64910.1812,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,91570.7176,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,56546.7382,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",51984.8602,Other,"DRG Weight, with Charge Based Outlier",,65,,87530.833,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",60422,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,37325.2036,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",40674,Other,CMS Methodology,,,"104.5% of Medicare, less IME",41067,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",39692,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",40085,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",40085,Other,CMS Methodology,,,"103% of Medicare, less IME",40478,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",41165,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,DRG,,,,Inpatient,,,85427.27,21356.8175,8420,72613.1795,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,49626.003,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34714.407,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,39261.915,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,43040.0481,Other,CMS Methodology,,65.6,,56040.28912,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,34714.407,Other,"DRG Weight, with Charge Based Outlier",,70,,59799.089,Percent of Total Billed Charges,,,85,,72613.1795,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,41757.7566,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,58090.5436,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,36377.4201,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",33442.6911,Other,"DRG Weight, with Charge Based Outlier",,65,,55527.7255,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",38870,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24011.8998,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",26166,Other,CMS Methodology,,,"104.5% of Medicare, less IME",26419,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",25534,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",25787,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",25787,Other,CMS Methodology,,,"103% of Medicare, less IME",26040,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",26482,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,DRG,,,,Inpatient,,,93446.94,23361.735,10120,79429.899,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,50992.459,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35670.271,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,40342.995,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,44225.1593,Other,CMS Methodology,,65.6,,61301.19264,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,35670.271,Other,"DRG Weight, with Charge Based Outlier",,70,,65412.858,Percent of Total Billed Charges,,,85,,79429.899,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,42907.5598,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,63543.9192,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,37379.0753,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",34363.5383,Other,"DRG Weight, with Charge Based Outlier",,65,,60740.511,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",39941,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,24673.0694,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",26887,Other,CMS Methodology,,,"104.5% of Medicare, less IME",27147,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",26237,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",26497,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",26497,Other,CMS Methodology,,,"103% of Medicare, less IME",26757,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",27212,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,10375,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,10270,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10120,Other,AR Medicaid Methodology
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,DRG,,,,Inpatient,,,48913.65,12228.4125,8420,41576.6025,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,28156.877,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19696.313,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,22276.485,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,24420.1279,Other,CMS Methodology,,65.6,,32087.3544,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,19696.313,Other,"DRG Weight, with Charge Based Outlier",,70,,34239.555,Percent of Total Billed Charges,,,85,,41576.6025,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,23692.5794,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,33261.282,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,20639.8759,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18974.7649,Other,"DRG Weight, with Charge Based Outlier",,65,,31793.8725,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",22054,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13623.9082,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14846,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14990,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",14488,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14631,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14631,Other,CMS Methodology,,,"103% of Medicare, less IME",14775,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",15026,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,DRG,,,,Inpatient,,,30770.62,7692.655,7570,26155.027,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,17129.502,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11982.438,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,13552.11,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,14856.2154,Other,CMS Methodology,,65.6,,20185.52672,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,11982.438,Other,"DRG Weight, with Charge Based Outlier",,70,,21539.434,Percent of Total Billed Charges,,,85,,26155.027,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,14413.6044,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,20924.0216,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,12556.4634,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",11543.4774,Other,"DRG Weight, with Charge Based Outlier",,65,,20000.903,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",13417,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,8288.2332,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9032,Other,CMS Methodology,,,"104.5% of Medicare, less IME",9119,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",8814,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",8901,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",8901,Other,CMS Methodology,,,"103% of Medicare, less IME",8988,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",9141,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,7697.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,7645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,7570,Other,AR Medicaid Methodology
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,DRG,,,,Inpatient,,,200108.27,50027.0675,14370,170092.0295,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,118707.111,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,83038.059,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,93915.855,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,102953.2797,Other,CMS Methodology,,65.6,,131271.0251,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,83038.059,Other,"DRG Weight, with Charge Based Outlier",,70,,140075.789,Percent of Total Billed Charges,,,85,,170092.0295,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,99885.9942,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,136073.6236,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,87016.0437,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",70037.8945,Other,"DRG Weight, with Charge Based Outlier",,65,,130070.3755,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",92979,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,57437.2926,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",62591,Other,CMS Methodology,,,"104.5% of Medicare, less IME",63196,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",61079,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",61684,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",61684,Other,CMS Methodology,,,"103% of Medicare, less IME",62289,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",63347,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,14837.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,14645,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,14370,Other,AR Medicaid Methodology
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,DRG,,,,Inpatient,,,121429.75,30357.4375,13520,103215.2875,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,56050.974,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,39208.806,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,44345.07,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,48612.3498,Other,CMS Methodology,,65.6,,79657.916,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,39208.806,Other,"DRG Weight, with Charge Based Outlier",,70,,85000.825,Percent of Total Billed Charges,,,85,,103215.2875,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,47164.0428,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,82572.23,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,41087.1258,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",37772.4438,Other,"DRG Weight, with Charge Based Outlier",,65,,78929.3375,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",43903,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,27120.6684,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",29554,Other,CMS Methodology,,,"104.5% of Medicare, less IME",29840,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",28840,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",29126,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",29126,Other,CMS Methodology,,,"103% of Medicare, less IME",29411,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",29911,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
HIV WITH MAJOR RELATED CONDITION WITH CC,975,DRG,,,,Inpatient,,,76065.34,19016.335,10970,64655.539,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,26679.678,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18662.982,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21107.79,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23138.9706,Other,CMS Methodology,,65.6,,49898.86304,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18662.982,Other,"DRG Weight, with Charge Based Outlier",,70,,53245.738,Percent of Total Billed Charges,,,85,,64655.539,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22449.5916,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,51724.4312,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19557.0426,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",17979.2886,Other,"DRG Weight, with Charge Based Outlier",,65,,49442.471,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",20897,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,12909.1548,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14067,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14203,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13728,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",13864,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",13864,Other,CMS Methodology,,,"103% of Medicare, less IME",13999,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14237,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,DRG,,,,Inpatient,,,33437.83,8359.4575,6720,28422.1555,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,18826.31,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13169.39,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,14894.55,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,16327.837,Other,CMS Methodology,,65.6,,21935.21648,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,13169.39,Other,"DRG Weight, with Charge Based Outlier",,70,,23406.481,Percent of Total Billed Charges,,,85,,28422.1555,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,15841.382,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,22737.7244,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,13800.277,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",12686.947,Other,"DRG Weight, with Charge Based Outlier",,65,,21734.5895,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",14746,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,9109.246,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",9927,Other,CMS Methodology,,,"104.5% of Medicare, less IME",10022,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",9687,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",9783,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",9783,Other,CMS Methodology,,,"103% of Medicare, less IME",9879,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",10046,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,DRG,,,,Inpatient,,,64096.23,16024.0575,10970,54481.7955,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,27064.463,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18932.147,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,21412.215,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,23472.6901,Other,CMS Methodology,,65.6,,42047.12688,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,18932.147,Other,"DRG Weight, with Charge Based Outlier",,70,,44867.361,Percent of Total Billed Charges,,,85,,54481.7955,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,22773.3686,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,43585.4364,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,19839.1021,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",18238.5931,Other,"DRG Weight, with Charge Based Outlier",,65,,41662.5495,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",21199,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,13095.3358,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",14270,Other,CMS Methodology,,,"104.5% of Medicare, less IME",14408,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",13926,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",14064,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",14064,Other,CMS Methodology,,,"103% of Medicare, less IME",14201,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",14443,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,11267.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,11145,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,10970,Other,AR Medicaid Methodology
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,DRG,,,,Inpatient,,,150877.42,37719.355,13520,128245.807,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,89230.703,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,62418.707,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,70595.415,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,77388.7381,Other,CMS Methodology,,65.6,,98975.58752,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,62418.707,Other,"DRG Weight, with Charge Based Outlier",,70,,105614.194,Percent of Total Billed Charges,,,85,,128245.807,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,75083.0966,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,102596.6456,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,65408.9101,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",60132.0811,Other,"DRG Weight, with Charge Based Outlier",,65,,98070.323,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",69891,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,43174.9198,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",47049,Other,CMS Methodology,,,"104.5% of Medicare, less IME",47503,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",45912,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",46367,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",46367,Other,CMS Methodology,,,"103% of Medicare, less IME",46822,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",47617,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,DRG,,,,Inpatient,,,84861.34,21215.335,9270,72132.139,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,45954.591,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32146.179,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,36357.255,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,39855.8757,Other,CMS Methodology,,65.6,,55669.03904,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,32146.179,Other,"DRG Weight, with Charge Based Outlier",,70,,59402.938,Percent of Total Billed Charges,,,85,,72132.139,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,38668.4502,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,57705.7112,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,33686.1597,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",30968.5467,Other,"DRG Weight, with Charge Based Outlier",,65,,55159.871,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",35995,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,22235.4606,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",24231,Other,CMS Methodology,,,"104.5% of Medicare, less IME",24465,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",23645,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",23879,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",23879,Other,CMS Methodology,,,"103% of Medicare, less IME",24113,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",24523,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,9482.5,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,9395,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,9270,Other,AR Medicaid Methodology
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,DRG,,,,Inpatient,,,57661.19,14415.2975,6720,49012.0115,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,31312.114,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21903.466,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,24772.77,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27156.6278,Other,CMS Methodology,,65.6,,37825.74064,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,21903.466,Other,"DRG Weight, with Charge Based Outlier",,70,,40362.833,Percent of Total Billed Charges,,,85,,49012.0115,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,26347.5508,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,39209.6092,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,22952.7638,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21101.0618,Other,"DRG Weight, with Charge Based Outlier",,65,,37479.7735,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",24526,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15150.5924,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16510,Other,CMS Methodology,,,"104.5% of Medicare, less IME",16670,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16111,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16271,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16271,Other,CMS Methodology,,,"103% of Medicare, less IME",16430,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",16709,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,6805,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,6770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,6720,Other,AR Medicaid Methodology
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,DRG,,,,Inpatient,,,110959.39,27739.8475,13520,94315.4815,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,65745.679,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45990.451,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,52015.095,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,57020.4533,Other,CMS Methodology,,65.6,,72789.35984,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,45990.451,Other,"DRG Weight, with Charge Based Outlier",,70,,77671.573,Percent of Total Billed Charges,,,85,,94315.4815,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,55321.6438,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,75452.3852,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,48193.6493,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",44305.6523,Other,"DRG Weight, with Charge Based Outlier",,65,,72123.6035,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",51496,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,31811.5214,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",34666,Other,CMS Methodology,,,"104.5% of Medicare, less IME",35001,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",33828,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",34163,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",34163,Other,CMS Methodology,,,"103% of Medicare, less IME",34498,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",35084,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,13945,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,13770,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,13520,Other,AR Medicaid Methodology
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,DRG,,,,Inpatient,,,63803.68,15950.92,8420,54233.128,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,32209.32,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22531.08,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,25482.6,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,27934.764,Other,CMS Methodology,,65.6,,41855.21408,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,22531.08,Other,"DRG Weight, with Charge Based Outlier",,70,,44662.576,Percent of Total Billed Charges,,,85,,54233.128,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,27102.504,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,43386.5024,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,23610.444,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",21705.684,Other,"DRG Weight, with Charge Based Outlier",,65,,41472.392,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",25228,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,15584.712,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",16983,Other,CMS Methodology,,,"104.5% of Medicare, less IME",17147,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",16573,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",16737,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",16737,Other,CMS Methodology,,,"103% of Medicare, less IME",16901,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",17188,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,DRG,,,,Inpatient,,,70517.04,17629.26,8420,59939.484,,,,Base rate of $18770 multiplied by MS-DRG weight. Outlier payment of 41.3% on charges exceeding $229251. ,21688.735,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15171.715,Other,"DRG Weight, with Charge Based Outlier",,,Base rate of $14850 multiplied by MS-DRG weight. Outlier payment of 43.7% on charges exceeding $211150. ,17159.175,Other,"DRG Weight, with Charge Based Outlier",,,225% of Baptist Health Medical Center-Little Rock Medicare,18810.3845,Other,CMS Methodology,,65.6,,46259.17824,Percent of Total Billed Charges,,,,Base rate of $13130 multiplied by MS-DRG weight. Outlier payment of 40% on charges exceeding $270000. ,15171.715,Other,"DRG Weight, with Charge Based Outlier",,70,,49361.928,Percent of Total Billed Charges,,,85,,59939.484,Percent of Total Billed Charges,,,,Base rate of $15794 multiplied by MS-DRG weight. Outlier payment of $4303 per diem when length of stay is greater than ALOS times 2. ,18249.967,Other,"DRG Weight, with Length of Stay Based Outlier",,68,,47951.5872,Percent of Total Billed Charges,,,,Base rate of $13759 multiplied by MS-DRG weight. Outlier payment of $5496 per diem when length of stay is greater than ALOS plus 3. ,15898.5245,Other,"DRG Weight, with Length of Stay Based Outlier",,,,,,,,,"Base rate of $12649 multiplied by MS-DRG weight. If total charges exceed $183000, payment of 35% on total charges. ",14615.9195,Other,"DRG Weight, with Charge Based Outlier",,65,,45836.076,Percent of Total Billed Charges,,,,"153.75% of Medicare, less DSH and IME.  Outlier payment at 100% of Medicare.",16988,Other,CMS Methodology,,,Base rate of $9082 multiplied by MS-DRG weight. Outlier payment of 32% on charges exceeding $270000. ,10494.251,Other,"DRG Weight, with Charge Based Outlier",,,"103.5% of Medicare, less IME",11436,Other,CMS Methodology,,,"104.5% of Medicare, less IME",11546,Other,CMS Methodology,,,"101% of Medicare, less IME; Bad Debt reimbursed",11160,Other,CMS Methodology,,,"102% of Medicare, less Operating IME",11270,Other,CMS Methodology,,,"102% of Medicare, less IME; Bad Debt reimbursed",11270,Other,CMS Methodology,,,"103% of Medicare, less IME",11381,Other,CMS Methodology,,,"104.75% of Medicare, less Operating IME",11574,Other,CMS Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology,,,Per Diem rate of $892.5. Discharge payment of $5020. ,8590,Other,AR Medicaid Methodology,,,Per Diem rate of $875. Discharge payment of $5020. ,8520,Other,AR Medicaid Methodology,,,Per Diem rate of $850. Discharge payment of $5020. ,8420,Other,AR Medicaid Methodology
A9575 - INJ GADOTERATE MEGLUMI 0.1ML,A9575,HCPCS,,,PO,Outpatient,0.1,ML,0.85,0.2125,0.01,1.6,,,,,,,,0.13,,,0.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.15,,,0.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.56,Percent of Total Billed Charges, ,0.13,,,0.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.6,Percent of Total Billed Charges, ,,85,,0.72,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.2,,0.58,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.51,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.13,,,0.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.6,,,1.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.6,,,1.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.6,,,1.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.6,,,1.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q9950 - INJ SULF HEXA LIPID MICROSPH,Q9950,HCPCS,,,JZ,Outpatient,1,ML,75.66,18.915,0.01,64.31,,,,,,,,21.29,,,21.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.8,,,23.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.63,Percent of Total Billed Charges, ,21.29,,,21.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.96,Percent of Total Billed Charges, ,,85,,64.31,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51.45,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,45.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.29,,,21.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q9950 - INJ SULF HEXA LIPID MICROSPH,Q9950,HCPCS,,,JW,Outpatient,1,ML,34,8.5,0.01,28.9,,,,,,,,21.29,,,21.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.8,,,23.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,22.3,Percent of Total Billed Charges, ,21.29,,,21.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23.8,Percent of Total Billed Charges, ,,85,,28.9,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,23.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,20.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.29,,,21.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q9966 - LOCM 200-299MG-ML IODINE1ML,Q9966,HCPCS,,,XU,Outpatient,1,ML,2.12,0.53,0.01,1.8,,,,,,,,0.43,,,0.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.44,,,0.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.39,Percent of Total Billed Charges, ,0.43,,,0.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.48,Percent of Total Billed Charges, ,,85,,1.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,1.44,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.27,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.43,,,0.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q9966 - LOCM 200-299MG-ML IODINE1ML,Q9966,HCPCS,,,PO,Outpatient,1,ML,14.76,3.69,0.01,12.55,,,,,,,,0.43,,,0.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.44,,,0.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.68,Percent of Total Billed Charges, ,0.43,,,0.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.33,Percent of Total Billed Charges, ,,85,,12.55,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.04,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,8.86,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.43,,,0.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q9967 - LOCM 300-399MG-ML IODINE1ML,Q9967,HCPCS,,,PO,Outpatient,1,ML,2.56,0.64,0.01,2.18,,,,,,,,0.17,,,0.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.18,,,0.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.68,Percent of Total Billed Charges, ,0.17,,,0.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.79,Percent of Total Billed Charges, ,,85,,2.18,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1.74,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.54,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.17,,,0.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q9967 - LOCM 300-399MG-ML IODINE1ML,Q9967,HCPCS,,,JW,Outpatient,1,ML,1.21,0.3025,0.01,1.03,,,,,,,,0.17,,,0.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.18,,,0.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.79,Percent of Total Billed Charges, ,0.17,,,0.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.85,Percent of Total Billed Charges, ,,85,,1.03,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.8,,0.82,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.73,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.17,,,0.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0255 - PHARMACY (ALSO SEE 063X AN EXTENSION OF 025X) - DRUGS INCIDENT TO RADIOLOGY,0255,RC,,,,Outpatient,,,3.86,0.965,2.32,3.28,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,2.53,Percent of Total Billed Charges, ,,,,,,,,70,,2.7,Percent of Total Billed Charges, ,,85,,3.28,Percent of Total Billed Charges, ,,,,,,,,67.9,,2.62,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,2.32,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
J7030 - NORMAL SALINE SOLUTION INFUS,J7030,HCPCS,,,AY,Outpatient,1000,UN,14.1,3.525,0.01,11.99,,,,,,,,2.93,,,2.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.36,,,3.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.25,Percent of Total Billed Charges, ,2.93,,,2.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9.87,Percent of Total Billed Charges, ,,85,,11.99,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9.59,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,8.46,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.93,,,2.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J7040 - NORMAL SALINE SOLUTION INFUS,J7040,HCPCS,,,AY,Outpatient,500,ML,55.77,13.9425,0.01,47.4,,,,,,,,1.46,,,1.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.69,,,1.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,36.59,Percent of Total Billed Charges, ,1.46,,,1.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,39.04,Percent of Total Billed Charges, ,,85,,47.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,37.92,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,33.46,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.46,,,1.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J7050 - NORMAL SALINE SOLUTION INFUS,J7050,HCPCS,,,AY,Outpatient,250,UN,4.07,1.0175,0.01,3.46,,,,,,,,0.74,,,0.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.84,,,0.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.67,Percent of Total Billed Charges, ,0.74,,,0.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.85,Percent of Total Billed Charges, ,,85,,3.46,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,2.77,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.44,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J7120 - RINGERS LACTATE INFUSION,J7120,HCPCS,,,AY,Outpatient,1000,UN,7.05,1.7625,0.01,5.99,,,,,,,,2.76,,,2.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.06,,,3.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.62,Percent of Total Billed Charges, ,2.76,,,2.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4.94,Percent of Total Billed Charges, ,,85,,5.99,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,4.79,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.23,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.76,,,2.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0258 - PHARMACY (ALSO SEE 063X AN EXTENSION OF 025X) - IV SOLUTIONS,0258,RC,,,,Outpatient,,,25.18,6.295,15.11,21.4,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,16.52,Percent of Total Billed Charges, ,,,,,,,,70,,17.63,Percent of Total Billed Charges, ,,85,,21.4,Percent of Total Billed Charges, ,,,,,,,,68,,17.12,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,15.11,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,96360,HCPCS,,,XU,Outpatient,,,439,109.75,200.31,373.15,,,46,,201.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,204.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,287.98,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,307.3,Percent of Total Billed Charges, ,,85,,373.15,Percent of Total Billed Charges, ,,50,,219.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,298.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,245.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,263.4,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,96360,HCPCS,,,XS,Outpatient,,,439,109.75,200.31,373.15,,,46,,201.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,204.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,287.98,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,307.3,Percent of Total Billed Charges, ,,85,,373.15,Percent of Total Billed Charges, ,,50,,219.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,298.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,245.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,263.4,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,96360,HCPCS,,,25,Outpatient,,,439,109.75,200.31,373.15,,,46,,201.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,204.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,287.98,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,307.3,Percent of Total Billed Charges, ,,85,,373.15,Percent of Total Billed Charges, ,,50,,219.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,298.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,245.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,263.4,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR,96361,HCPCS,,,XU,Outpatient,,,104,26,43.87,88.4,,,46,,47.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,48.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,68.22,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,72.8,Percent of Total Billed Charges, ,,85,,88.4,Percent of Total Billed Charges, ,,50,,52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,70.72,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,58.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,62.4,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96365 - IV INFUSION THERAPY-PROPHYLAXIS -DX 1ST TO 1 HR,96365,HCPCS,,,XU,Outpatient,,,493.92,123.48,200.31,419.83,,,46,,227.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,229.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,324.01,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,345.74,Percent of Total Billed Charges, ,,85,,419.83,Percent of Total Billed Charges, ,,50,,246.96,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,335.87,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,276.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,296.35,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96365 - IV INFUSION THERAPY-PROPHYLAXIS -DX 1ST TO 1 HR,96365,HCPCS,,,XS,Outpatient,,,493,123.25,200.31,419.05,,,46,,226.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,229.25,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,323.41,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,345.1,Percent of Total Billed Charges, ,,85,,419.05,Percent of Total Billed Charges, ,,50,,246.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,335.24,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,276.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,295.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96365 - IV INFUSION THERAPY-PROPHYLAXIS -DX 1ST TO 1 HR,96365,HCPCS,,,XP,Outpatient,,,493,123.25,200.31,419.05,,,46,,226.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,229.25,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,323.41,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,345.1,Percent of Total Billed Charges, ,,85,,419.05,Percent of Total Billed Charges, ,,50,,246.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,335.24,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,276.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,295.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96365 - IV INFUSION THERAPY-PROPHYLAXIS -DX 1ST TO 1 HR,96365,HCPCS,,,XE,Outpatient,,,493,123.25,200.31,419.05,,,46,,226.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,229.25,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,323.41,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,345.1,Percent of Total Billed Charges, ,,85,,419.05,Percent of Total Billed Charges, ,,50,,246.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,335.24,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,276.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,295.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96365 - IV INFUSION THERAPY-PROPHYLAXIS -DX 1ST TO 1 HR,96365,HCPCS,,,59,Outpatient,,,493,123.25,200.31,419.05,,,46,,226.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,229.25,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,323.41,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,345.1,Percent of Total Billed Charges, ,,85,,419.05,Percent of Total Billed Charges, ,,50,,246.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,335.24,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,276.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,295.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96366 - IV INFUSION THERAPY PROPHYLAXIS-DX EA HOUR,96366,HCPCS,,,XU,Outpatient,,,163.33,40.8325,43.87,138.83,,,46,,75.13,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,75.95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,107.14,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.33,Percent of Total Billed Charges, ,,85,,138.83,Percent of Total Billed Charges, ,,50,,81.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,111.06,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,91.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,98,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR,96367,HCPCS,,,XU,Outpatient,,,262.26,65.565,67.66,222.92,,,46,,120.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,121.95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,172.04,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,183.58,Percent of Total Billed Charges, ,,85,,222.92,Percent of Total Billed Charges, ,,50,,131.13,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,178.34,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,146.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,157.36,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96368 - IV NFS THERAPY PROPHYLAXIS-DX CONCURRENT NFS,96368,HCPCS,,,XU,Outpatient,,,212,53,0.01,180.2,,,46,,97.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.67,,,28.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,98.58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,139.07,Percent of Total Billed Charges, ,28.67,,,28.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,148.4,Percent of Total Billed Charges, ,,85,,180.2,Percent of Total Billed Charges, ,,50,,106,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,144.16,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,118.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,127.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.77,,,27.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96374 - THER PROPH-DX NJX IV PUSH SINGLE-1ST SBST-DRUG,96374,HCPCS,,,XU,Outpatient,,,388,97,178.48,329.8,,,46,,178.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,180.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,254.53,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,271.6,Percent of Total Billed Charges, ,,85,,329.8,Percent of Total Billed Charges, ,,50,,194,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,263.84,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,217.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,232.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96374 - THER PROPH-DX NJX IV PUSH SINGLE-1ST SBST-DRUG,96374,HCPCS,,,XS,Outpatient,,,388,97,178.48,329.8,,,46,,178.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,180.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,254.53,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,271.6,Percent of Total Billed Charges, ,,85,,329.8,Percent of Total Billed Charges, ,,50,,194,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,263.84,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,217.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,232.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96374 - THER PROPH-DX NJX IV PUSH SINGLE-1ST SBST-DRUG,96374,HCPCS,,,JB,Outpatient,,,388,97,178.48,329.8,,,46,,178.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,180.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,254.53,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,271.6,Percent of Total Billed Charges, ,,85,,329.8,Percent of Total Billed Charges, ,,50,,194,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,263.84,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,217.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,232.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96374 - THER PROPH-DX NJX IV PUSH SINGLE-1ST SBST-DRUG,96374,HCPCS,,,25,Outpatient,,,,,200.31,311.16,,,,,,,,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Service Paid at Rev Code level,,,,,,,,,,,,,,,,,,,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,96375,HCPCS,,,XU,Outpatient,,,153,38.25,43.87,130.05,,,46,,70.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,71.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,100.37,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.1,Percent of Total Billed Charges, ,,85,,130.05,Percent of Total Billed Charges, ,,50,,76.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,104.04,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,85.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,91.8,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,96375,HCPCS,,,JB,Outpatient,,,153,38.25,43.87,130.05,,,46,,70.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,71.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,100.37,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.1,Percent of Total Billed Charges, ,,85,,130.05,Percent of Total Billed Charges, ,,50,,76.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,104.04,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,85.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,91.8,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,96375,HCPCS,,,25,Outpatient,,,153,38.25,43.87,130.05,,,46,,70.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,71.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,100.37,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.1,Percent of Total Billed Charges, ,,85,,130.05,Percent of Total Billed Charges, ,,50,,76.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,104.04,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,85.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,91.8,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96376 - THER PROPH-DX NJX EA SEQL IV PUSH SBST-DRUG FAC,96376,HCPCS,,,XU,Outpatient,,,125.79,31.4475,0.01,106.92,,,46,,57.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.52,,,47.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,58.49,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,82.52,Percent of Total Billed Charges, ,47.52,,,47.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,88.05,Percent of Total Billed Charges, ,,85,,106.92,Percent of Total Billed Charges, ,,50,,62.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,85.54,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,70.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,75.47,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.03,,,46.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96377 - APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION,96377,HCPCS,,,XU,Outpatient,,,92,23,42.78,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,42.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,60.35,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,64.4,Percent of Total Billed Charges, ,,85,,78.2,Percent of Total Billed Charges, ,,50,,46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,62.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,51.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,55.2,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96377 - APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION,96377,HCPCS,,,XS,Outpatient,,,92,23,42.78,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,42.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,60.35,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,64.4,Percent of Total Billed Charges, ,,85,,78.2,Percent of Total Billed Charges, ,,50,,46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,62.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,51.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,55.2,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96377 - APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION,96377,HCPCS,,,JB,Outpatient,,,92,23,42.78,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,42.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,60.35,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,64.4,Percent of Total Billed Charges, ,,85,,78.2,Percent of Total Billed Charges, ,,50,,46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,62.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,51.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,55.2,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1190.76,,,1190.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0260 - IV THERAPY - GENERAL CLASSIFICATION,0260,RC,,,,Outpatient,,,183.95,45.9875,110.37,712,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,120.67,Percent of Total Billed Charges, ,,,,,,,,70,,128.77,Percent of Total Billed Charges, ,,85,,156.36,Percent of Total Billed Charges, ,,,,,,,,68,,125.09,Percent of Total Billed Charges,0,712,,,712,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,110.37,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
L0621 - SIO FLEX PELVIC-SACR PRE OTS,L0621,HCPCS,,,GP,Outpatient,,,116,29,58,118.44,,,,,,,,,,,,,,,,,,,,118.44,,,118.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,76.1,Percent of Total Billed Charges, ,,,,,,,,70,,81.2,Percent of Total Billed Charges, ,,85,,98.6,Percent of Total Billed Charges, ,,50,,58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,78.88,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,69.6,Percent of Total Billed Charges, ,114.53,,,114.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,77.1,,,77.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.84,,,77.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.23,,,75.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.49,,,74.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.23,,,75.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.72,,,76.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.03,,,78.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3030 - FOOT ARCH SUPPORT REMOV PREM,L3030,HCPCS,,,PO,Outpatient,,,91,22.75,45.5,147,,,,,,,,,,,,,,,,,,,,147,,,147,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,59.7,Percent of Total Billed Charges, ,,,,,,,,70,,63.7,Percent of Total Billed Charges, ,,85,,77.35,Percent of Total Billed Charges, ,,50,,45.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,61.88,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,54.6,Percent of Total Billed Charges, ,142.14,,,142.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,95.69,,,95.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.61,,,96.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.37,,,93.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.45,,,92.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.37,,,93.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.22,,,95.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.84,,,96.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3030 - FOOT ARCH SUPPORT REMOV PREM,L3030,HCPCS,,,GP,Outpatient,,,91,22.75,45.5,147,,,,,,,,,,,,,,,,,,,,147,,,147,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,59.7,Percent of Total Billed Charges, ,,,,,,,,70,,63.7,Percent of Total Billed Charges, ,,85,,77.35,Percent of Total Billed Charges, ,,50,,45.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,61.88,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,54.6,Percent of Total Billed Charges, ,142.14,,,142.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,95.69,,,95.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.61,,,96.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.37,,,93.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.45,,,92.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.37,,,93.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.22,,,95.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.84,,,96.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3030 - FOOT ARCH SUPPORT REMOV PREM,L3030,HCPCS,,,GO,Outpatient,,,91,22.75,45.5,147,,,,,,,,,,,,,,,,,,,,147,,,147,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,59.7,Percent of Total Billed Charges, ,,,,,,,,70,,63.7,Percent of Total Billed Charges, ,,85,,77.35,Percent of Total Billed Charges, ,,50,,45.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,61.88,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,54.6,Percent of Total Billed Charges, ,142.14,,,142.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,95.69,,,95.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.61,,,96.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.37,,,93.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.45,,,92.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.37,,,93.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.22,,,95.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.84,,,96.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3332 - SHOE LIFTS TAPERED TO ONE-HA,L3332,HCPCS,,,PO,Outpatient,,,89,22.25,44.5,142.05,,,,,,,,,,,,,,,,,,,,142.05,,,142.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,58.38,Percent of Total Billed Charges, ,,,,,,,,70,,62.3,Percent of Total Billed Charges, ,,85,,75.65,Percent of Total Billed Charges, ,,50,,44.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,60.52,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,53.4,Percent of Total Billed Charges, ,137.36,,,137.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,92.47,,,92.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.36,,,93.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.23,,,90.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.34,,,89.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.23,,,90.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.02,,,92.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.58,,,93.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3332 - SHOE LIFTS TAPERED TO ONE-HA,L3332,HCPCS,,,GP,Outpatient,,,89,22.25,44.5,142.05,,,,,,,,,,,,,,,,,,,,142.05,,,142.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,58.38,Percent of Total Billed Charges, ,,,,,,,,70,,62.3,Percent of Total Billed Charges, ,,85,,75.65,Percent of Total Billed Charges, ,,50,,44.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,60.52,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,53.4,Percent of Total Billed Charges, ,137.36,,,137.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,92.47,,,92.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.36,,,93.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.23,,,90.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.34,,,89.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.23,,,90.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.02,,,92.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.58,,,93.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3670 - SO ACRO-CLAV CAN WEB PRE OTS,L3670,HCPCS,,,RT,Outpatient,,,190.67,47.6675,95.34,205.79,,,,,,,,,,,,,,,,,,,,205.79,,,205.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,125.08,Percent of Total Billed Charges, ,,,,,,,,70,,133.47,Percent of Total Billed Charges, ,,85,,162.07,Percent of Total Billed Charges, ,,50,,95.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,129.66,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,114.4,Percent of Total Billed Charges, ,199,,,199,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,133.96,,,133.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.25,,,135.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.72,,,130.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.43,,,129.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.72,,,130.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,133.31,,,133.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.58,,,135.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3670 - SO ACRO-CLAV CAN WEB PRE OTS,L3670,HCPCS,,,LT,Outpatient,,,95.86,23.965,47.93,205.79,,,,,,,,,,,,,,,,,,,,205.79,,,205.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,62.88,Percent of Total Billed Charges, ,,,,,,,,70,,67.1,Percent of Total Billed Charges, ,,85,,81.48,Percent of Total Billed Charges, ,,50,,47.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,65.18,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,57.52,Percent of Total Billed Charges, ,199,,,199,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,133.96,,,133.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.25,,,135.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.72,,,130.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.43,,,129.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.72,,,130.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,133.31,,,133.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.58,,,135.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3670 - SO ACRO-CLAV CAN WEB PRE OTS,L3670,HCPCS,,,GO,Outpatient,,,316,79,129.43,268.6,,,,,,,,,,,,,,,,,,,,205.79,,,205.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,207.3,Percent of Total Billed Charges, ,,,,,,,,70,,221.2,Percent of Total Billed Charges, ,,85,,268.6,Percent of Total Billed Charges, ,,50,,158,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,214.88,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,189.6,Percent of Total Billed Charges, ,199,,,199,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,133.96,,,133.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.25,,,135.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.72,,,130.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.43,,,129.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.72,,,130.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,133.31,,,133.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.58,,,135.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3762 - EO RIGID W-O JOINTS PRE OTS,L3762,HCPCS,,,GO,Outpatient,,,190,47.5,95,188.51,,,,,,,,,,,,,,,,,,,,188.51,,,188.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,124.64,Percent of Total Billed Charges, ,,,,,,,,70,,133,Percent of Total Billed Charges, ,,85,,161.5,Percent of Total Billed Charges, ,,50,,95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,129.2,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,114,Percent of Total Billed Charges, ,182.29,,,182.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,122.71,,,122.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.9,,,123.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.75,,,119.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,118.56,,,118.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.75,,,119.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.12,,,122.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.19,,,124.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3763 - EWHO RIGID W-O JNTS CF,L3763,HCPCS,,,GO,Outpatient,,,1243,310.75,621.5,1227.11,,,,,,,,,,,,,,,50,,621.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1227.11,,,1227.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,815.41,Percent of Total Billed Charges, ,,,,,,,,70,,870.1,Percent of Total Billed Charges, ,,85,,1056.55,Percent of Total Billed Charges, ,,50,,621.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,845.24,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,745.8,Percent of Total Billed Charges, ,1186.6,,,1186.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,798.78,,,798.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,806.5,,,806.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,779.49,,,779.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,771.77,,,771.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,779.49,,,779.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,794.92,,,794.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,808.43,,,808.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3806 - WHFO W-JOINT(S) CUSTOM FAB,L3806,HCPCS,,,GO,Outpatient,,,807,201.75,403.5,796.19,,,,,,,,,,,,,,,,,,,,796.19,,,796.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,529.39,Percent of Total Billed Charges, ,,,,,,,,70,,564.9,Percent of Total Billed Charges, ,,85,,685.95,Percent of Total Billed Charges, ,,50,,403.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,548.76,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,484.2,Percent of Total Billed Charges, ,769.9,,,769.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,518.28,,,518.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,523.28,,,523.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,505.76,,,505.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,500.75,,,500.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,505.76,,,505.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,515.77,,,515.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,524.54,,,524.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3807 - WHFO W-O JOINTS PRE CST,L3807,HCPCS,,,GO,Outpatient,,,444,111,222,438.3,,,,,,,,,,,,,,,,,,,,438.3,,,438.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,291.26,Percent of Total Billed Charges, ,,,,,,,,70,,310.8,Percent of Total Billed Charges, ,,85,,377.4,Percent of Total Billed Charges, ,,50,,222,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,301.92,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,266.4,Percent of Total Billed Charges, ,423.83,,,423.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,285.31,,,285.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.06,,,288.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,278.42,,,278.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.66,,,275.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,278.42,,,278.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.93,,,283.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.75,,,288.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3808 - WHFO RIGID W-O JOINTS,L3808,HCPCS,,,PO,Outpatient,,,357,89.25,178.5,585.72,,,,,,,,,,,,,,,,,,,,585.72,,,585.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,234.19,Percent of Total Billed Charges, ,,,,,,,,70,,249.9,Percent of Total Billed Charges, ,,85,,303.45,Percent of Total Billed Charges, ,,50,,178.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,242.76,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,214.2,Percent of Total Billed Charges, ,566.38,,,566.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,381.27,,,381.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,384.96,,,384.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,372.06,,,372.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,368.38,,,368.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,372.06,,,372.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.43,,,379.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.88,,,385.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3808 - WHFO RIGID W-O JOINTS,L3808,HCPCS,,,GO,Outpatient,,,357,89.25,178.5,585.72,,,,,,,,,,,,,,,,,,,,585.72,,,585.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,234.19,Percent of Total Billed Charges, ,,,,,,,,70,,249.9,Percent of Total Billed Charges, ,,85,,303.45,Percent of Total Billed Charges, ,,50,,178.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,242.76,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,214.2,Percent of Total Billed Charges, ,566.38,,,566.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,381.27,,,381.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,384.96,,,384.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,372.06,,,372.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,368.38,,,368.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,372.06,,,372.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.43,,,379.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.88,,,385.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3809 - WHFO W-O JOINTS PRE OTS,L3809,HCPCS,,,GO,Outpatient,,,444,111,222,438.3,,,,,,,,,,,,,,,,,,,,438.3,,,438.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,291.26,Percent of Total Billed Charges, ,,,,,,,,70,,310.8,Percent of Total Billed Charges, ,,85,,377.4,Percent of Total Billed Charges, ,,50,,222,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,301.92,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,266.4,Percent of Total Billed Charges, ,423.83,,,423.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,285.31,,,285.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.06,,,288.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,278.42,,,278.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.66,,,275.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,278.42,,,278.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.93,,,283.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.75,,,288.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3905 - WHO W-NONTORSION JNT(S) CF,L3905,HCPCS,,,GO,Outpatient,,,1761,440.25,880.5,1738.17,,,,,,,,,,,,,,,50,,880.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1738.17,,,1738.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1155.22,Percent of Total Billed Charges, ,,,,,,,,70,,1232.7,Percent of Total Billed Charges, ,,85,,1496.85,Percent of Total Billed Charges, ,,50,,880.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1197.48,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,1056.6,Percent of Total Billed Charges, ,1680.78,,,1680.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,1131.45,,,1131.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1142.38,,,1142.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1104.12,,,1104.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1093.19,,,1093.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1104.12,,,1104.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1125.99,,,1125.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1145.12,,,1145.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3906 - WHO W-O JOINTS CF,L3906,HCPCS,,,PO,Outpatient,,,702,175.5,351,692.62,,,,,,,,,,,,,,,,,,,,692.62,,,692.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,460.51,Percent of Total Billed Charges, ,,,,,,,,70,,491.4,Percent of Total Billed Charges, ,,85,,596.7,Percent of Total Billed Charges, ,,50,,351,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,477.36,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,421.2,Percent of Total Billed Charges, ,669.75,,,669.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,450.86,,,450.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,455.21,,,455.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,439.97,,,439.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,435.61,,,435.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,439.97,,,439.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,448.68,,,448.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,456.3,,,456.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3906 - WHO W-O JOINTS CF,L3906,HCPCS,,,GO,Outpatient,,,702,175.5,351,692.62,,,,,,,,,,,,,,,,,,,,692.62,,,692.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,460.51,Percent of Total Billed Charges, ,,,,,,,,70,,491.4,Percent of Total Billed Charges, ,,85,,596.7,Percent of Total Billed Charges, ,,50,,351,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,477.36,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,421.2,Percent of Total Billed Charges, ,669.75,,,669.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,450.86,,,450.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,455.21,,,455.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,439.97,,,439.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,435.61,,,435.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,439.97,,,439.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,448.68,,,448.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,456.3,,,456.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3908 - WHO COCK-UP NONMOLDE PRE OTS,L3908,HCPCS,,,GO,Outpatient,,,106,26.5,53,105.02,,,,,,,,,,,,,,,,,,,,105.02,,,105.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,69.54,Percent of Total Billed Charges, ,,,,,,,,70,,74.2,Percent of Total Billed Charges, ,,85,,90.1,Percent of Total Billed Charges, ,,50,,53,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,72.08,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,63.6,Percent of Total Billed Charges, ,101.55,,,101.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,68.36,,,68.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.02,,,69.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.71,,,66.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.05,,,66.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.71,,,66.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.03,,,68.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.19,,,69.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3912 - HFO FLEXION GLOVE PRE OTS,L3912,HCPCS,,,GO,Outpatient,,,345,86.25,137.44,293.25,,,,,,,,,,,,,,,,,,,,218.53,,,218.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,226.32,Percent of Total Billed Charges, ,,,,,,,,70,,241.5,Percent of Total Billed Charges, ,,85,,293.25,Percent of Total Billed Charges, ,,50,,172.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,234.6,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,207,Percent of Total Billed Charges, ,211.31,,,211.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,142.25,,,142.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.62,,,143.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,138.81,,,138.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,137.44,,,137.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,138.81,,,138.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,141.56,,,141.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.97,,,143.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3913 - HFO W-O JOINTS CF,L3913,HCPCS,,,LT,Outpatient,,,710,177.5,298.58,603.5,,,,,,,,,,,,,,,,,,,,474.74,,,474.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,465.76,Percent of Total Billed Charges, ,,,,,,,,70,,497,Percent of Total Billed Charges, ,,85,,603.5,Percent of Total Billed Charges, ,,50,,355,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,482.8,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,426,Percent of Total Billed Charges, ,459.07,,,459.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,309.03,,,309.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,312.02,,,312.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,301.57,,,301.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,298.58,,,298.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,301.57,,,301.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,307.54,,,307.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,312.76,,,312.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3913 - HFO W-O JOINTS CF,L3913,HCPCS,,,GO,Outpatient,,,710,177.5,298.58,603.5,,,,,,,,,,,,,,,,,,,,474.74,,,474.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,465.76,Percent of Total Billed Charges, ,,,,,,,,70,,497,Percent of Total Billed Charges, ,,85,,603.5,Percent of Total Billed Charges, ,,50,,355,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,482.8,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,426,Percent of Total Billed Charges, ,459.07,,,459.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,309.03,,,309.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,312.02,,,312.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,301.57,,,301.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,298.58,,,298.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,301.57,,,301.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,307.54,,,307.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,312.76,,,312.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3917 - METACARP FX ORTHOSIS PRE CST,L3917,HCPCS,,,PO,Outpatient,,,189,47.25,94.5,185.11,,,,,,,,,,,,,,,,,,,,185.11,,,185.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,123.98,Percent of Total Billed Charges, ,,,,,,,,70,,132.3,Percent of Total Billed Charges, ,,85,,160.65,Percent of Total Billed Charges, ,,50,,94.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,128.52,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,113.4,Percent of Total Billed Charges, ,179,,,179,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,120.49,,,120.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.66,,,121.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.58,,,117.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,116.42,,,116.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.58,,,117.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.91,,,119.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.95,,,121.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3917 - METACARP FX ORTHOSIS PRE CST,L3917,HCPCS,,,GO,Outpatient,,,189,47.25,94.5,185.11,,,,,,,,,,,,,,,,,,,,185.11,,,185.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,123.98,Percent of Total Billed Charges, ,,,,,,,,70,,132.3,Percent of Total Billed Charges, ,,85,,160.65,Percent of Total Billed Charges, ,,50,,94.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,128.52,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,113.4,Percent of Total Billed Charges, ,179,,,179,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,120.49,,,120.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.66,,,121.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.58,,,117.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,116.42,,,116.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.58,,,117.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.91,,,119.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.95,,,121.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3921 - HFO W-JOINT(S) CF,L3921,HCPCS,,,GO,Outpatient,,,843,210.75,354.06,716.55,,,,,,,,,,,,,,,,,,,,562.96,,,562.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,553.01,Percent of Total Billed Charges, ,,,,,,,,70,,590.1,Percent of Total Billed Charges, ,,85,,716.55,Percent of Total Billed Charges, ,,50,,421.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,573.24,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,505.8,Percent of Total Billed Charges, ,544.37,,,544.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,366.45,,,366.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,369.99,,,369.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,357.6,,,357.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.06,,,354.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,357.6,,,357.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,364.68,,,364.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,370.88,,,370.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3923 - HFO WITHOUT JOINTS PRE CST,L3923,HCPCS,,,GO,Outpatient,,,155,38.75,77.5,152.48,,,,,,,,,,,,,,,,,,,,152.48,,,152.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.68,Percent of Total Billed Charges, ,,,,,,,,70,,108.5,Percent of Total Billed Charges, ,,85,,131.75,Percent of Total Billed Charges, ,,50,,77.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,105.4,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,93,Percent of Total Billed Charges, ,147.45,,,147.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,99.26,,,99.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.22,,,100.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.86,,,96.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.9,,,95.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.86,,,96.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.78,,,98.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.46,,,100.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3924 - HFO WITHOUT JOINTS PRE OTS,L3924,HCPCS,,,GO,Outpatient,,,155,38.75,77.5,152.48,,,,,,,,,,,,,,,,,,,,152.48,,,152.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.68,Percent of Total Billed Charges, ,,,,,,,,70,,108.5,Percent of Total Billed Charges, ,,85,,131.75,Percent of Total Billed Charges, ,,50,,77.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,105.4,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,93,Percent of Total Billed Charges, ,147.45,,,147.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,99.26,,,99.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.22,,,100.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.86,,,96.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.9,,,95.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.86,,,96.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.78,,,98.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.46,,,100.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3925 - FO PIP DIP JNT-SPRNG PRE OTS,L3925,HCPCS,,,GO,Outpatient,,,98,24.5,49,94.19,,,,,,,,,,,,,,,,,,,,94.19,,,94.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,64.29,Percent of Total Billed Charges, ,,,,,,,,70,,68.6,Percent of Total Billed Charges, ,,85,,83.3,Percent of Total Billed Charges, ,,50,,49,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,66.64,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,58.8,Percent of Total Billed Charges, ,91.08,,,91.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,61.31,,,61.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.91,,,61.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.83,,,59.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.24,,,59.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.83,,,59.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.02,,,61.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.05,,,62.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3931 - WHFO NONTORSION JOINT PREFAB,L3931,HCPCS,,,GO,Outpatient,,,219,54.75,109.5,360.06,,,,,,,,,,,,,,,,,,,,360.06,,,360.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,143.66,Percent of Total Billed Charges, ,,,,,,,,70,,153.3,Percent of Total Billed Charges, ,,85,,186.15,Percent of Total Billed Charges, ,,50,,109.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,148.92,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,131.4,Percent of Total Billed Charges, ,348.17,,,348.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,234.38,,,234.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.64,,,236.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.71,,,228.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,226.45,,,226.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.71,,,228.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,233.24,,,233.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.21,,,237.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3933 - FO W-O JOINTS CF,L3933,HCPCS,,,PN,Outpatient,,,379,94.75,189.5,373.98,,,,,,,,,,,,,,,,,,,,373.98,,,373.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,248.62,Percent of Total Billed Charges, ,,,,,,,,70,,265.3,Percent of Total Billed Charges, ,,85,,322.15,Percent of Total Billed Charges, ,,50,,189.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,257.72,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,227.4,Percent of Total Billed Charges, ,361.64,,,361.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,243.44,,,243.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,245.79,,,245.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.56,,,237.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,235.21,,,235.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.56,,,237.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,242.27,,,242.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,246.38,,,246.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
L3933 - FO W-O JOINTS CF,L3933,HCPCS,,,GO,Outpatient,,,379,94.75,189.5,373.98,,,,,,,,,,,,,,,,,,,,373.98,,,373.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,248.62,Percent of Total Billed Charges, ,,,,,,,,70,,265.3,Percent of Total Billed Charges, ,,85,,322.15,Percent of Total Billed Charges, ,,50,,189.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,257.72,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,227.4,Percent of Total Billed Charges, ,361.64,,,361.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,243.44,,,243.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,245.79,,,245.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.56,,,237.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,235.21,,,235.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.56,,,237.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,242.27,,,242.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,246.38,,,246.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q0481 - MICROPRCSR CU ELEC VAD REP,Q0481,HCPCS,,,RB,Outpatient,,,21450,5362.5,10725,28040.1,,,50,,10725,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,50,,10725,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28040.1,,,28040.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14071.2,Percent of Total Billed Charges, ,,,,,,,,70,,15015,Percent of Total Billed Charges, ,,85,,18232.5,Percent of Total Billed Charges, ,,50,,10725,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14586,Percent of Total Billed Charges,0,,50,,10725,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,12870,Percent of Total Billed Charges, ,27114.24,,,27114.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,18252.51,,,18252.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18428.87,,,18428.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17811.63,,,17811.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17635.28,,,17635.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17811.63,,,17811.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18164.34,,,18164.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18472.96,,,18472.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q0501 - SHWR COV ELEC-COMBO VAD REP,Q0501,HCPCS,,,RB,Outpatient,,,591,147.75,295.5,985.51,,,,,,,,,,,,,,,,,,,,985.51,,,985.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,387.7,Percent of Total Billed Charges, ,,,,,,,,70,,413.7,Percent of Total Billed Charges, ,,85,,502.35,Percent of Total Billed Charges, ,,50,,295.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,401.88,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,354.6,Percent of Total Billed Charges, ,952.97,,,952.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,641.51,,,641.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,647.71,,,647.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,626.02,,,626.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,619.82,,,619.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,626.02,,,626.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,638.41,,,638.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,649.26,,,649.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q0506 - LITH-ION BATT ELEC-PNEUM VAD,Q0506,HCPCS,,,RB,Outpatient,,,1575.2,393.8,787.6,1648.21,,,,,,,,,,,,,,,50,,787.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1648.21,,,1648.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1033.33,Percent of Total Billed Charges, ,,,,,,,,70,,1102.64,Percent of Total Billed Charges, ,,85,,1338.92,Percent of Total Billed Charges, ,,50,,787.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1071.14,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,945.12,Percent of Total Billed Charges, ,1593.79,,,1593.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,1072.89,,,1072.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1083.26,,,1083.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1046.98,,,1046.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1036.61,,,1036.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1046.98,,,1046.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1067.71,,,1067.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1085.85,,,1085.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q0506 - LITH-ION BATT ELEC-PNEUM VAD,Q0506,HCPCS,,,RA,Outpatient,,,1312,328,656,1648.21,,,,,,,,,,,,,,,50,,656,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1648.21,,,1648.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,860.67,Percent of Total Billed Charges, ,,,,,,,,70,,918.4,Percent of Total Billed Charges, ,,85,,1115.2,Percent of Total Billed Charges, ,,50,,656,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,892.16,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,787.2,Percent of Total Billed Charges, ,1593.79,,,1593.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,1072.89,,,1072.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1083.26,,,1083.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1046.98,,,1046.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1036.61,,,1036.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1046.98,,,1046.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1067.71,,,1067.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1085.85,,,1085.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q0508 - MIS SUP-ACC IMP VAD,Q0508,HCPCS,,,RB,Outpatient,,,19306,4826.5,0.01,16410.1,,,50,,9653,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,50,,9653,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12664.74,Percent of Total Billed Charges, ,,,,,,,,70,,13514.2,Percent of Total Billed Charges, ,,85,,16410.1,Percent of Total Billed Charges, ,,50,,9653,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13128.08,Percent of Total Billed Charges,0,,50,,9653,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,11583.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0274 - MEDICAL-SURGICAL SUPPLIES AND DEVICES (ALSO SEE 062X AN EXTENSION OF 027X) - PROSTHETIC-ORTHOTIC DEVICES,0274,RC,,,,Outpatient,,,484.57,121.1425,242.29,411.88,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,317.88,Percent of Total Billed Charges, ,,,,,,,,70,,339.2,Percent of Total Billed Charges, ,,85,,411.88,Percent of Total Billed Charges, ,,50,,242.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,329.51,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,290.74,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
C1785 - PMKR DUAL RATE-RESP,C1785,HCPCS,,,SC,Outpatient,,,6069.33,1517.3325,0.01,5158.93,,,50,,3034.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,50,,3034.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3981.48,Percent of Total Billed Charges, ,,,,,,,,70,,4248.53,Percent of Total Billed Charges, ,,85,,5158.93,Percent of Total Billed Charges, ,,50,,3034.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4127.14,Percent of Total Billed Charges,0,,50,,3034.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3641.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C1785 - PMKR DUAL RATE-RESP,C1785,HCPCS,,,KX,Outpatient,,,6119.74,1529.935,0.01,5201.78,,,50,,3059.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,50,,3059.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4014.55,Percent of Total Billed Charges, ,,,,,,,,70,,4283.82,Percent of Total Billed Charges, ,,85,,5201.78,Percent of Total Billed Charges, ,,50,,3059.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4161.42,Percent of Total Billed Charges,0,,50,,3059.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3671.84,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C2621 - PMKR OTHER THAN SING-DUAL,C2621,HCPCS,,,KX,Outpatient,,,11000,2750,0.01,9350,,,50,,5500,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,50,,5500,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7216,Percent of Total Billed Charges, ,,,,,,,,70,,7700,Percent of Total Billed Charges, ,,85,,9350,Percent of Total Billed Charges, ,,50,,5500,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7480,Percent of Total Billed Charges,0,,50,,5500,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6600,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0275 - MEDICAL-SURGICAL SUPPLIES AND DEVICES (ALSO SEE 062 X AN EXTENSION OF 027X) - PACEMAKER,0275,RC,,,,Outpatient,,,6429.72,1607.43,3214.86,5465.26,,,50,,3214.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,50,,3214.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,4217.9,Percent of Total Billed Charges, ,,,,,,,,70,,4500.8,Percent of Total Billed Charges, ,,85,,5465.26,Percent of Total Billed Charges, ,,50,,3214.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4372.21,Percent of Total Billed Charges,0,,50,,3214.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3857.83,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
V2787 - ASTIGMATISM-CORRECT FUNCTION,V2787,HCPCS,,,GZ,Outpatient,,,1010,252.5,0.01,858.5,,,,,,,,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,50,,505,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,662.56,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,707,Percent of Total Billed Charges, ,,85,,858.5,Percent of Total Billed Charges, ,,50,,505,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,686.8,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,606,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0276 - MEDICAL-SURGICAL SUPPLIES AND DEVICES (ALSO SEE 062X  AN EXTENSION OF 027X) - INTRAOCULAR LENS,0276,RC,,,,Outpatient,,,1010,252.5,505,858.5,,,,,,,,,,,,,,,50,,505,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,662.56,Percent of Total Billed Charges, ,,,,,,,,70,,707,Percent of Total Billed Charges, ,,85,,858.5,Percent of Total Billed Charges, ,,50,,505,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,686.8,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,606,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
C1761 - CATH TRANS INTRA LITHO-CORO,C1761,HCPCS,,,GZ,Outpatient,,,9400,2350,0.01,7990,,,50,,4700,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,50,,4700,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6166.4,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6580,Percent of Total Billed Charges, ,,85,,7990,Percent of Total Billed Charges, ,,50,,4700,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6392,Percent of Total Billed Charges,0,,50,,4700,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,5640,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C1761 - CATH TRANS INTRA LITHO-CORO,C1761,HCPCS,,,91,Outpatient,,,9400,2350,0.01,7990,,,50,,4700,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,50,,4700,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6166.4,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6580,Percent of Total Billed Charges, ,,85,,7990,Percent of Total Billed Charges, ,,50,,4700,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6392,Percent of Total Billed Charges,0,,50,,4700,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,5640,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C2616 - BRACHYTX NON-STRYTTRIUM-90,C2616,HCPCS,,,XU,Outpatient,,,31165,7791.25,15582.5,31506.93,,,50,,15582.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31506.93,,,31506.93,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,50,,15582.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25822.97,,,25822.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20444.24,Percent of Total Billed Charges, ,31506.93,,,31506.93,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21815.5,Percent of Total Billed Charges, ,,85,,26490.25,Percent of Total Billed Charges, ,,50,,15582.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21192.2,Percent of Total Billed Charges,0,,50,,15582.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,18699,Percent of Total Billed Charges, ,25559.06,,,25559.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30519.25,,,30519.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17205.61,,,17205.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17371.85,,,17371.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16790.02,,,16790.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16623.78,,,16623.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16790.02,,,16790.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17122.49,,,17122.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17413.41,,,17413.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0278 - MEDICAL-SURGICAL SUPPLIES AND DEVICES (ALSO SEE 062X AN EXTENSION OF 027X) - OTHER IMPLANT,0278,RC,,,,Outpatient,,,15618.57,3904.6425,7809.29,13275.78,,,50,,7809.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,50,,7809.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,10245.78,Percent of Total Billed Charges, ,,,,,,,,70,,10933,Percent of Total Billed Charges, ,,85,,13275.78,Percent of Total Billed Charges, ,,50,,7809.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10620.63,Percent of Total Billed Charges,0,,50,,7809.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,9371.14,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
E0603 - ELECTRIC BREAST PUMP,E0603,HCPCS,,,GT,Outpatient,,,445,111.25,0.01,378.25,,,,,,,,,,,,,,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,291.92,Percent of Total Billed Charges, ,,,,,,,,70,,311.5,Percent of Total Billed Charges, ,,85,,378.25,Percent of Total Billed Charges, ,,,,,,,,68,,302.6,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,267,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0292 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - PURCHASE OF NEW DME,0292,RC,,,,Outpatient,,,445,111.25,267,378.25,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,291.92,Percent of Total Billed Charges, ,,,,,,,,70,,311.5,Percent of Total Billed Charges, ,,85,,378.25,Percent of Total Billed Charges, ,,,,,,,,68,,302.6,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,267,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
0202U - Nfct ds 22 trgt sars-cov-2,0202U,HCPCS,,,GZ,Outpatient,,,1251,312.75,0.01,1063.35,,,34.4,,430.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,662.68,,,662.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,820.66,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,875.7,Percent of Total Billed Charges, ,,85,,1063.35,Percent of Total Billed Charges, ,,,,,,,,68,,850.68,Percent of Total Billed Charges,0,416.78,,,416.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,750.6,Percent of Total Billed Charges, ,640.8,,,640.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,431.37,,,431.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,435.54,,,435.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,420.95,,,420.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,416.78,,,416.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,420.95,,,420.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,429.28,,,429.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,436.58,,,436.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0202U - Nfct ds 22 trgt sars-cov-2,0202U,HCPCS,,,59,Outpatient,,,1251,312.75,0.01,1063.35,,,34.4,,430.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,662.68,,,662.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,820.66,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,875.7,Percent of Total Billed Charges, ,,85,,1063.35,Percent of Total Billed Charges, ,,,,,,,,68,,850.68,Percent of Total Billed Charges,0,416.78,,,416.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,750.6,Percent of Total Billed Charges, ,640.8,,,640.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,431.37,,,431.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,435.54,,,435.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,420.95,,,420.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,416.78,,,416.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,420.95,,,420.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,429.28,,,429.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,436.58,,,436.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0241U - Nfct ds vir resp rna 4 trgt,0241U,HCPCS,,,GZ,Outpatient,,,428,107,142.6,453.56,,,34.4,,147.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,160.17,,,160.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,453.56,,,453.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,280.77,Percent of Total Billed Charges, ,160.17,,,160.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,299.6,Percent of Total Billed Charges, ,,85,,363.8,Percent of Total Billed Charges, ,,,,,,,,68,,291.04,Percent of Total Billed Charges,0,142.6,,,142.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,256.8,Percent of Total Billed Charges, ,438.59,,,438.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.18,,,155.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,295.24,,,295.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,298.1,,,298.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.11,,,288.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,285.26,,,285.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.11,,,288.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.82,,,293.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,298.81,,,298.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0241U - Nfct ds vir resp rna 4 trgt,0241U,HCPCS,,,91,Outpatient,,,428,107,142.6,453.56,,,34.4,,147.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,160.17,,,160.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,453.56,,,453.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,280.77,Percent of Total Billed Charges, ,160.17,,,160.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,299.6,Percent of Total Billed Charges, ,,85,,363.8,Percent of Total Billed Charges, ,,,,,,,,68,,291.04,Percent of Total Billed Charges,0,142.6,,,142.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,256.8,Percent of Total Billed Charges, ,438.59,,,438.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.18,,,155.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,295.24,,,295.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,298.1,,,298.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.11,,,288.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,285.26,,,285.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.11,,,288.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.82,,,293.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,298.81,,,298.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0241U - Nfct ds vir resp rna 4 trgt,0241U,HCPCS,,,59,Outpatient,,,428,107,142.6,453.56,,,34.4,,147.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,160.17,,,160.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,453.56,,,453.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,280.77,Percent of Total Billed Charges, ,160.17,,,160.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,299.6,Percent of Total Billed Charges, ,,85,,363.8,Percent of Total Billed Charges, ,,,,,,,,68,,291.04,Percent of Total Billed Charges,0,142.6,,,142.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,256.8,Percent of Total Billed Charges, ,438.59,,,438.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.18,,,155.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,295.24,,,295.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,298.1,,,298.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.11,,,288.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,285.26,,,285.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,288.11,,,288.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.82,,,293.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,298.81,,,298.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,423.61,,,423.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0353U - Iadna chlmydANDgonorr amp prb,0353U,HCPCS,,,59,Outpatient,,,250,62.5,70.18,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,65.6,,164,Percent of Total Billed Charges, ,,,,,,,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,,,68,,170,Percent of Total Billed Charges,0,70.18,,,70.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,150,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE,36415,HCPCS,,,GA,Outpatient,,,25,6.25,0.01,21.25,,,46,,11.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.38,,,5.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.04,,,14.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17.5,Percent of Total Billed Charges, ,,85,,21.25,Percent of Total Billed Charges, ,,50,,12.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17,Percent of Total Billed Charges,0,3,,,3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15,Percent of Total Billed Charges, ,13.58,,,13.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.14,,,9.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.23,,,9.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.92,,,8.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.92,,,8.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.09,,,9.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.25,,,9.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36415 - COLLECTION VENOUS BLOOD VENIPUNCTURE,36415,HCPCS,,,59,Outpatient,,,25,6.25,0.01,21.25,,,46,,11.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.38,,,5.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.04,,,14.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17.5,Percent of Total Billed Charges, ,,85,,21.25,Percent of Total Billed Charges, ,,50,,12.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17,Percent of Total Billed Charges,0,3,,,3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15,Percent of Total Billed Charges, ,13.58,,,13.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.14,,,9.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.23,,,9.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.92,,,8.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.92,,,8.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.09,,,9.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.25,,,9.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
86900 - BLOOD TYPING SEROLOGIC ABO,86900,HCPCS,,,AY,Outpatient,,,199,49.75,2.99,190.37,,,34.4,,68.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,134.39,,,134.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.35,,,5.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,130.54,Percent of Total Billed Charges, ,134.39,,,134.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,139.3,Percent of Total Billed Charges, ,,85,,169.15,Percent of Total Billed Charges, ,,50,,99.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,135.32,Percent of Total Billed Charges,0,2.99,,,2.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,111.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,119.4,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.2,,,130.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.65,,,12.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.65,,,12.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.65,,,12.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.65,,,12.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86900 - BLOOD TYPING SEROLOGIC ABO,86900,HCPCS,,,91,Outpatient,,,199,49.75,2.99,190.37,,,34.4,,68.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,134.39,,,134.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.35,,,5.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,130.54,Percent of Total Billed Charges, ,134.39,,,134.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,139.3,Percent of Total Billed Charges, ,,85,,169.15,Percent of Total Billed Charges, ,,50,,99.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,135.32,Percent of Total Billed Charges,0,2.99,,,2.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,111.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,119.4,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.2,,,130.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.65,,,12.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.65,,,12.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.65,,,12.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.65,,,12.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86901 - BLOOD TYPING SEROLOGIC RH (D),86901,HCPCS,,,91,Outpatient,,,89,22.25,2.99,103.95,,,34.4,,30.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.31,,,39.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.35,,,5.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,57.97,,,57.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,58.38,Percent of Total Billed Charges, ,39.31,,,39.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,62.3,Percent of Total Billed Charges, ,,85,,75.65,Percent of Total Billed Charges, ,,50,,44.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,60.52,Percent of Total Billed Charges,0,2.99,,,2.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,49.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,53.4,Percent of Total Billed Charges, ,57.38,,,57.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.08,,,38.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38.63,,,38.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39,,,39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.69,,,37.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.32,,,37.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.69,,,37.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.44,,,38.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.09,,,39.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86902 - BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH,86902,HCPCS,,,91,Outpatient,,,446,111.5,6.35,531.25,,,34.4,,153.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.4,,,11.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,531.25,,,531.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,292.58,Percent of Total Billed Charges, ,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,312.2,Percent of Total Billed Charges, ,,85,,379.1,Percent of Total Billed Charges, ,,50,,223,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,303.28,Percent of Total Billed Charges,0,6.35,,,6.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,249.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,267.6,Percent of Total Billed Charges, ,525.83,,,525.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.42,,,363.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,353.97,,,353.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,357.39,,,357.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342,,,342,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,352.26,,,352.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.25,,,358.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.98,,,15.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.98,,,15.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.98,,,15.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.98,,,15.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86920 - COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE,86920,HCPCS,,,91,Outpatient,,,229,57.25,63.31,253.08,,,34.4,,78.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.31,,,63.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,150.22,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,160.3,Percent of Total Billed Charges, ,,85,,194.65,Percent of Total Billed Charges, ,,50,,114.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,155.72,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,128.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,137.4,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.98,,,100.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,100.98,,,100.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,100.98,,,100.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,100.98,,,100.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86922 - COMPATIBILITY EACH UNIT ANTIGLOBULIN,86922,HCPCS,,,91,Outpatient,,,263,65.75,67.68,253.08,,,34.4,,90.47,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.68,,,67.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,172.53,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,184.1,Percent of Total Billed Charges, ,,85,,223.55,Percent of Total Billed Charges, ,,50,,131.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,178.84,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,147.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,157.8,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,141.08,,,141.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,141.08,,,141.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,141.08,,,141.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,141.08,,,141.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86923 - COMPATIBILITY EACH UNIT ELECTRONIC,86923,HCPCS,,,91,Outpatient,,,263,65.75,20.2,253.08,,,34.4,,90.47,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.92,,,50.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,172.53,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,184.1,Percent of Total Billed Charges, ,,85,,223.55,Percent of Total Billed Charges, ,,50,,131.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,178.84,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,147.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,157.8,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.2,,,20.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.2,,,20.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.2,,,20.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.2,,,20.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86923 - COMPATIBILITY EACH UNIT ELECTRONIC,86923,HCPCS,,,59,Outpatient,,,263,65.75,20.2,253.08,,,34.4,,90.47,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.92,,,50.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,172.53,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,184.1,Percent of Total Billed Charges, ,,85,,223.55,Percent of Total Billed Charges, ,,50,,131.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,178.84,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,147.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,157.8,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.2,,,20.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.2,,,20.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.2,,,20.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.2,,,20.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87070 - CUL BACT XCPT URINE BLOOD-STOOL AEROBIC ISOL,87070,HCPCS,,,AY,Outpatient,,,79,19.75,8.62,67.15,,,34.4,,27.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.04,,,11.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.46,,,15.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.71,,,13.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.82,Percent of Total Billed Charges, ,11.04,,,11.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,55.3,Percent of Total Billed Charges, ,,85,,67.15,Percent of Total Billed Charges, ,,50,,39.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.72,Percent of Total Billed Charges,0,8.62,,,8.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,47.4,Percent of Total Billed Charges, ,13.25,,,13.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.7,,,10.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.92,,,8.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.01,,,9.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.71,,,8.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.62,,,8.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.71,,,8.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.88,,,8.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.03,,,9.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87070 - CUL BACT XCPT URINE BLOOD-STOOL AEROBIC ISOL,87070,HCPCS,,,91,Outpatient,,,79,19.75,8.62,67.15,,,34.4,,27.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.04,,,11.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.46,,,15.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.71,,,13.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.82,Percent of Total Billed Charges, ,11.04,,,11.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,55.3,Percent of Total Billed Charges, ,,85,,67.15,Percent of Total Billed Charges, ,,50,,39.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.72,Percent of Total Billed Charges,0,8.62,,,8.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,47.4,Percent of Total Billed Charges, ,13.25,,,13.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.7,,,10.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.92,,,8.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.01,,,9.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.71,,,8.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.62,,,8.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.71,,,8.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.88,,,8.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.03,,,9.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87070 - CUL BACT XCPT URINE BLOOD-STOOL AEROBIC ISOL,87070,HCPCS,,,59,Outpatient,,,79,19.75,8.62,67.15,,,34.4,,27.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.04,,,11.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.46,,,15.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.71,,,13.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.82,Percent of Total Billed Charges, ,11.04,,,11.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,55.3,Percent of Total Billed Charges, ,,85,,67.15,Percent of Total Billed Charges, ,,50,,39.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.72,Percent of Total Billed Charges,0,8.62,,,8.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,47.4,Percent of Total Billed Charges, ,13.25,,,13.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.7,,,10.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.92,,,8.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.01,,,9.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.71,,,8.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.62,,,8.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.71,,,8.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.88,,,8.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.03,,,9.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.53,,,36.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
89050 - CELL COUNT MISCELLANEOUS BODY FLUIDS,89050,HCPCS,,,59,Outpatient,,,25,6.25,4.72,21.25,,,34.4,,8.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.04,,,6.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.47,,,8.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.5,,,7.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16.4,Percent of Total Billed Charges, ,6.04,,,6.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17.5,Percent of Total Billed Charges, ,,85,,21.25,Percent of Total Billed Charges, ,,50,,12.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17,Percent of Total Billed Charges,0,4.72,,,4.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15,Percent of Total Billed Charges, ,7.26,,,7.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.85,,,5.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.89,,,4.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.93,,,4.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.77,,,4.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.72,,,4.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.77,,,4.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.86,,,4.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.94,,,4.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.05,,,20.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.05,,,20.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.05,,,20.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.05,,,20.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0300 - LABORATORY - GENERAL CLASSIFICATION,0300,RC,,,,Outpatient,,,975.89,243.9725,585.53,829.51,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,640.18,Percent of Total Billed Charges, ,,,,,,,,70,,683.12,Percent of Total Billed Charges, ,,85,,829.51,Percent of Total Billed Charges, ,,,,,,,,68,,663.61,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,585.53,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
80047 - BASIC METABOLIC PANEL CALCIUM IONIZED,80047,HCPCS,,,XU,Outpatient,,,404,101,13.73,343.4,,,34.4,,138.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.62,,,24.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.66,,,43.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.02,Percent of Total Billed Charges, ,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.8,Percent of Total Billed Charges, ,,85,,343.4,Percent of Total Billed Charges, ,,50,,202,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.72,Percent of Total Billed Charges,0,13.73,,,13.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,226.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,242.4,Percent of Total Billed Charges, ,42.22,,,42.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.03,,,17.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.42,,,28.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.7,,,28.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.46,,,27.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.28,,,28.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.76,,,28.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80047 - BASIC METABOLIC PANEL CALCIUM IONIZED,80047,HCPCS,,,XE,Outpatient,,,404,101,13.73,343.4,,,34.4,,138.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.62,,,24.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.66,,,43.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.02,Percent of Total Billed Charges, ,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.8,Percent of Total Billed Charges, ,,85,,343.4,Percent of Total Billed Charges, ,,50,,202,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.72,Percent of Total Billed Charges,0,13.73,,,13.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,226.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,242.4,Percent of Total Billed Charges, ,42.22,,,42.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.03,,,17.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.42,,,28.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.7,,,28.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.46,,,27.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.28,,,28.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.76,,,28.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80047 - BASIC METABOLIC PANEL CALCIUM IONIZED,80047,HCPCS,,,AY,Outpatient,,,404,101,13.73,343.4,,,34.4,,138.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.62,,,24.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.66,,,43.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.02,Percent of Total Billed Charges, ,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.8,Percent of Total Billed Charges, ,,85,,343.4,Percent of Total Billed Charges, ,,50,,202,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.72,Percent of Total Billed Charges,0,13.73,,,13.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,226.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,242.4,Percent of Total Billed Charges, ,42.22,,,42.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.03,,,17.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.42,,,28.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.7,,,28.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.46,,,27.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.28,,,28.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.76,,,28.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80047 - BASIC METABOLIC PANEL CALCIUM IONIZED,80047,HCPCS,,,91,Outpatient,,,404,101,13.73,343.4,,,34.4,,138.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.62,,,24.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.66,,,43.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.02,Percent of Total Billed Charges, ,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.8,Percent of Total Billed Charges, ,,85,,343.4,Percent of Total Billed Charges, ,,50,,202,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.72,Percent of Total Billed Charges,0,13.73,,,13.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,226.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,242.4,Percent of Total Billed Charges, ,42.22,,,42.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.03,,,17.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.42,,,28.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.7,,,28.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.46,,,27.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.28,,,28.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.76,,,28.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80047 - BASIC METABOLIC PANEL CALCIUM IONIZED,80047,HCPCS,,,59,Outpatient,,,404,101,13.73,343.4,,,34.4,,138.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.62,,,24.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.66,,,43.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.02,Percent of Total Billed Charges, ,17.57,,,17.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.8,Percent of Total Billed Charges, ,,85,,343.4,Percent of Total Billed Charges, ,,50,,202,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.72,Percent of Total Billed Charges,0,13.73,,,13.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,226.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,242.4,Percent of Total Billed Charges, ,42.22,,,42.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.03,,,17.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.42,,,28.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.7,,,28.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.46,,,27.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.28,,,28.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.76,,,28.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.71,,,91.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80048 - BASIC METABOLIC PANEL CALCIUM TOTAL,80048,HCPCS,,,XE,Outpatient,,,307,76.75,8.46,260.95,,,34.4,,105.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.18,,,15.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.9,,,26.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,201.39,Percent of Total Billed Charges, ,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,214.9,Percent of Total Billed Charges, ,,85,,260.95,Percent of Total Billed Charges, ,,50,,153.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,208.76,Percent of Total Billed Charges,0,8.46,,,8.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,171.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,184.2,Percent of Total Billed Charges, ,26.01,,,26.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.49,,,10.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.51,,,17.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.68,,,17.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.92,,,16.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.43,,,17.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.72,,,17.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80048 - BASIC METABOLIC PANEL CALCIUM TOTAL,80048,HCPCS,,,RT,Outpatient,,,307,76.75,8.46,260.95,,,34.4,,105.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.18,,,15.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.9,,,26.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,201.39,Percent of Total Billed Charges, ,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,214.9,Percent of Total Billed Charges, ,,85,,260.95,Percent of Total Billed Charges, ,,50,,153.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,208.76,Percent of Total Billed Charges,0,8.46,,,8.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,171.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,184.2,Percent of Total Billed Charges, ,26.01,,,26.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.49,,,10.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.51,,,17.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.68,,,17.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.92,,,16.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.43,,,17.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.72,,,17.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80048 - BASIC METABOLIC PANEL CALCIUM TOTAL,80048,HCPCS,,,GZ,Outpatient,,,307,76.75,8.46,260.95,,,34.4,,105.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.18,,,15.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.9,,,26.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,201.39,Percent of Total Billed Charges, ,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,214.9,Percent of Total Billed Charges, ,,85,,260.95,Percent of Total Billed Charges, ,,50,,153.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,208.76,Percent of Total Billed Charges,0,8.46,,,8.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,171.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,184.2,Percent of Total Billed Charges, ,26.01,,,26.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.49,,,10.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.51,,,17.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.68,,,17.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.92,,,16.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.43,,,17.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.72,,,17.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80048 - BASIC METABOLIC PANEL CALCIUM TOTAL,80048,HCPCS,,,AY,Outpatient,,,307,76.75,8.46,260.95,,,34.4,,105.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.18,,,15.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.9,,,26.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,201.39,Percent of Total Billed Charges, ,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,214.9,Percent of Total Billed Charges, ,,85,,260.95,Percent of Total Billed Charges, ,,50,,153.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,208.76,Percent of Total Billed Charges,0,8.46,,,8.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,171.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,184.2,Percent of Total Billed Charges, ,26.01,,,26.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.49,,,10.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.51,,,17.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.68,,,17.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.92,,,16.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.43,,,17.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.72,,,17.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80048 - BASIC METABOLIC PANEL CALCIUM TOTAL,80048,HCPCS,,,91,Outpatient,,,308.31,77.0775,8.46,262.06,,,34.4,,106.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.18,,,15.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.9,,,26.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,202.25,Percent of Total Billed Charges, ,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,215.82,Percent of Total Billed Charges, ,,85,,262.06,Percent of Total Billed Charges, ,,50,,154.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,209.65,Percent of Total Billed Charges,0,8.46,,,8.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,172.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,184.99,Percent of Total Billed Charges, ,26.01,,,26.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.49,,,10.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.51,,,17.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.68,,,17.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.92,,,16.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.43,,,17.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.72,,,17.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80048 - BASIC METABOLIC PANEL CALCIUM TOTAL,80048,HCPCS,,,59,Outpatient,,,307,76.75,8.46,260.95,,,34.4,,105.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.18,,,15.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.9,,,26.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,201.39,Percent of Total Billed Charges, ,10.83,,,10.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,214.9,Percent of Total Billed Charges, ,,85,,260.95,Percent of Total Billed Charges, ,,50,,153.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,208.76,Percent of Total Billed Charges,0,8.46,,,8.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,171.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,184.2,Percent of Total Billed Charges, ,26.01,,,26.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.49,,,10.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.51,,,17.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.68,,,17.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.92,,,16.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.09,,,17.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.43,,,17.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.72,,,17.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.91,,,35.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80051 - ELECTROLYTE PANEL,80051,HCPCS,,,AY,Outpatient,,,65,16.25,7.01,55.25,,,34.4,,22.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.97,,,8.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.29,,,22.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,42.64,Percent of Total Billed Charges, ,8.97,,,8.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,45.5,Percent of Total Billed Charges, ,,85,,55.25,Percent of Total Billed Charges, ,,50,,32.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,44.2,Percent of Total Billed Charges,0,7.01,,,7.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,36.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,39,Percent of Total Billed Charges, ,21.56,,,21.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.69,,,8.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.51,,,14.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.65,,,14.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.16,,,14.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.02,,,14.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.16,,,14.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.44,,,14.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.69,,,14.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80051 - ELECTROLYTE PANEL,80051,HCPCS,,,91,Outpatient,,,65,16.25,7.01,55.25,,,34.4,,22.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.97,,,8.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.29,,,22.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,42.64,Percent of Total Billed Charges, ,8.97,,,8.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,45.5,Percent of Total Billed Charges, ,,85,,55.25,Percent of Total Billed Charges, ,,50,,32.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,44.2,Percent of Total Billed Charges,0,7.01,,,7.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,36.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,39,Percent of Total Billed Charges, ,21.56,,,21.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.69,,,8.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.51,,,14.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.65,,,14.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.16,,,14.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.02,,,14.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.16,,,14.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.44,,,14.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.69,,,14.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80051 - ELECTROLYTE PANEL,80051,HCPCS,,,59,Outpatient,,,65,16.25,7.01,55.25,,,34.4,,22.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.97,,,8.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.29,,,22.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,42.64,Percent of Total Billed Charges, ,8.97,,,8.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,45.5,Percent of Total Billed Charges, ,,85,,55.25,Percent of Total Billed Charges, ,,50,,32.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,44.2,Percent of Total Billed Charges,0,7.01,,,7.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,36.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,39,Percent of Total Billed Charges, ,21.56,,,21.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.69,,,8.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.51,,,14.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.65,,,14.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.16,,,14.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.02,,,14.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.16,,,14.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.44,,,14.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.69,,,14.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80053 - COMPREHENSIVE METABOLIC PANEL,80053,HCPCS,,,XE,Outpatient,,,1194,298.5,10.56,1014.9,,,34.4,,410.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.93,,,18.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.58,,,33.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,783.26,Percent of Total Billed Charges, ,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,835.8,Percent of Total Billed Charges, ,,85,,1014.9,Percent of Total Billed Charges, ,,50,,597,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,811.92,Percent of Total Billed Charges,0,10.56,,,10.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,668.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,716.4,Percent of Total Billed Charges, ,32.47,,,32.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.1,,,13.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.07,,,22.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.12,,,21.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.12,,,22.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80053 - COMPREHENSIVE METABOLIC PANEL,80053,HCPCS,,,GZ,Outpatient,,,1194,298.5,10.56,1014.9,,,34.4,,410.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.93,,,18.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.58,,,33.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,783.26,Percent of Total Billed Charges, ,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,835.8,Percent of Total Billed Charges, ,,85,,1014.9,Percent of Total Billed Charges, ,,50,,597,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,811.92,Percent of Total Billed Charges,0,10.56,,,10.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,668.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,716.4,Percent of Total Billed Charges, ,32.47,,,32.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.1,,,13.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.07,,,22.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.12,,,21.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.12,,,22.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80053 - COMPREHENSIVE METABOLIC PANEL,80053,HCPCS,,,AY,Outpatient,,,1194,298.5,10.56,1014.9,,,34.4,,410.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.93,,,18.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.58,,,33.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,783.26,Percent of Total Billed Charges, ,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,835.8,Percent of Total Billed Charges, ,,85,,1014.9,Percent of Total Billed Charges, ,,50,,597,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,811.92,Percent of Total Billed Charges,0,10.56,,,10.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,668.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,716.4,Percent of Total Billed Charges, ,32.47,,,32.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.1,,,13.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.07,,,22.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.12,,,21.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.12,,,22.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80053 - COMPREHENSIVE METABOLIC PANEL,80053,HCPCS,,,91,Outpatient,,,1194,298.5,10.56,1014.9,,,34.4,,410.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.93,,,18.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.58,,,33.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,783.26,Percent of Total Billed Charges, ,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,835.8,Percent of Total Billed Charges, ,,85,,1014.9,Percent of Total Billed Charges, ,,50,,597,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,811.92,Percent of Total Billed Charges,0,10.56,,,10.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,668.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,716.4,Percent of Total Billed Charges, ,32.47,,,32.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.1,,,13.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.07,,,22.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.12,,,21.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.12,,,22.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80053 - COMPREHENSIVE METABOLIC PANEL,80053,HCPCS,,,59,Outpatient,,,1194,298.5,10.56,1014.9,,,34.4,,410.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.93,,,18.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.58,,,33.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,783.26,Percent of Total Billed Charges, ,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,835.8,Percent of Total Billed Charges, ,,85,,1014.9,Percent of Total Billed Charges, ,,50,,597,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,811.92,Percent of Total Billed Charges,0,10.56,,,10.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,668.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,716.4,Percent of Total Billed Charges, ,32.47,,,32.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.1,,,13.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.07,,,22.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.12,,,21.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.12,,,22.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80053 - COMPREHENSIVE METABOLIC PANEL,80053,HCPCS,,,25,Outpatient,,,1194,298.5,10.56,1014.9,,,34.4,,410.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.93,,,18.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.58,,,33.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,783.26,Percent of Total Billed Charges, ,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,835.8,Percent of Total Billed Charges, ,,85,,1014.9,Percent of Total Billed Charges, ,,50,,597,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,811.92,Percent of Total Billed Charges,0,10.56,,,10.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,668.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,716.4,Percent of Total Billed Charges, ,32.47,,,32.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.1,,,13.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.07,,,22.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.12,,,21.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.12,,,22.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.85,,,44.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80061 - LIPID PANEL,80061,HCPCS,,,GZ,Outpatient,,,577.67,144.4175,13.39,491.02,,,34.4,,198.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.14,,,17.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.01,,,24.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.58,,,42.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,378.95,Percent of Total Billed Charges, ,17.14,,,17.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,404.37,Percent of Total Billed Charges, ,,85,,491.02,Percent of Total Billed Charges, ,,50,,288.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,392.82,Percent of Total Billed Charges,0,13.39,,,13.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,323.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,346.6,Percent of Total Billed Charges, ,41.17,,,41.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.6,,,16.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.72,,,27.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.99,,,27.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.78,,,26.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.58,,,27.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.05,,,28.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80061 - LIPID PANEL,80061,HCPCS,,,GA,Outpatient,,,510.67,127.6675,13.39,434.07,,,34.4,,175.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.14,,,17.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.01,,,24.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.58,,,42.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,335,Percent of Total Billed Charges, ,17.14,,,17.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,357.47,Percent of Total Billed Charges, ,,85,,434.07,Percent of Total Billed Charges, ,,50,,255.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,347.26,Percent of Total Billed Charges,0,13.39,,,13.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,306.4,Percent of Total Billed Charges, ,41.17,,,41.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.6,,,16.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.72,,,27.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.99,,,27.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.78,,,26.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.58,,,27.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.05,,,28.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80061 - LIPID PANEL,80061,HCPCS,,,91,Outpatient,,,332,83,13.39,282.2,,,34.4,,114.21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.14,,,17.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.01,,,24.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.58,,,42.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,217.79,Percent of Total Billed Charges, ,17.14,,,17.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,232.4,Percent of Total Billed Charges, ,,85,,282.2,Percent of Total Billed Charges, ,,50,,166,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,225.76,Percent of Total Billed Charges,0,13.39,,,13.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,185.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.2,Percent of Total Billed Charges, ,41.17,,,41.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.6,,,16.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.72,,,27.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.99,,,27.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.78,,,26.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.58,,,27.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.05,,,28.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.94,,,53.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80069 - RENAL FUNCTION PANEL,80069,HCPCS,,,GZ,Outpatient,,,80,20,8.68,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.12,,,11.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.57,,,15.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.6,,,27.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,11.12,,,11.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,8.68,,,8.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,26.69,,,26.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.77,,,10.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.97,,,17.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.14,,,18.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.53,,,17.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.36,,,17.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.53,,,17.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.88,,,17.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.18,,,18.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80069 - RENAL FUNCTION PANEL,80069,HCPCS,,,AY,Outpatient,,,80,20,8.68,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.12,,,11.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.57,,,15.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.6,,,27.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,11.12,,,11.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,8.68,,,8.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,26.69,,,26.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.77,,,10.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.97,,,17.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.14,,,18.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.53,,,17.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.36,,,17.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.53,,,17.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.88,,,17.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.18,,,18.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80069 - RENAL FUNCTION PANEL,80069,HCPCS,,,91,Outpatient,,,80,20,8.68,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.12,,,11.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.57,,,15.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.6,,,27.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,11.12,,,11.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,8.68,,,8.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,26.69,,,26.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.77,,,10.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.97,,,17.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.14,,,18.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.53,,,17.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.36,,,17.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.53,,,17.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.88,,,17.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.18,,,18.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80069 - RENAL FUNCTION PANEL,80069,HCPCS,,,59,Outpatient,,,80,20,8.68,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.12,,,11.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.57,,,15.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.6,,,27.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,11.12,,,11.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,8.68,,,8.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,26.69,,,26.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.77,,,10.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.97,,,17.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.14,,,18.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.53,,,17.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.36,,,17.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.53,,,17.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.88,,,17.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.18,,,18.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.83,,,36.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80074 - ACUTE HEPATITIS PANEL,80074,HCPCS,,,GZ,Outpatient,,,162,40.5,47.63,201.99,,,34.4,,55.73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,60.98,,,60.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,85.45,,,85.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,75.73,,,75.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,106.27,Percent of Total Billed Charges, ,60.98,,,60.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,113.4,Percent of Total Billed Charges, ,,85,,137.7,Percent of Total Billed Charges, ,,50,,81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,110.16,Percent of Total Billed Charges,0,47.63,,,47.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,90.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,97.2,Percent of Total Billed Charges, ,73.23,,,73.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.08,,,59.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,49.3,,,49.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.77,,,49.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.11,,,48.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.63,,,47.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.11,,,48.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.06,,,49.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.89,,,49.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.99,,,201.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,201.99,,,201.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,201.99,,,201.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,201.99,,,201.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80074 - ACUTE HEPATITIS PANEL,80074,HCPCS,,,GA,Outpatient,,,162,40.5,47.63,201.99,,,34.4,,55.73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,60.98,,,60.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,85.45,,,85.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,75.73,,,75.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,106.27,Percent of Total Billed Charges, ,60.98,,,60.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,113.4,Percent of Total Billed Charges, ,,85,,137.7,Percent of Total Billed Charges, ,,50,,81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,110.16,Percent of Total Billed Charges,0,47.63,,,47.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,90.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,97.2,Percent of Total Billed Charges, ,73.23,,,73.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.08,,,59.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,49.3,,,49.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.77,,,49.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.11,,,48.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.63,,,47.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.11,,,48.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.06,,,49.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.89,,,49.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.99,,,201.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,201.99,,,201.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,201.99,,,201.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,201.99,,,201.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80076 - HEPATIC FUNCTION PANEL,80076,HCPCS,,,XE,Outpatient,,,75,18.75,8.17,63.75,,,34.4,,25.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.66,,,14.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.99,,,12.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.2,Percent of Total Billed Charges, ,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.5,Percent of Total Billed Charges, ,,85,,63.75,Percent of Total Billed Charges, ,,50,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51,Percent of Total Billed Charges,0,8.17,,,8.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,45,Percent of Total Billed Charges, ,12.56,,,12.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.13,,,10.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.46,,,8.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.54,,,8.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.42,,,8.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.56,,,8.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80076 - HEPATIC FUNCTION PANEL,80076,HCPCS,,,GZ,Outpatient,,,75,18.75,8.17,63.75,,,34.4,,25.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.66,,,14.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.99,,,12.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.2,Percent of Total Billed Charges, ,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.5,Percent of Total Billed Charges, ,,85,,63.75,Percent of Total Billed Charges, ,,50,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51,Percent of Total Billed Charges,0,8.17,,,8.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,45,Percent of Total Billed Charges, ,12.56,,,12.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.13,,,10.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.46,,,8.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.54,,,8.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.42,,,8.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.56,,,8.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80076 - HEPATIC FUNCTION PANEL,80076,HCPCS,,,AY,Outpatient,,,75,18.75,8.17,63.75,,,34.4,,25.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.66,,,14.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.99,,,12.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.2,Percent of Total Billed Charges, ,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.5,Percent of Total Billed Charges, ,,85,,63.75,Percent of Total Billed Charges, ,,50,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51,Percent of Total Billed Charges,0,8.17,,,8.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,45,Percent of Total Billed Charges, ,12.56,,,12.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.13,,,10.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.46,,,8.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.54,,,8.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.42,,,8.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.56,,,8.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80076 - HEPATIC FUNCTION PANEL,80076,HCPCS,,,91,Outpatient,,,75,18.75,8.17,63.75,,,34.4,,25.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.66,,,14.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.99,,,12.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.2,Percent of Total Billed Charges, ,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.5,Percent of Total Billed Charges, ,,85,,63.75,Percent of Total Billed Charges, ,,50,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51,Percent of Total Billed Charges,0,8.17,,,8.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,45,Percent of Total Billed Charges, ,12.56,,,12.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.13,,,10.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.46,,,8.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.54,,,8.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.42,,,8.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.56,,,8.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80076 - HEPATIC FUNCTION PANEL,80076,HCPCS,,,59,Outpatient,,,75,18.75,8.17,63.75,,,34.4,,25.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.66,,,14.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.99,,,12.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.2,Percent of Total Billed Charges, ,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.5,Percent of Total Billed Charges, ,,85,,63.75,Percent of Total Billed Charges, ,,50,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51,Percent of Total Billed Charges,0,8.17,,,8.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,45,Percent of Total Billed Charges, ,12.56,,,12.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.13,,,10.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.46,,,8.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.54,,,8.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.42,,,8.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.56,,,8.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.66,,,34.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80143 - DRUG ASSAY ACETAMINOPHEN,80143,HCPCS,,,91,Outpatient,,,101,25.25,18.64,85.85,,,34.4,,34.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.86,,,23.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.45,,,33.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.64,,,29.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,66.26,Percent of Total Billed Charges, ,23.86,,,23.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70.7,Percent of Total Billed Charges, ,,85,,85.85,Percent of Total Billed Charges, ,,50,,50.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68.68,Percent of Total Billed Charges,0,18.64,,,18.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60.6,Percent of Total Billed Charges, ,28.66,,,28.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.12,,,23.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.29,,,19.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.83,,,18.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.64,,,18.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.83,,,18.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.2,,,19.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.53,,,19.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80143 - DRUG ASSAY ACETAMINOPHEN,80143,HCPCS,,,59,Outpatient,,,101,25.25,18.64,85.85,,,34.4,,34.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.86,,,23.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.45,,,33.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.64,,,29.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,66.26,Percent of Total Billed Charges, ,23.86,,,23.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70.7,Percent of Total Billed Charges, ,,85,,85.85,Percent of Total Billed Charges, ,,50,,50.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68.68,Percent of Total Billed Charges,0,18.64,,,18.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60.6,Percent of Total Billed Charges, ,28.66,,,28.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.12,,,23.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.29,,,19.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.83,,,18.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.64,,,18.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.83,,,18.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.2,,,19.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.53,,,19.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80178 - DRUG SCREEN QUANTITATIVE LITHIUM,80178,HCPCS,,,91,Outpatient,,,82,20.5,6.61,69.7,,,34.4,,28.21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.47,,,8.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.87,,,11.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.02,,,21.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,53.79,Percent of Total Billed Charges, ,8.47,,,8.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,57.4,Percent of Total Billed Charges, ,,85,,69.7,Percent of Total Billed Charges, ,,50,,41,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,55.76,Percent of Total Billed Charges,0,6.61,,,6.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,45.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,49.2,Percent of Total Billed Charges, ,20.33,,,20.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.2,,,8.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.68,,,13.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.81,,,13.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.35,,,13.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.22,,,13.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.35,,,13.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.62,,,13.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.85,,,13.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.01,,,28.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.01,,,28.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.01,,,28.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.01,,,28.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80179 - DRUG ASSAY SALICYLATE,80179,HCPCS,,,91,Outpatient,,,101,25.25,18.64,85.85,,,34.4,,34.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.86,,,23.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.45,,,33.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.64,,,29.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,66.26,Percent of Total Billed Charges, ,23.86,,,23.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70.7,Percent of Total Billed Charges, ,,85,,85.85,Percent of Total Billed Charges, ,,50,,50.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68.68,Percent of Total Billed Charges,0,18.64,,,18.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60.6,Percent of Total Billed Charges, ,28.66,,,28.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.12,,,23.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.29,,,19.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.83,,,18.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.64,,,18.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.83,,,18.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.2,,,19.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.53,,,19.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.36,,,55.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80305 - DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE,80305,HCPCS,,,GZ,Outpatient,,,32,8,11.01,44.43,,,34.4,,11.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.13,,,16.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.6,,,22.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.07,,,40.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.99,Percent of Total Billed Charges, ,16.13,,,16.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22.4,Percent of Total Billed Charges, ,,85,,27.2,Percent of Total Billed Charges, ,,50,,16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.76,Percent of Total Billed Charges,0,12.6,,,12.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.2,Percent of Total Billed Charges, ,38.75,,,38.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.62,,,15.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.08,,,26.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.33,,,26.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.45,,,25.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.2,,,25.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.45,,,25.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.96,,,25.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.4,,,26.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.43,,,44.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.43,,,44.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.43,,,44.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.43,,,44.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80305 - DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE,80305,HCPCS,,,GA,Outpatient,,,32,8,11.01,44.43,,,34.4,,11.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.13,,,16.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.6,,,22.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.07,,,40.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.99,Percent of Total Billed Charges, ,16.13,,,16.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22.4,Percent of Total Billed Charges, ,,85,,27.2,Percent of Total Billed Charges, ,,50,,16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.76,Percent of Total Billed Charges,0,12.6,,,12.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.2,Percent of Total Billed Charges, ,38.75,,,38.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.62,,,15.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.08,,,26.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.33,,,26.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.45,,,25.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.2,,,25.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.45,,,25.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.96,,,25.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.4,,,26.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.43,,,44.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.43,,,44.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.43,,,44.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.43,,,44.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80307 - DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE,80307,HCPCS,,,GZ,Outpatient,,,190,47.5,0.01,237.04,,,34.4,,65.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,111.48,,,111.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.8,,,98.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,124.64,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,133,Percent of Total Billed Charges, ,,85,,161.5,Percent of Total Billed Charges, ,,50,,95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,129.2,Percent of Total Billed Charges,0,62.14,,,62.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,106.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,114,Percent of Total Billed Charges, ,95.54,,,95.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.31,,,64.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.94,,,64.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.76,,,62.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.14,,,62.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.76,,,62.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64,,,64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.09,,,65.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80307 - DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE,80307,HCPCS,,,GA,Outpatient,,,190,47.5,0.01,237.04,,,34.4,,65.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,111.48,,,111.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.8,,,98.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,124.64,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,133,Percent of Total Billed Charges, ,,85,,161.5,Percent of Total Billed Charges, ,,50,,95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,129.2,Percent of Total Billed Charges,0,62.14,,,62.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,106.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,114,Percent of Total Billed Charges, ,95.54,,,95.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.31,,,64.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.94,,,64.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.76,,,62.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.14,,,62.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.76,,,62.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64,,,64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.09,,,65.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80307 - DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE,80307,HCPCS,,,91,Outpatient,,,190,47.5,0.01,237.04,,,34.4,,65.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,111.48,,,111.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.8,,,98.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,124.64,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,133,Percent of Total Billed Charges, ,,85,,161.5,Percent of Total Billed Charges, ,,50,,95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,129.2,Percent of Total Billed Charges,0,62.14,,,62.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,106.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,114,Percent of Total Billed Charges, ,95.54,,,95.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.31,,,64.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.94,,,64.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.76,,,62.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.14,,,62.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.76,,,62.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64,,,64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.09,,,65.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
80307 - DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE,80307,HCPCS,,,59,Outpatient,,,190,47.5,0.01,237.04,,,34.4,,65.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,111.48,,,111.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.8,,,98.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,124.64,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,133,Percent of Total Billed Charges, ,,85,,161.5,Percent of Total Billed Charges, ,,50,,95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,129.2,Percent of Total Billed Charges,0,62.14,,,62.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,106.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,114,Percent of Total Billed Charges, ,95.54,,,95.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.31,,,64.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.94,,,64.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.76,,,62.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.14,,,62.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.76,,,62.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64,,,64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.09,,,65.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.04,,,237.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82010 - KETONE BODYS QUANTITATIVE,82010,HCPCS,,,91,Outpatient,,,112,28,8.17,95.2,,,34.4,,38.53,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.66,,,14.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.98,,,25.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,73.47,Percent of Total Billed Charges, ,10.46,,,10.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,78.4,Percent of Total Billed Charges, ,,85,,95.2,Percent of Total Billed Charges, ,,50,,56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,76.16,Percent of Total Billed Charges,0,8.17,,,8.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,62.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,67.2,Percent of Total Billed Charges, ,25.12,,,25.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.13,,,10.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.91,,,16.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.08,,,17.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.5,,,16.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.34,,,16.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.5,,,16.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.83,,,16.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.12,,,17.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.73,,,29.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82040 - ALBUMIN SERUM PLASMA-WHOLE BLOOD,82040,HCPCS,,,AY,Outpatient,,,75,18.75,4.95,63.75,,,34.4,,25.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.74,,,15.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.2,Percent of Total Billed Charges, ,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.5,Percent of Total Billed Charges, ,,85,,63.75,Percent of Total Billed Charges, ,,50,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51,Percent of Total Billed Charges,0,4.95,,,4.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,45,Percent of Total Billed Charges, ,15.22,,,15.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.14,,,6.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.25,,,10.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.35,,,10.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10,,,10,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.9,,,9.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10,,,10,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.2,,,10.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.37,,,10.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82040 - ALBUMIN SERUM PLASMA-WHOLE BLOOD,82040,HCPCS,,,91,Outpatient,,,75,18.75,4.95,63.75,,,34.4,,25.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.74,,,15.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.2,Percent of Total Billed Charges, ,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.5,Percent of Total Billed Charges, ,,85,,63.75,Percent of Total Billed Charges, ,,50,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51,Percent of Total Billed Charges,0,4.95,,,4.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,45,Percent of Total Billed Charges, ,15.22,,,15.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.14,,,6.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.25,,,10.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.35,,,10.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10,,,10,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.9,,,9.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10,,,10,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.2,,,10.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.37,,,10.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82040 - ALBUMIN SERUM PLASMA-WHOLE BLOOD,82040,HCPCS,,,59,Outpatient,,,71.67,17.9175,4.95,60.92,,,34.4,,24.65,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.74,,,15.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,47.02,Percent of Total Billed Charges, ,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,50.17,Percent of Total Billed Charges, ,,85,,60.92,Percent of Total Billed Charges, ,,50,,35.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,48.74,Percent of Total Billed Charges,0,4.95,,,4.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,40.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,43,Percent of Total Billed Charges, ,15.22,,,15.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.14,,,6.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.25,,,10.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.35,,,10.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10,,,10,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.9,,,9.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10,,,10,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.2,,,10.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.37,,,10.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.03,,,21.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82042 - OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN,82042,HCPCS,,,59,Outpatient,,,80,20,7.78,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.96,,,9.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.97,,,13.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.74,,,24.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,9.96,,,9.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,7.78,,,7.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,23.92,,,23.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.65,,,9.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.1,,,16.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.26,,,16.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.72,,,15.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.56,,,15.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.72,,,15.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.03,,,16.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.3,,,16.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82077 - ASSAY OF ALCOHOL (ETHANOL) SPEC XCP URANDBREATH IA,82077,HCPCS,,,91,Outpatient,,,142,35.5,17.27,120.7,,,34.4,,48.85,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.11,,,22.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.99,,,30.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.46,,,27.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,93.15,Percent of Total Billed Charges, ,22.11,,,22.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,99.4,Percent of Total Billed Charges, ,,85,,120.7,Percent of Total Billed Charges, ,,50,,71,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,96.56,Percent of Total Billed Charges,0,17.27,,,17.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,79.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,85.2,Percent of Total Billed Charges, ,26.55,,,26.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.42,,,21.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.87,,,17.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.05,,,18.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.44,,,17.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.27,,,17.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.44,,,17.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.79,,,17.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.09,,,18.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.29,,,51.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.29,,,51.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.29,,,51.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.29,,,51.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82077 - ASSAY OF ALCOHOL (ETHANOL) SPEC XCP URANDBREATH IA,82077,HCPCS,,,59,Outpatient,,,142,35.5,17.27,120.7,,,34.4,,48.85,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.11,,,22.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.99,,,30.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.46,,,27.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,93.15,Percent of Total Billed Charges, ,22.11,,,22.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,99.4,Percent of Total Billed Charges, ,,85,,120.7,Percent of Total Billed Charges, ,,50,,71,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,96.56,Percent of Total Billed Charges,0,17.27,,,17.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,79.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,85.2,Percent of Total Billed Charges, ,26.55,,,26.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.42,,,21.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.87,,,17.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.05,,,18.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.44,,,17.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.27,,,17.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.44,,,17.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.79,,,17.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.09,,,18.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.29,,,51.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.29,,,51.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.29,,,51.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.29,,,51.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82105 - ALPHA-FETOPROTEIN SERUM,82105,HCPCS,,,GZ,Outpatient,,,339,84.75,16.77,288.15,,,34.4,,116.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.47,,,21.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.08,,,30.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.66,,,26.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,222.38,Percent of Total Billed Charges, ,21.47,,,21.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,237.3,Percent of Total Billed Charges, ,,85,,288.15,Percent of Total Billed Charges, ,,50,,169.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,230.52,Percent of Total Billed Charges,0,16.77,,,16.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,189.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,203.4,Percent of Total Billed Charges, ,25.78,,,25.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.8,,,20.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.36,,,17.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.52,,,17.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.94,,,16.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.77,,,16.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.94,,,16.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.27,,,17.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.57,,,17.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.13,,,71.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.13,,,71.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.13,,,71.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.13,,,71.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82105 - ALPHA-FETOPROTEIN SERUM,82105,HCPCS,,,GA,Outpatient,,,339,84.75,16.77,288.15,,,34.4,,116.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.47,,,21.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.08,,,30.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.66,,,26.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,222.38,Percent of Total Billed Charges, ,21.47,,,21.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,237.3,Percent of Total Billed Charges, ,,85,,288.15,Percent of Total Billed Charges, ,,50,,169.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,230.52,Percent of Total Billed Charges,0,16.77,,,16.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,189.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,203.4,Percent of Total Billed Charges, ,25.78,,,25.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.8,,,20.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.36,,,17.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.52,,,17.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.94,,,16.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.77,,,16.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.94,,,16.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.27,,,17.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.57,,,17.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.13,,,71.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.13,,,71.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.13,,,71.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.13,,,71.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82150 - ASSAY OF AMYLASE,82150,HCPCS,,,91,Outpatient,,,60,15,6.48,51,,,34.4,,20.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.3,,,8.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.61,,,20.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.36,Percent of Total Billed Charges, ,8.3,,,8.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,42,Percent of Total Billed Charges, ,,85,,51,Percent of Total Billed Charges, ,,50,,30,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.8,Percent of Total Billed Charges,0,6.48,,,6.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,33.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,36,Percent of Total Billed Charges, ,19.93,,,19.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.04,,,8.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.41,,,13.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.54,,,13.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.09,,,13.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.96,,,12.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.09,,,13.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.35,,,13.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.58,,,13.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.5,,,27.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.5,,,27.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.5,,,27.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.5,,,27.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82247 - BILIRUBIN TOTAL,82247,HCPCS,,,91,Outpatient,,,151,37.75,5.02,128.35,,,34.4,,51.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.42,,,6.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9,,,9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.96,,,15.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,99.06,Percent of Total Billed Charges, ,6.42,,,6.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105.7,Percent of Total Billed Charges, ,,85,,128.35,Percent of Total Billed Charges, ,,50,,75.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,102.68,Percent of Total Billed Charges,0,5.02,,,5.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,84.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90.6,Percent of Total Billed Charges, ,15.44,,,15.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.22,,,6.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.39,,,10.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.49,,,10.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.14,,,10.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.14,,,10.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.52,,,10.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.29,,,21.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.29,,,21.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.29,,,21.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.29,,,21.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82247 - BILIRUBIN TOTAL,82247,HCPCS,,,59,Outpatient,,,151,37.75,5.02,128.35,,,34.4,,51.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.42,,,6.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9,,,9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.96,,,15.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,99.06,Percent of Total Billed Charges, ,6.42,,,6.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105.7,Percent of Total Billed Charges, ,,85,,128.35,Percent of Total Billed Charges, ,,50,,75.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,102.68,Percent of Total Billed Charges,0,5.02,,,5.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,84.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90.6,Percent of Total Billed Charges, ,15.44,,,15.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.22,,,6.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.39,,,10.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.49,,,10.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.14,,,10.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.14,,,10.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.52,,,10.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.29,,,21.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.29,,,21.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.29,,,21.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.29,,,21.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82306 - 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,82306,HCPCS,,,GZ,Outpatient,,,237,59.25,29.6,201.45,,,34.4,,81.53,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,37.89,,,37.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.1,,,53.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.06,,,47.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,155.47,Percent of Total Billed Charges, ,37.89,,,37.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,165.9,Percent of Total Billed Charges, ,,85,,201.45,Percent of Total Billed Charges, ,,50,,118.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,161.16,Percent of Total Billed Charges,0,29.6,,,29.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,132.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,142.2,Percent of Total Billed Charges, ,45.51,,,45.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.71,,,36.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.64,,,30.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.93,,,30.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.9,,,29.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.6,,,29.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.9,,,29.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.49,,,30.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.01,,,31.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82306 - 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,82306,HCPCS,,,GA,Outpatient,,,237,59.25,29.6,201.45,,,34.4,,81.53,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,37.89,,,37.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.1,,,53.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.06,,,47.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,155.47,Percent of Total Billed Charges, ,37.89,,,37.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,165.9,Percent of Total Billed Charges, ,,85,,201.45,Percent of Total Billed Charges, ,,50,,118.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,161.16,Percent of Total Billed Charges,0,29.6,,,29.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,132.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,142.2,Percent of Total Billed Charges, ,45.51,,,45.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.71,,,36.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.64,,,30.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.93,,,30.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.9,,,29.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.6,,,29.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.9,,,29.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.49,,,30.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.01,,,31.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82306 - 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,82306,HCPCS,,,AY,Outpatient,,,237,59.25,29.6,201.45,,,34.4,,81.53,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,37.89,,,37.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.1,,,53.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.06,,,47.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,155.47,Percent of Total Billed Charges, ,37.89,,,37.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,165.9,Percent of Total Billed Charges, ,,85,,201.45,Percent of Total Billed Charges, ,,50,,118.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,161.16,Percent of Total Billed Charges,0,29.6,,,29.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,132.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,142.2,Percent of Total Billed Charges, ,45.51,,,45.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.71,,,36.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.64,,,30.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.93,,,30.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.9,,,29.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.6,,,29.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.9,,,29.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.49,,,30.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.01,,,31.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,125.54,,,125.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82310 - CALCIUM TOTAL,82310,HCPCS,,,GZ,Outpatient,,,47,11.75,5.16,39.95,,,34.4,,16.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.25,,,9.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.41,,,16.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,30.83,Percent of Total Billed Charges, ,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,32.9,Percent of Total Billed Charges, ,,85,,39.95,Percent of Total Billed Charges, ,,50,,23.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,31.96,Percent of Total Billed Charges,0,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,26.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,28.2,Percent of Total Billed Charges, ,15.87,,,15.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.4,,,6.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.78,,,10.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.32,,,10.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.63,,,10.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.81,,,10.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82310 - CALCIUM TOTAL,82310,HCPCS,,,AY,Outpatient,,,47,11.75,5.16,39.95,,,34.4,,16.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.25,,,9.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.41,,,16.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,30.83,Percent of Total Billed Charges, ,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,32.9,Percent of Total Billed Charges, ,,85,,39.95,Percent of Total Billed Charges, ,,50,,23.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,31.96,Percent of Total Billed Charges,0,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,26.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,28.2,Percent of Total Billed Charges, ,15.87,,,15.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.4,,,6.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.78,,,10.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.32,,,10.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.63,,,10.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.81,,,10.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82310 - CALCIUM TOTAL,82310,HCPCS,,,91,Outpatient,,,47,11.75,5.16,39.95,,,34.4,,16.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.25,,,9.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.41,,,16.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,30.83,Percent of Total Billed Charges, ,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,32.9,Percent of Total Billed Charges, ,,85,,39.95,Percent of Total Billed Charges, ,,50,,23.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,31.96,Percent of Total Billed Charges,0,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,26.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,28.2,Percent of Total Billed Charges, ,15.87,,,15.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.4,,,6.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.78,,,10.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.32,,,10.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.63,,,10.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.81,,,10.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82310 - CALCIUM TOTAL,82310,HCPCS,,,59,Outpatient,,,47,11.75,5.16,39.95,,,34.4,,16.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.25,,,9.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.41,,,16.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,30.83,Percent of Total Billed Charges, ,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,32.9,Percent of Total Billed Charges, ,,85,,39.95,Percent of Total Billed Charges, ,,50,,23.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,31.96,Percent of Total Billed Charges,0,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,26.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,28.2,Percent of Total Billed Charges, ,15.87,,,15.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.4,,,6.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.78,,,10.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.32,,,10.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.63,,,10.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.81,,,10.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.86,,,21.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82330 - CALCIUM IONIZED,82330,HCPCS,,,AY,Outpatient,,,126,31.5,13.68,107.1,,,34.4,,43.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.52,,,17.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.54,,,24.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.5,,,43.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,82.66,Percent of Total Billed Charges, ,17.52,,,17.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,88.2,Percent of Total Billed Charges, ,,85,,107.1,Percent of Total Billed Charges, ,,50,,63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,85.68,Percent of Total Billed Charges,0,13.68,,,13.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,70.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,75.6,Percent of Total Billed Charges, ,42.07,,,42.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.97,,,16.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.32,,,28.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.59,,,28.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.63,,,27.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.36,,,27.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.63,,,27.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.18,,,28.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.66,,,28.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.04,,,56.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.04,,,56.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.04,,,56.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.04,,,56.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82330 - CALCIUM IONIZED,82330,HCPCS,,,91,Outpatient,,,126,31.5,13.68,107.1,,,34.4,,43.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.52,,,17.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.54,,,24.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.5,,,43.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,82.66,Percent of Total Billed Charges, ,17.52,,,17.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,88.2,Percent of Total Billed Charges, ,,85,,107.1,Percent of Total Billed Charges, ,,50,,63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,85.68,Percent of Total Billed Charges,0,13.68,,,13.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,70.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,75.6,Percent of Total Billed Charges, ,42.07,,,42.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.97,,,16.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.32,,,28.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.59,,,28.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.63,,,27.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.36,,,27.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.63,,,27.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.18,,,28.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.66,,,28.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.04,,,56.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.04,,,56.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.04,,,56.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.04,,,56.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82374 - CARBON DIOXIDE BICARBONATE,82374,HCPCS,,,AY,Outpatient,,,45,11.25,4.88,38.25,,,34.4,,15.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.24,,,6.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.75,,,8.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.52,,,15.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29.52,Percent of Total Billed Charges, ,6.24,,,6.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31.5,Percent of Total Billed Charges, ,,85,,38.25,Percent of Total Billed Charges, ,,50,,22.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30.6,Percent of Total Billed Charges,0,4.88,,,4.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,25.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,27,Percent of Total Billed Charges, ,15.01,,,15.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.05,,,6.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.1,,,10.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.2,,,10.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.86,,,9.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.76,,,9.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.86,,,9.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.05,,,10.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.22,,,10.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82374 - CARBON DIOXIDE BICARBONATE,82374,HCPCS,,,91,Outpatient,,,45,11.25,4.88,38.25,,,34.4,,15.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.24,,,6.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.75,,,8.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.52,,,15.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29.52,Percent of Total Billed Charges, ,6.24,,,6.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31.5,Percent of Total Billed Charges, ,,85,,38.25,Percent of Total Billed Charges, ,,50,,22.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30.6,Percent of Total Billed Charges,0,4.88,,,4.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,25.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,27,Percent of Total Billed Charges, ,15.01,,,15.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.05,,,6.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.1,,,10.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.2,,,10.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.86,,,9.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.76,,,9.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.86,,,9.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.05,,,10.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.22,,,10.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82374 - CARBON DIOXIDE BICARBONATE,82374,HCPCS,,,59,Outpatient,,,45,11.25,4.88,38.25,,,34.4,,15.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.24,,,6.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.75,,,8.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.52,,,15.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29.52,Percent of Total Billed Charges, ,6.24,,,6.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31.5,Percent of Total Billed Charges, ,,85,,38.25,Percent of Total Billed Charges, ,,50,,22.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30.6,Percent of Total Billed Charges,0,4.88,,,4.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,25.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,27,Percent of Total Billed Charges, ,15.01,,,15.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.05,,,6.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.1,,,10.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.2,,,10.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.86,,,9.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.76,,,9.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.86,,,9.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.05,,,10.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.22,,,10.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82375 - CARBOXYHEMOGLOBIN QUANTITATIVE,82375,HCPCS,,,91,Outpatient,,,113,28.25,12.32,96.05,,,34.4,,38.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.77,,,15.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.11,,,22.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.59,,,19.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,74.13,Percent of Total Billed Charges, ,15.77,,,15.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,79.1,Percent of Total Billed Charges, ,,85,,96.05,Percent of Total Billed Charges, ,,50,,56.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,76.84,Percent of Total Billed Charges,0,12.32,,,12.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,63.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,67.8,Percent of Total Billed Charges, ,18.94,,,18.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.28,,,15.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.75,,,12.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.87,,,12.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.44,,,12.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.32,,,12.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.44,,,12.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.69,,,12.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.91,,,12.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.27,,,52.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.27,,,52.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.27,,,52.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.27,,,52.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82375 - CARBOXYHEMOGLOBIN QUANTITATIVE,82375,HCPCS,,,59,Outpatient,,,113,28.25,12.32,96.05,,,34.4,,38.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.77,,,15.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.11,,,22.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.59,,,19.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,74.13,Percent of Total Billed Charges, ,15.77,,,15.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,79.1,Percent of Total Billed Charges, ,,85,,96.05,Percent of Total Billed Charges, ,,50,,56.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,76.84,Percent of Total Billed Charges,0,12.32,,,12.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,63.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,67.8,Percent of Total Billed Charges, ,18.94,,,18.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.28,,,15.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.75,,,12.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.87,,,12.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.44,,,12.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.32,,,12.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.44,,,12.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.69,,,12.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.91,,,12.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.27,,,52.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.27,,,52.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.27,,,52.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.27,,,52.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82378 - CARCINOEMBRYONIC ANTIGEN CEA,82378,HCPCS,,,GZ,Outpatient,,,97,24.25,18.96,82.45,,,34.4,,33.37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.27,,,24.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34,,,34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.15,,,30.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,63.63,Percent of Total Billed Charges, ,24.27,,,24.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,67.9,Percent of Total Billed Charges, ,,85,,82.45,Percent of Total Billed Charges, ,,50,,48.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,65.96,Percent of Total Billed Charges,0,18.96,,,18.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,54.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,58.2,Percent of Total Billed Charges, ,29.15,,,29.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.51,,,23.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.62,,,19.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.81,,,19.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.15,,,19.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.96,,,18.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.15,,,19.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.53,,,19.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.86,,,19.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.46,,,80.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.46,,,80.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.46,,,80.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.46,,,80.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82435 - CHLORIDE BLD,82435,HCPCS,,,AY,Outpatient,,,28,7,4.6,23.8,,,34.4,,9.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.88,,,5.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.63,,,14.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18.37,Percent of Total Billed Charges, ,5.88,,,5.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19.6,Percent of Total Billed Charges, ,,85,,23.8,Percent of Total Billed Charges, ,,50,,14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19.04,Percent of Total Billed Charges,0,4.6,,,4.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16.8,Percent of Total Billed Charges, ,14.15,,,14.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.7,,,5.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.52,,,9.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.61,,,9.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.2,,,9.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.48,,,9.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.64,,,9.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82435 - CHLORIDE BLD,82435,HCPCS,,,91,Outpatient,,,28,7,4.6,23.8,,,34.4,,9.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.88,,,5.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.63,,,14.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18.37,Percent of Total Billed Charges, ,5.88,,,5.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19.6,Percent of Total Billed Charges, ,,85,,23.8,Percent of Total Billed Charges, ,,50,,14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19.04,Percent of Total Billed Charges,0,4.6,,,4.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16.8,Percent of Total Billed Charges, ,14.15,,,14.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.7,,,5.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.52,,,9.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.61,,,9.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.2,,,9.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.48,,,9.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.64,,,9.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82435 - CHLORIDE BLD,82435,HCPCS,,,59,Outpatient,,,28,7,4.6,23.8,,,34.4,,9.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.88,,,5.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.25,,,8.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.63,,,14.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18.37,Percent of Total Billed Charges, ,5.88,,,5.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19.6,Percent of Total Billed Charges, ,,85,,23.8,Percent of Total Billed Charges, ,,50,,14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19.04,Percent of Total Billed Charges,0,4.6,,,4.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16.8,Percent of Total Billed Charges, ,14.15,,,14.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.7,,,5.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.52,,,9.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.61,,,9.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.2,,,9.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.48,,,9.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.64,,,9.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82465 - CHOLESTEROL SERUM-WHOLE BLOOD TOTAL,82465,HCPCS,,,GZ,Outpatient,,,67,16.75,4.35,56.95,,,34.4,,23.05,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.57,,,5.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.81,,,7.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.83,,,13.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.95,Percent of Total Billed Charges, ,5.57,,,5.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.9,Percent of Total Billed Charges, ,,85,,56.95,Percent of Total Billed Charges, ,,50,,33.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,45.56,Percent of Total Billed Charges,0,4.35,,,4.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,37.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,40.2,Percent of Total Billed Charges, ,13.38,,,13.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.4,,,5.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9,,,9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.09,,,9.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.79,,,8.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.79,,,8.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.96,,,8.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.11,,,9.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.47,,,18.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.47,,,18.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.47,,,18.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.47,,,18.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82550 - CREATINE KINASE TOTAL,82550,HCPCS,,,91,Outpatient,,,60,15,6.51,51,,,34.4,,20.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.33,,,8.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.67,,,11.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.7,,,20.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.36,Percent of Total Billed Charges, ,8.33,,,8.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,42,Percent of Total Billed Charges, ,,85,,51,Percent of Total Billed Charges, ,,50,,30,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.8,Percent of Total Billed Charges,0,6.51,,,6.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,33.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,36,Percent of Total Billed Charges, ,20.02,,,20.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.07,,,8.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.48,,,13.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.61,,,13.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.15,,,13.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.02,,,13.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.15,,,13.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.41,,,13.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.64,,,13.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.65,,,27.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.65,,,27.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.65,,,27.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.65,,,27.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82550 - CREATINE KINASE TOTAL,82550,HCPCS,,,25,Outpatient,,,60,15,6.51,51,,,34.4,,20.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.33,,,8.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.67,,,11.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.7,,,20.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.36,Percent of Total Billed Charges, ,8.33,,,8.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,42,Percent of Total Billed Charges, ,,85,,51,Percent of Total Billed Charges, ,,50,,30,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.8,Percent of Total Billed Charges,0,6.51,,,6.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,33.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,36,Percent of Total Billed Charges, ,20.02,,,20.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.07,,,8.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.48,,,13.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.61,,,13.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.15,,,13.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.02,,,13.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.15,,,13.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.41,,,13.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.64,,,13.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.65,,,27.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.65,,,27.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.65,,,27.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.65,,,27.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82565 - CREATININE BLOOD,82565,HCPCS,,,GZ,Outpatient,,,21,5.25,5.12,21.71,,,34.4,,7.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.56,,,6.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.19,,,9.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13.78,Percent of Total Billed Charges, ,6.56,,,6.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14.7,Percent of Total Billed Charges, ,,85,,17.85,Percent of Total Billed Charges, ,,50,,10.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.28,Percent of Total Billed Charges,0,5.12,,,5.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12.6,Percent of Total Billed Charges, ,15.74,,,15.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.35,,,6.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.6,,,10.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.7,,,10.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.24,,,10.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.55,,,10.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.73,,,10.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82565 - CREATININE BLOOD,82565,HCPCS,,,AY,Outpatient,,,21,5.25,5.12,21.71,,,34.4,,7.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.56,,,6.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.19,,,9.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13.78,Percent of Total Billed Charges, ,6.56,,,6.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14.7,Percent of Total Billed Charges, ,,85,,17.85,Percent of Total Billed Charges, ,,50,,10.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.28,Percent of Total Billed Charges,0,5.12,,,5.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12.6,Percent of Total Billed Charges, ,15.74,,,15.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.35,,,6.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.6,,,10.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.7,,,10.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.24,,,10.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.55,,,10.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.73,,,10.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82565 - CREATININE BLOOD,82565,HCPCS,,,91,Outpatient,,,21,5.25,5.12,21.71,,,34.4,,7.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.56,,,6.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.19,,,9.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13.78,Percent of Total Billed Charges, ,6.56,,,6.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14.7,Percent of Total Billed Charges, ,,85,,17.85,Percent of Total Billed Charges, ,,50,,10.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.28,Percent of Total Billed Charges,0,5.12,,,5.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12.6,Percent of Total Billed Charges, ,15.74,,,15.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.35,,,6.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.6,,,10.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.7,,,10.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.24,,,10.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.55,,,10.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.73,,,10.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82565 - CREATININE BLOOD,82565,HCPCS,,,59,Outpatient,,,21,5.25,5.12,21.71,,,34.4,,7.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.56,,,6.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.19,,,9.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13.78,Percent of Total Billed Charges, ,6.56,,,6.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14.7,Percent of Total Billed Charges, ,,85,,17.85,Percent of Total Billed Charges, ,,50,,10.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.28,Percent of Total Billed Charges,0,5.12,,,5.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12.6,Percent of Total Billed Charges, ,15.74,,,15.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.35,,,6.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.6,,,10.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.7,,,10.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.24,,,10.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.55,,,10.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.73,,,10.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.71,,,21.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82570 - CREATININE OTHER SOURCE,82570,HCPCS,,,AY,Outpatient,,,41.4,10.35,5.18,35.19,,,34.4,,14.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.3,,,9.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.47,,,16.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.16,Percent of Total Billed Charges, ,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28.98,Percent of Total Billed Charges, ,,85,,35.19,Percent of Total Billed Charges, ,,50,,20.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.15,Percent of Total Billed Charges,0,5.18,,,5.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,23.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,24.84,Percent of Total Billed Charges, ,15.93,,,15.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.43,,,6.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.72,,,10.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.36,,,10.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.67,,,10.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.85,,,10.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82570 - CREATININE OTHER SOURCE,82570,HCPCS,,,91,Outpatient,,,31.5,7.875,5.18,26.78,,,34.4,,10.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.3,,,9.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.47,,,16.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.66,Percent of Total Billed Charges, ,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22.05,Percent of Total Billed Charges, ,,85,,26.78,Percent of Total Billed Charges, ,,50,,15.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.42,Percent of Total Billed Charges,0,5.18,,,5.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18.9,Percent of Total Billed Charges, ,15.93,,,15.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.43,,,6.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.72,,,10.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.36,,,10.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.67,,,10.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.85,,,10.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82570 - CREATININE OTHER SOURCE,82570,HCPCS,,,59,Outpatient,,,36.45,9.1125,5.18,30.98,,,34.4,,12.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.3,,,9.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.47,,,16.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23.91,Percent of Total Billed Charges, ,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.52,Percent of Total Billed Charges, ,,85,,30.98,Percent of Total Billed Charges, ,,50,,18.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24.79,Percent of Total Billed Charges,0,5.18,,,5.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21.87,Percent of Total Billed Charges, ,15.93,,,15.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.43,,,6.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.72,,,10.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.36,,,10.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.67,,,10.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.85,,,10.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82607 - CYANOCOBALAMIN VITAMIN B-12,82607,HCPCS,,,GZ,Outpatient,,,139,34.75,15.08,118.15,,,34.4,,47.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.3,,,19.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.98,,,23.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,91.18,Percent of Total Billed Charges, ,19.3,,,19.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,97.3,Percent of Total Billed Charges, ,,85,,118.15,Percent of Total Billed Charges, ,,50,,69.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,94.52,Percent of Total Billed Charges,0,15.08,,,15.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,77.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,83.4,Percent of Total Billed Charges, ,23.19,,,23.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.7,,,18.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.61,,,15.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.76,,,15.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.23,,,15.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.08,,,15.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.23,,,15.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.53,,,15.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.8,,,15.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82607 - CYANOCOBALAMIN VITAMIN B-12,82607,HCPCS,,,GA,Outpatient,,,139,34.75,15.08,118.15,,,34.4,,47.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.3,,,19.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.98,,,23.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,91.18,Percent of Total Billed Charges, ,19.3,,,19.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,97.3,Percent of Total Billed Charges, ,,85,,118.15,Percent of Total Billed Charges, ,,50,,69.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,94.52,Percent of Total Billed Charges,0,15.08,,,15.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,77.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,83.4,Percent of Total Billed Charges, ,23.19,,,23.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.7,,,18.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.61,,,15.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.76,,,15.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.23,,,15.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.08,,,15.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.23,,,15.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.53,,,15.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.8,,,15.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82607 - CYANOCOBALAMIN VITAMIN B-12,82607,HCPCS,,,AY,Outpatient,,,139,34.75,15.08,118.15,,,34.4,,47.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.3,,,19.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.98,,,23.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,91.18,Percent of Total Billed Charges, ,19.3,,,19.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,97.3,Percent of Total Billed Charges, ,,85,,118.15,Percent of Total Billed Charges, ,,50,,69.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,94.52,Percent of Total Billed Charges,0,15.08,,,15.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,77.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,83.4,Percent of Total Billed Charges, ,23.19,,,23.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.7,,,18.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.61,,,15.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.76,,,15.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.23,,,15.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.08,,,15.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.23,,,15.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.53,,,15.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.8,,,15.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82607 - CYANOCOBALAMIN VITAMIN B-12,82607,HCPCS,,,91,Outpatient,,,139,34.75,15.08,118.15,,,34.4,,47.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.3,,,19.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.05,,,27.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.98,,,23.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,91.18,Percent of Total Billed Charges, ,19.3,,,19.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,97.3,Percent of Total Billed Charges, ,,85,,118.15,Percent of Total Billed Charges, ,,50,,69.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,94.52,Percent of Total Billed Charges,0,15.08,,,15.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,77.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,83.4,Percent of Total Billed Charges, ,23.19,,,23.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.7,,,18.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.61,,,15.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.76,,,15.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.23,,,15.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.08,,,15.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.23,,,15.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.53,,,15.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.8,,,15.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.91,,,63.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82652 - 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED,82652,HCPCS,,,GZ,Outpatient,,,215,53.75,38.5,182.75,,,34.4,,73.96,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,49.29,,,49.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,69.08,,,69.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,61.22,,,61.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,141.04,Percent of Total Billed Charges, ,49.29,,,49.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,150.5,Percent of Total Billed Charges, ,,85,,182.75,Percent of Total Billed Charges, ,,50,,107.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,146.2,Percent of Total Billed Charges,0,38.5,,,38.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,120.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,129,Percent of Total Billed Charges, ,59.19,,,59.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.85,,,39.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.23,,,40.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.89,,,38.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.5,,,38.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.89,,,38.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.66,,,39.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.33,,,40.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,163.23,,,163.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,163.23,,,163.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,163.23,,,163.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,163.23,,,163.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82728 - ASSAY OF FERRITIN,82728,HCPCS,,,GZ,Outpatient,,,100,25,13.63,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.45,,,17.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.45,,,24.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.67,,,21.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,17.45,,,17.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,13.63,,,13.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,20.96,,,20.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.91,,,16.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.11,,,14.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.24,,,14.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.77,,,13.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.63,,,13.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.77,,,13.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.04,,,14.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.28,,,14.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82728 - ASSAY OF FERRITIN,82728,HCPCS,,,GA,Outpatient,,,100,25,13.63,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.45,,,17.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.45,,,24.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.67,,,21.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,17.45,,,17.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,13.63,,,13.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,20.96,,,20.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.91,,,16.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.11,,,14.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.24,,,14.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.77,,,13.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.63,,,13.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.77,,,13.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.04,,,14.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.28,,,14.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82728 - ASSAY OF FERRITIN,82728,HCPCS,,,AY,Outpatient,,,100,25,13.63,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.45,,,17.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.45,,,24.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.67,,,21.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,17.45,,,17.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,13.63,,,13.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,20.96,,,20.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.91,,,16.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.11,,,14.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.24,,,14.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.77,,,13.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.63,,,13.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.77,,,13.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.04,,,14.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.28,,,14.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.8,,,57.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82746 - ASSAY OF FOLIC ACID SERUM,82746,HCPCS,,,GZ,Outpatient,,,135,33.75,14.7,114.75,,,34.4,,46.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.82,,,18.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.39,,,26.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.37,,,23.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,88.56,Percent of Total Billed Charges, ,18.82,,,18.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,94.5,Percent of Total Billed Charges, ,,85,,114.75,Percent of Total Billed Charges, ,,50,,67.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,91.8,Percent of Total Billed Charges,0,14.7,,,14.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,75.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,81,Percent of Total Billed Charges, ,22.6,,,22.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.23,,,18.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.21,,,15.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.36,,,15.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.85,,,14.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.7,,,14.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.85,,,14.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.14,,,15.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.4,,,15.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82746 - ASSAY OF FOLIC ACID SERUM,82746,HCPCS,,,GA,Outpatient,,,135,33.75,14.7,114.75,,,34.4,,46.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.82,,,18.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.39,,,26.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.37,,,23.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,88.56,Percent of Total Billed Charges, ,18.82,,,18.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,94.5,Percent of Total Billed Charges, ,,85,,114.75,Percent of Total Billed Charges, ,,50,,67.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,91.8,Percent of Total Billed Charges,0,14.7,,,14.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,75.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,81,Percent of Total Billed Charges, ,22.6,,,22.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.23,,,18.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.21,,,15.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.36,,,15.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.85,,,14.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.7,,,14.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.85,,,14.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.14,,,15.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.4,,,15.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82746 - ASSAY OF FOLIC ACID SERUM,82746,HCPCS,,,AY,Outpatient,,,135,33.75,14.7,114.75,,,34.4,,46.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.82,,,18.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.39,,,26.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.37,,,23.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,88.56,Percent of Total Billed Charges, ,18.82,,,18.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,94.5,Percent of Total Billed Charges, ,,85,,114.75,Percent of Total Billed Charges, ,,50,,67.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,91.8,Percent of Total Billed Charges,0,14.7,,,14.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,75.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,81,Percent of Total Billed Charges, ,22.6,,,22.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.23,,,18.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.21,,,15.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.36,,,15.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.85,,,14.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.7,,,14.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.85,,,14.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.14,,,15.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.4,,,15.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82746 - ASSAY OF FOLIC ACID SERUM,82746,HCPCS,,,91,Outpatient,,,135,33.75,14.7,114.75,,,34.4,,46.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.82,,,18.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.39,,,26.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.37,,,23.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,88.56,Percent of Total Billed Charges, ,18.82,,,18.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,94.5,Percent of Total Billed Charges, ,,85,,114.75,Percent of Total Billed Charges, ,,50,,67.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,91.8,Percent of Total Billed Charges,0,14.7,,,14.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,75.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,81,Percent of Total Billed Charges, ,22.6,,,22.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.23,,,18.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.21,,,15.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.36,,,15.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.85,,,14.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.7,,,14.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.85,,,14.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.14,,,15.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.4,,,15.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82785 - ASSAY OF GAMMAGLOBULIN IGE,82785,HCPCS,,,GZ,Outpatient,,,109,27.25,16.46,92.65,,,34.4,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.07,,,21.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.53,,,29.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.17,,,26.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,71.5,Percent of Total Billed Charges, ,21.07,,,21.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,76.3,Percent of Total Billed Charges, ,,85,,92.65,Percent of Total Billed Charges, ,,50,,54.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,74.12,Percent of Total Billed Charges,0,16.46,,,16.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,61.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,65.4,Percent of Total Billed Charges, ,25.31,,,25.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.41,,,20.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.04,,,17.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.2,,,17.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.62,,,16.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.46,,,16.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.62,,,16.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.95,,,16.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.24,,,17.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.7,,,68.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.7,,,68.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.7,,,68.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.7,,,68.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82785 - ASSAY OF GAMMAGLOBULIN IGE,82785,HCPCS,,,GA,Outpatient,,,109,27.25,16.46,92.65,,,34.4,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.07,,,21.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.53,,,29.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.17,,,26.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,71.5,Percent of Total Billed Charges, ,21.07,,,21.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,76.3,Percent of Total Billed Charges, ,,85,,92.65,Percent of Total Billed Charges, ,,50,,54.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,74.12,Percent of Total Billed Charges,0,16.46,,,16.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,61.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,65.4,Percent of Total Billed Charges, ,25.31,,,25.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.41,,,20.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.04,,,17.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.2,,,17.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.62,,,16.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.46,,,16.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.62,,,16.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.95,,,16.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.24,,,17.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.7,,,68.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.7,,,68.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.7,,,68.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.7,,,68.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82805 - GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY,82805,HCPCS,,,91,Outpatient,,,197,49.25,67.77,167.45,,,34.4,,67.77,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,100.85,,,100.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,141.31,,,141.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,125.24,,,125.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,129.23,Percent of Total Billed Charges, ,100.85,,,100.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,137.9,Percent of Total Billed Charges, ,,85,,167.45,Percent of Total Billed Charges, ,,50,,98.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,133.96,Percent of Total Billed Charges,0,78.77,,,78.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,110.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,118.2,Percent of Total Billed Charges, ,121.11,,,121.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,97.7,,,97.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.53,,,81.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.31,,,82.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.56,,,79.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.77,,,78.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.56,,,79.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.13,,,81.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.51,,,82.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.34,,,120.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.34,,,120.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.34,,,120.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.34,,,120.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82805 - GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY,82805,HCPCS,,,59,Outpatient,,,197,49.25,67.77,167.45,,,34.4,,67.77,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,100.85,,,100.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,141.31,,,141.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,125.24,,,125.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,129.23,Percent of Total Billed Charges, ,100.85,,,100.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,137.9,Percent of Total Billed Charges, ,,85,,167.45,Percent of Total Billed Charges, ,,50,,98.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,133.96,Percent of Total Billed Charges,0,78.77,,,78.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,110.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,118.2,Percent of Total Billed Charges, ,121.11,,,121.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,97.7,,,97.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.53,,,81.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.31,,,82.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.56,,,79.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.77,,,78.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.56,,,79.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.13,,,81.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.51,,,82.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.34,,,120.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.34,,,120.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.34,,,120.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.34,,,120.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82945 - GLUCOSE BODY FLUID OTHER THAN BLOOD,82945,HCPCS,,,59,Outpatient,,,73,18.25,3.93,62.05,,,34.4,,25.11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.03,,,5.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.04,,,7.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.25,,,6.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,47.89,Percent of Total Billed Charges, ,5.03,,,5.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.1,Percent of Total Billed Charges, ,,85,,62.05,Percent of Total Billed Charges, ,,50,,36.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,49.64,Percent of Total Billed Charges,0,3.93,,,3.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,40.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,43.8,Percent of Total Billed Charges, ,6.04,,,6.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.87,,,4.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.07,,,4.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.11,,,4.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.97,,,3.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.93,,,3.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.97,,,3.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.05,,,4.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.12,,,4.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82947 - GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP,82947,HCPCS,,,GZ,Outpatient,,,36,9,3.93,30.6,,,34.4,,12.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.03,,,5.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.04,,,7.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.5,,,12.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23.62,Percent of Total Billed Charges, ,5.03,,,5.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.2,Percent of Total Billed Charges, ,,85,,30.6,Percent of Total Billed Charges, ,,50,,18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24.48,Percent of Total Billed Charges,0,3.93,,,3.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21.6,Percent of Total Billed Charges, ,12.08,,,12.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.87,,,4.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.14,,,8.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.21,,,8.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.94,,,7.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.86,,,7.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.94,,,7.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.1,,,8.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.23,,,8.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82947 - GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP,82947,HCPCS,,,91,Outpatient,,,36,9,3.93,30.6,,,34.4,,12.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.03,,,5.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.04,,,7.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.5,,,12.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23.62,Percent of Total Billed Charges, ,5.03,,,5.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.2,Percent of Total Billed Charges, ,,85,,30.6,Percent of Total Billed Charges, ,,50,,18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24.48,Percent of Total Billed Charges,0,3.93,,,3.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21.6,Percent of Total Billed Charges, ,12.08,,,12.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.87,,,4.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.14,,,8.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.21,,,8.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.94,,,7.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.86,,,7.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.94,,,7.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.1,,,8.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.23,,,8.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82947 - GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP,82947,HCPCS,,,59,Outpatient,,,36,9,3.93,30.6,,,34.4,,12.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.03,,,5.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.04,,,7.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.5,,,12.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23.62,Percent of Total Billed Charges, ,5.03,,,5.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.2,Percent of Total Billed Charges, ,,85,,30.6,Percent of Total Billed Charges, ,,50,,18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24.48,Percent of Total Billed Charges,0,3.93,,,3.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21.6,Percent of Total Billed Charges, ,12.08,,,12.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.87,,,4.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.14,,,8.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.21,,,8.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.94,,,7.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.86,,,7.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.94,,,7.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.1,,,8.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.23,,,8.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.63,,,16.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
82977 - ASSAY OF GLUTAMYLTRASE GAMMA,82977,HCPCS,,,GZ,Outpatient,,,66,16.5,7.2,56.1,,,34.4,,22.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.22,,,9.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.92,,,12.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.9,,,22.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.3,Percent of Total Billed Charges, ,9.22,,,9.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.2,Percent of Total Billed Charges, ,,85,,56.1,Percent of Total Billed Charges, ,,50,,33,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,44.88,Percent of Total Billed Charges,0,7.2,,,7.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,36.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,39.6,Percent of Total Billed Charges, ,22.14,,,22.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.93,,,8.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.9,,,14.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.05,,,15.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.54,,,14.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.4,,,14.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.54,,,14.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.83,,,14.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.08,,,15.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.53,,,30.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,30.53,,,30.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,30.53,,,30.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,30.53,,,30.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83010 - ASSAY OF HAPTOGLOBIN QUANTITATIVE,83010,HCPCS,,,59,Outpatient,,,79,19.75,12.58,67.15,,,34.4,,27.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.1,,,16.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.58,,,22.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20,,,20,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.82,Percent of Total Billed Charges, ,16.1,,,16.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,55.3,Percent of Total Billed Charges, ,,85,,67.15,Percent of Total Billed Charges, ,,50,,39.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.72,Percent of Total Billed Charges,0,12.58,,,12.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,47.4,Percent of Total Billed Charges, ,19.34,,,19.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.6,,,15.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.02,,,13.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.15,,,13.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.71,,,12.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.58,,,12.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.71,,,12.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.96,,,12.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.18,,,13.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83036 - HEMOGLOBIN GLYCOSYLATED A1C,83036,HCPCS,,,GZ,Outpatient,,,89,22.25,9.71,75.65,,,34.4,,30.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.43,,,12.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.42,,,17.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.88,,,30.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,58.38,Percent of Total Billed Charges, ,12.43,,,12.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,62.3,Percent of Total Billed Charges, ,,85,,75.65,Percent of Total Billed Charges, ,,50,,44.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,60.52,Percent of Total Billed Charges,0,9.71,,,9.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,49.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,53.4,Percent of Total Billed Charges, ,29.86,,,29.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.04,,,12.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.1,,,20.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.29,,,20.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.61,,,19.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.42,,,19.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.61,,,19.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20,,,20,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.34,,,20.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.19,,,41.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.19,,,41.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.19,,,41.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.19,,,41.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83036 - HEMOGLOBIN GLYCOSYLATED A1C,83036,HCPCS,,,GA,Outpatient,,,89,22.25,9.71,75.65,,,34.4,,30.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.43,,,12.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.42,,,17.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.88,,,30.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,58.38,Percent of Total Billed Charges, ,12.43,,,12.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,62.3,Percent of Total Billed Charges, ,,85,,75.65,Percent of Total Billed Charges, ,,50,,44.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,60.52,Percent of Total Billed Charges,0,9.71,,,9.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,49.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,53.4,Percent of Total Billed Charges, ,29.86,,,29.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.04,,,12.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.1,,,20.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.29,,,20.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.61,,,19.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.42,,,19.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.61,,,19.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20,,,20,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.34,,,20.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.19,,,41.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.19,,,41.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.19,,,41.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.19,,,41.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83090 - ASSAY OF HOMOCYSTEINE,83090,HCPCS,,,GA,Outpatient,,,189,47.25,17.92,160.65,,,34.4,,65.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.94,,,22.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.15,,,32.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.49,,,28.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,123.98,Percent of Total Billed Charges, ,22.94,,,22.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,132.3,Percent of Total Billed Charges, ,,85,,160.65,Percent of Total Billed Charges, ,,50,,94.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,128.52,Percent of Total Billed Charges,0,17.92,,,17.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,105.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,113.4,Percent of Total Billed Charges, ,27.55,,,27.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.23,,,22.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.55,,,18.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.73,,,18.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.1,,,18.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.92,,,17.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.1,,,18.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.46,,,18.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.77,,,18.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.55,,,71.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.55,,,71.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.55,,,71.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.55,,,71.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83519 - IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY,83519,HCPCS,,,59,Outpatient,,,333,83.25,18.4,283.05,,,34.4,,114.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.56,,,23.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.01,,,33.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.26,,,29.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,218.45,Percent of Total Billed Charges, ,23.56,,,23.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,233.1,Percent of Total Billed Charges, ,,85,,283.05,Percent of Total Billed Charges, ,,50,,166.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,226.44,Percent of Total Billed Charges,0,18.4,,,18.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,186.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.8,Percent of Total Billed Charges, ,28.29,,,28.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.83,,,22.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.04,,,19.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.23,,,19.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.58,,,18.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.4,,,18.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.58,,,18.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.95,,,18.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.27,,,19.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83540 - ASSAY OF IRON,83540,HCPCS,,,GZ,Outpatient,,,60,15,6.47,51,,,34.4,,20.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.36,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,42,Percent of Total Billed Charges, ,,85,,51,Percent of Total Billed Charges, ,,50,,30,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.8,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,33.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,36,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83540 - ASSAY OF IRON,83540,HCPCS,,,GA,Outpatient,,,60,15,6.47,51,,,34.4,,20.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.36,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,42,Percent of Total Billed Charges, ,,85,,51,Percent of Total Billed Charges, ,,50,,30,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.8,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,33.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,36,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83540 - ASSAY OF IRON,83540,HCPCS,,,AY,Outpatient,,,60,15,6.47,51,,,34.4,,20.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.36,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,42,Percent of Total Billed Charges, ,,85,,51,Percent of Total Billed Charges, ,,50,,30,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.8,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,33.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,36,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83540 - ASSAY OF IRON,83540,HCPCS,,,91,Outpatient,,,60,15,6.47,51,,,34.4,,20.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.36,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,42,Percent of Total Billed Charges, ,,85,,51,Percent of Total Billed Charges, ,,50,,30,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.8,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,33.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,36,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83550 - IRON BINDING CAPACITY,83550,HCPCS,,,GZ,Outpatient,,,80,20,8.74,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.19,,,11.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.68,,,15.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.9,,,13.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,11.19,,,11.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,8.74,,,8.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,13.44,,,13.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.84,,,10.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.05,,,9.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.13,,,9.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.74,,,8.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9,,,9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.16,,,9.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83550 - IRON BINDING CAPACITY,83550,HCPCS,,,GA,Outpatient,,,80,20,8.74,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.19,,,11.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.68,,,15.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.9,,,13.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,11.19,,,11.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,8.74,,,8.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,13.44,,,13.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.84,,,10.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.05,,,9.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.13,,,9.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.74,,,8.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9,,,9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.16,,,9.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83550 - IRON BINDING CAPACITY,83550,HCPCS,,,AY,Outpatient,,,80,20,8.74,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.19,,,11.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.68,,,15.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.9,,,13.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,11.19,,,11.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,8.74,,,8.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,13.44,,,13.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.84,,,10.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.05,,,9.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.13,,,9.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.74,,,8.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9,,,9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.16,,,9.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83550 - IRON BINDING CAPACITY,83550,HCPCS,,,91,Outpatient,,,80,20,8.74,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.19,,,11.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.68,,,15.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.9,,,13.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,11.19,,,11.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,8.74,,,8.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,13.44,,,13.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.84,,,10.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.05,,,9.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.13,,,9.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.74,,,8.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.83,,,8.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9,,,9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.16,,,9.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.07,,,37.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83605 - ASSAY OF LACTATE,83605,HCPCS,,,91,Outpatient,,,98,24.5,11.57,83.3,,,34.4,,33.71,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.81,,,14.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.76,,,20.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.79,,,36.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,64.29,Percent of Total Billed Charges, ,14.81,,,14.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,68.6,Percent of Total Billed Charges, ,,85,,83.3,Percent of Total Billed Charges, ,,50,,49,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,66.64,Percent of Total Billed Charges,0,11.57,,,11.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,54.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,58.8,Percent of Total Billed Charges, ,35.58,,,35.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.35,,,14.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.95,,,23.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.18,,,24.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.37,,,23.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.14,,,23.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.37,,,23.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.83,,,23.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.24,,,24.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.29,,,45.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.29,,,45.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.29,,,45.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.29,,,45.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83690 - ASSAY OF LIPASE,83690,HCPCS,,,XE,Outpatient,,,80,20,6.89,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.82,,,8.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.36,,,12.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.96,,,10.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,8.82,,,8.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,6.89,,,6.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,10.59,,,10.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.54,,,8.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.13,,,7.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.2,,,7.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.96,,,6.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.89,,,6.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.96,,,6.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.1,,,7.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.22,,,7.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.22,,,29.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.22,,,29.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.22,,,29.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.22,,,29.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83690 - ASSAY OF LIPASE,83690,HCPCS,,,91,Outpatient,,,80,20,6.89,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.82,,,8.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.36,,,12.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.96,,,10.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,8.82,,,8.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,6.89,,,6.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,10.59,,,10.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.54,,,8.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.13,,,7.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.2,,,7.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.96,,,6.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.89,,,6.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.96,,,6.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.1,,,7.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.22,,,7.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.22,,,29.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.22,,,29.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.22,,,29.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.22,,,29.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83721 - LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL,83721,HCPCS,,,91,Outpatient,,,57,14.25,10.5,48.45,,,34.4,,19.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.44,,,13.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.85,,,18.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.39,,,33.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,37.39,Percent of Total Billed Charges, ,13.44,,,13.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,39.9,Percent of Total Billed Charges, ,,85,,48.45,Percent of Total Billed Charges, ,,50,,28.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,38.76,Percent of Total Billed Charges,0,10.5,,,10.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,31.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,34.2,Percent of Total Billed Charges, ,32.29,,,32.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.02,,,13.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.74,,,21.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.21,,,21.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21,,,21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.21,,,21.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.63,,,21.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22,,,22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.45,,,40.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,40.45,,,40.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,40.45,,,40.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,40.45,,,40.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83721 - LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL,83721,HCPCS,,,59,Outpatient,,,57,14.25,10.5,48.45,,,34.4,,19.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.44,,,13.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.85,,,18.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.39,,,33.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,37.39,Percent of Total Billed Charges, ,13.44,,,13.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,39.9,Percent of Total Billed Charges, ,,85,,48.45,Percent of Total Billed Charges, ,,50,,28.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,38.76,Percent of Total Billed Charges,0,10.5,,,10.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,31.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,34.2,Percent of Total Billed Charges, ,32.29,,,32.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.02,,,13.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.74,,,21.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.21,,,21.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21,,,21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.21,,,21.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.63,,,21.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22,,,22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.45,,,40.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,40.45,,,40.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,40.45,,,40.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,40.45,,,40.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83735 - ASSAY OF MAGNESIUM,83735,HCPCS,,,AY,Outpatient,,,62,15.5,6.7,52.7,,,34.4,,21.33,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.58,,,8.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.03,,,12.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.65,,,10.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,40.67,Percent of Total Billed Charges, ,8.58,,,8.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,43.4,Percent of Total Billed Charges, ,,85,,52.7,Percent of Total Billed Charges, ,,50,,31,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,42.16,Percent of Total Billed Charges,0,6.7,,,6.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,34.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,37.2,Percent of Total Billed Charges, ,10.3,,,10.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.31,,,8.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.93,,,6.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7,,,7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.77,,,6.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.77,,,6.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.9,,,6.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.02,,,7.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.42,,,28.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.42,,,28.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.42,,,28.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.42,,,28.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83735 - ASSAY OF MAGNESIUM,83735,HCPCS,,,91,Outpatient,,,62,15.5,6.7,52.7,,,34.4,,21.33,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.58,,,8.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.03,,,12.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.65,,,10.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,40.67,Percent of Total Billed Charges, ,8.58,,,8.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,43.4,Percent of Total Billed Charges, ,,85,,52.7,Percent of Total Billed Charges, ,,50,,31,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,42.16,Percent of Total Billed Charges,0,6.7,,,6.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,34.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,37.2,Percent of Total Billed Charges, ,10.3,,,10.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.31,,,8.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.93,,,6.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7,,,7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.77,,,6.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.77,,,6.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.9,,,6.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.02,,,7.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.42,,,28.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.42,,,28.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.42,,,28.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.42,,,28.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83874 - MYOGLOBIN,83874,HCPCS,,,91,Outpatient,,,44,11,12.92,54.74,,,34.4,,15.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.54,,,16.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.18,,,23.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.54,,,20.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.86,Percent of Total Billed Charges, ,16.54,,,16.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.8,Percent of Total Billed Charges, ,,85,,37.4,Percent of Total Billed Charges, ,,50,,22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.92,Percent of Total Billed Charges,0,12.92,,,12.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26.4,Percent of Total Billed Charges, ,19.86,,,19.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.03,,,16.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.37,,,13.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.5,,,13.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.05,,,13.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.92,,,12.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.05,,,13.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.31,,,13.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.53,,,13.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.74,,,54.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,54.74,,,54.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,54.74,,,54.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,54.74,,,54.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83880 - NATRIURETIC PEPTIDE,83880,HCPCS,,,91,Outpatient,,,232,58,39.26,197.2,,,34.4,,79.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.27,,,50.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.44,,,70.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,124.85,,,124.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,152.19,Percent of Total Billed Charges, ,50.27,,,50.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,162.4,Percent of Total Billed Charges, ,,85,,197.2,Percent of Total Billed Charges, ,,50,,116,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.76,Percent of Total Billed Charges,0,39.26,,,39.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,139.2,Percent of Total Billed Charges, ,120.72,,,120.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.7,,,48.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.27,,,81.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.05,,,82.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.31,,,79.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.52,,,78.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.31,,,79.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.88,,,80.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.25,,,82.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,140.87,,,140.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,140.87,,,140.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,140.87,,,140.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,140.87,,,140.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83880 - NATRIURETIC PEPTIDE,83880,HCPCS,,,59,Outpatient,,,232,58,39.26,197.2,,,34.4,,79.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.27,,,50.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.44,,,70.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,124.85,,,124.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,152.19,Percent of Total Billed Charges, ,50.27,,,50.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,162.4,Percent of Total Billed Charges, ,,85,,197.2,Percent of Total Billed Charges, ,,50,,116,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.76,Percent of Total Billed Charges,0,39.26,,,39.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,139.2,Percent of Total Billed Charges, ,120.72,,,120.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.7,,,48.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.27,,,81.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.05,,,82.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.31,,,79.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.52,,,78.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.31,,,79.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.88,,,80.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.25,,,82.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,140.87,,,140.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,140.87,,,140.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,140.87,,,140.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,140.87,,,140.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83970 - ASSAY OF PARATHORMONE,83970,HCPCS,,,AY,Outpatient,,,301,75.25,41.28,255.85,,,34.4,,103.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.85,,,52.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,74.05,,,74.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,65.64,,,65.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,197.46,Percent of Total Billed Charges, ,52.85,,,52.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,210.7,Percent of Total Billed Charges, ,,85,,255.85,Percent of Total Billed Charges, ,,50,,150.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,204.68,Percent of Total Billed Charges,0,41.28,,,41.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,168.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,180.6,Percent of Total Billed Charges, ,63.47,,,63.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.2,,,51.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.72,,,42.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.14,,,43.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.69,,,41.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.28,,,41.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.69,,,41.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.52,,,42.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.24,,,43.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.05,,,175.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.05,,,175.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.05,,,175.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.05,,,175.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
83970 - ASSAY OF PARATHORMONE,83970,HCPCS,,,91,Outpatient,,,301,75.25,41.28,255.85,,,34.4,,103.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.85,,,52.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,74.05,,,74.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,65.64,,,65.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,197.46,Percent of Total Billed Charges, ,52.85,,,52.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,210.7,Percent of Total Billed Charges, ,,85,,255.85,Percent of Total Billed Charges, ,,50,,150.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,204.68,Percent of Total Billed Charges,0,41.28,,,41.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,168.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,180.6,Percent of Total Billed Charges, ,63.47,,,63.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.2,,,51.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.72,,,42.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.14,,,43.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.69,,,41.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.28,,,41.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.69,,,41.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.52,,,42.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.24,,,43.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.05,,,175.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.05,,,175.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.05,,,175.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.05,,,175.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84075 - ASSAY OF PHOSPHATASE ALKALINE,84075,HCPCS,,,AY,Outpatient,,,81,20.25,5.18,68.85,,,34.4,,27.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.3,,,9.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.47,,,16.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,53.14,Percent of Total Billed Charges, ,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56.7,Percent of Total Billed Charges, ,,85,,68.85,Percent of Total Billed Charges, ,,50,,40.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,55.08,Percent of Total Billed Charges,0,5.18,,,5.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,45.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48.6,Percent of Total Billed Charges, ,15.93,,,15.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.43,,,6.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.72,,,10.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.36,,,10.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.67,,,10.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.85,,,10.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84075 - ASSAY OF PHOSPHATASE ALKALINE,84075,HCPCS,,,91,Outpatient,,,81,20.25,5.18,68.85,,,34.4,,27.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.3,,,9.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.47,,,16.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,53.14,Percent of Total Billed Charges, ,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56.7,Percent of Total Billed Charges, ,,85,,68.85,Percent of Total Billed Charges, ,,50,,40.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,55.08,Percent of Total Billed Charges,0,5.18,,,5.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,45.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48.6,Percent of Total Billed Charges, ,15.93,,,15.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.43,,,6.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.72,,,10.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.36,,,10.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.67,,,10.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.85,,,10.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84075 - ASSAY OF PHOSPHATASE ALKALINE,84075,HCPCS,,,59,Outpatient,,,53,13.25,5.18,45.05,,,34.4,,18.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.3,,,9.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.47,,,16.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.77,Percent of Total Billed Charges, ,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.1,Percent of Total Billed Charges, ,,85,,45.05,Percent of Total Billed Charges, ,,50,,26.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.04,Percent of Total Billed Charges,0,5.18,,,5.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,29.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.8,Percent of Total Billed Charges, ,15.93,,,15.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.43,,,6.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.72,,,10.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.36,,,10.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.67,,,10.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.85,,,10.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84100 - ASSAY OF PHOSPHORUS INORGANIC,84100,HCPCS,,,AY,Outpatient,,,44,11,4.74,37.4,,,34.4,,15.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.06,,,6.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.5,,,8.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.86,Percent of Total Billed Charges, ,6.06,,,6.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.8,Percent of Total Billed Charges, ,,85,,37.4,Percent of Total Billed Charges, ,,50,,22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.92,Percent of Total Billed Charges,0,4.74,,,4.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26.4,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.88,,,5.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84100 - ASSAY OF PHOSPHORUS INORGANIC,84100,HCPCS,,,91,Outpatient,,,44,11,4.74,37.4,,,34.4,,15.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.06,,,6.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.5,,,8.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.86,Percent of Total Billed Charges, ,6.06,,,6.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.8,Percent of Total Billed Charges, ,,85,,37.4,Percent of Total Billed Charges, ,,50,,22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.92,Percent of Total Billed Charges,0,4.74,,,4.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26.4,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.88,,,5.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84100 - ASSAY OF PHOSPHORUS INORGANIC,84100,HCPCS,,,59,Outpatient,,,44,11,4.74,37.4,,,34.4,,15.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.06,,,6.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.5,,,8.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.86,Percent of Total Billed Charges, ,6.06,,,6.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.8,Percent of Total Billed Charges, ,,85,,37.4,Percent of Total Billed Charges, ,,50,,22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.92,Percent of Total Billed Charges,0,4.74,,,4.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26.4,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.88,,,5.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84112 - EVAL C-V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN,84112,HCPCS,,,91,Outpatient,,,270,67.5,92.88,269.2,,,34.4,,92.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,125.61,,,125.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,176.01,,,176.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.99,,,155.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,177.12,Percent of Total Billed Charges, ,125.61,,,125.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,189,Percent of Total Billed Charges, ,,85,,229.5,Percent of Total Billed Charges, ,,50,,135,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,183.6,Percent of Total Billed Charges,0,98.11,,,98.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,151.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,162,Percent of Total Billed Charges, ,150.84,,,150.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.69,,,121.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,101.54,,,101.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.52,,,102.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.09,,,99.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.11,,,98.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.09,,,99.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.05,,,101.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.77,,,102.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,269.2,,,269.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.2,,,269.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.2,,,269.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.2,,,269.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84132 - POTASSIUM SERUM PLASMA-WHOLE BLOOD,84132,HCPCS,,,AY,Outpatient,,,42,10.5,4.76,35.7,,,34.4,,14.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.1,,,6.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.14,,,15.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.55,Percent of Total Billed Charges, ,6.1,,,6.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.4,Percent of Total Billed Charges, ,,85,,35.7,Percent of Total Billed Charges, ,,50,,21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.56,Percent of Total Billed Charges,0,4.76,,,4.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,23.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,25.2,Percent of Total Billed Charges, ,14.64,,,14.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.91,,,5.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.85,,,9.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.52,,,9.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.81,,,9.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.97,,,9.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84132 - POTASSIUM SERUM PLASMA-WHOLE BLOOD,84132,HCPCS,,,91,Outpatient,,,42,10.5,4.76,35.7,,,34.4,,14.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.1,,,6.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.14,,,15.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.55,Percent of Total Billed Charges, ,6.1,,,6.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.4,Percent of Total Billed Charges, ,,85,,35.7,Percent of Total Billed Charges, ,,50,,21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.56,Percent of Total Billed Charges,0,4.76,,,4.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,23.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,25.2,Percent of Total Billed Charges, ,14.64,,,14.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.91,,,5.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.85,,,9.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.52,,,9.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.81,,,9.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.97,,,9.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84132 - POTASSIUM SERUM PLASMA-WHOLE BLOOD,84132,HCPCS,,,59,Outpatient,,,42,10.5,4.76,35.7,,,34.4,,14.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.1,,,6.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.14,,,15.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.55,Percent of Total Billed Charges, ,6.1,,,6.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.4,Percent of Total Billed Charges, ,,85,,35.7,Percent of Total Billed Charges, ,,50,,21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.56,Percent of Total Billed Charges,0,4.76,,,4.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,23.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,25.2,Percent of Total Billed Charges, ,14.64,,,14.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.91,,,5.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.85,,,9.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.52,,,9.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.81,,,9.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.97,,,9.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.48,,,19.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84153 - ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL,84153,HCPCS,,,GZ,Outpatient,,,122,30.5,18.39,103.7,,,34.4,,41.97,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.54,,,23.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.98,,,32.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.24,,,29.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,80.03,Percent of Total Billed Charges, ,23.54,,,23.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,85.4,Percent of Total Billed Charges, ,,85,,103.7,Percent of Total Billed Charges, ,,50,,61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,82.96,Percent of Total Billed Charges,0,18.39,,,18.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,68.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,73.2,Percent of Total Billed Charges, ,28.27,,,28.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.8,,,22.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.03,,,19.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.22,,,19.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.39,,,18.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.94,,,18.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.26,,,19.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84153 - ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL,84153,HCPCS,,,GA,Outpatient,,,122,30.5,18.39,103.7,,,34.4,,41.97,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.54,,,23.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.98,,,32.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.24,,,29.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,80.03,Percent of Total Billed Charges, ,23.54,,,23.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,85.4,Percent of Total Billed Charges, ,,85,,103.7,Percent of Total Billed Charges, ,,50,,61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,82.96,Percent of Total Billed Charges,0,18.39,,,18.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,68.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,73.2,Percent of Total Billed Charges, ,28.27,,,28.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.8,,,22.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.03,,,19.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.22,,,19.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.39,,,18.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.94,,,18.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.26,,,19.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84153 - ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL,84153,HCPCS,,,91,Outpatient,,,122,30.5,18.39,103.7,,,34.4,,41.97,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.54,,,23.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.98,,,32.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.24,,,29.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,80.03,Percent of Total Billed Charges, ,23.54,,,23.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,85.4,Percent of Total Billed Charges, ,,85,,103.7,Percent of Total Billed Charges, ,,50,,61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,82.96,Percent of Total Billed Charges,0,18.39,,,18.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,68.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,73.2,Percent of Total Billed Charges, ,28.27,,,28.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.8,,,22.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.03,,,19.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.22,,,19.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.39,,,18.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.94,,,18.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.26,,,19.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84154 - ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE,84154,HCPCS,,,91,Outpatient,,,197,49.25,18.39,167.45,,,34.4,,67.77,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.54,,,23.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.98,,,32.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.24,,,29.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,129.23,Percent of Total Billed Charges, ,23.54,,,23.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,137.9,Percent of Total Billed Charges, ,,85,,167.45,Percent of Total Billed Charges, ,,50,,98.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,133.96,Percent of Total Billed Charges,0,18.39,,,18.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,110.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,118.2,Percent of Total Billed Charges, ,28.27,,,28.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.8,,,22.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.03,,,19.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.22,,,19.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.39,,,18.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.94,,,18.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.26,,,19.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,78.02,,,78.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84155 - PROTEIN XCPT REFRACTOMETRY SERUM PLASMA-WHL BLD,84155,HCPCS,,,XS,Outpatient,,,53,13.25,3.67,45.05,,,34.4,,18.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.67,,,11.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.77,Percent of Total Billed Charges, ,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.1,Percent of Total Billed Charges, ,,85,,45.05,Percent of Total Billed Charges, ,,50,,26.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.04,Percent of Total Billed Charges,0,3.67,,,3.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,29.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.8,Percent of Total Billed Charges, ,11.29,,,11.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.6,,,7.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.67,,,7.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.34,,,7.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.56,,,7.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.69,,,7.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84155 - PROTEIN XCPT REFRACTOMETRY SERUM PLASMA-WHL BLD,84155,HCPCS,,,AY,Outpatient,,,53,13.25,3.67,45.05,,,34.4,,18.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.67,,,11.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.77,Percent of Total Billed Charges, ,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.1,Percent of Total Billed Charges, ,,85,,45.05,Percent of Total Billed Charges, ,,50,,26.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.04,Percent of Total Billed Charges,0,3.67,,,3.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,29.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.8,Percent of Total Billed Charges, ,11.29,,,11.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.6,,,7.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.67,,,7.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.34,,,7.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.56,,,7.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.69,,,7.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84155 - PROTEIN XCPT REFRACTOMETRY SERUM PLASMA-WHL BLD,84155,HCPCS,,,91,Outpatient,,,53,13.25,3.67,45.05,,,34.4,,18.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.67,,,11.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.77,Percent of Total Billed Charges, ,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.1,Percent of Total Billed Charges, ,,85,,45.05,Percent of Total Billed Charges, ,,50,,26.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.04,Percent of Total Billed Charges,0,3.67,,,3.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,29.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.8,Percent of Total Billed Charges, ,11.29,,,11.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.6,,,7.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.67,,,7.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.34,,,7.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.56,,,7.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.69,,,7.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84155 - PROTEIN XCPT REFRACTOMETRY SERUM PLASMA-WHL BLD,84155,HCPCS,,,59,Outpatient,,,53,13.25,3.67,45.05,,,34.4,,18.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.67,,,11.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.77,Percent of Total Billed Charges, ,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.1,Percent of Total Billed Charges, ,,85,,45.05,Percent of Total Billed Charges, ,,50,,26.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.04,Percent of Total Billed Charges,0,3.67,,,3.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,29.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.8,Percent of Total Billed Charges, ,11.29,,,11.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.6,,,7.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.67,,,7.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.34,,,7.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.56,,,7.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.69,,,7.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.53,,,15.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84156 - PROTEIN TOTAL XCPT REFRACTOMETRY URINE,84156,HCPCS,,,91,Outpatient,,,86,21.5,3.67,73.1,,,34.4,,29.58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.84,,,5.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,56.42,Percent of Total Billed Charges, ,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,60.2,Percent of Total Billed Charges, ,,85,,73.1,Percent of Total Billed Charges, ,,50,,43,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,58.48,Percent of Total Billed Charges,0,3.67,,,3.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,48.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,51.6,Percent of Total Billed Charges, ,5.64,,,5.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.8,,,3.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.71,,,3.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.67,,,3.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.71,,,3.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84156 - PROTEIN TOTAL XCPT REFRACTOMETRY URINE,84156,HCPCS,,,59,Outpatient,,,86,21.5,3.67,73.1,,,34.4,,29.58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.6,,,6.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.84,,,5.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,56.42,Percent of Total Billed Charges, ,4.69,,,4.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,60.2,Percent of Total Billed Charges, ,,85,,73.1,Percent of Total Billed Charges, ,,50,,43,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,58.48,Percent of Total Billed Charges,0,3.67,,,3.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,48.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,51.6,Percent of Total Billed Charges, ,5.64,,,5.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.8,,,3.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.71,,,3.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.67,,,3.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.71,,,3.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84157 - PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC,84157,HCPCS,,,AY,Outpatient,,,80,20,4,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.12,,,5.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.18,,,7.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.72,,,12.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,5.12,,,5.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,4,,,4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,12.3,,,12.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.96,,,4.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.28,,,8.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.36,,,8.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.08,,,8.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8,,,8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.08,,,8.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.24,,,8.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.38,,,8.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,15.59,,,15.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84207 - ASSAY OF PYRIDOXAL PHOSPHATE,84207,HCPCS,,,GA,Outpatient,,,167,41.75,28.1,141.95,,,34.4,,57.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.97,,,35.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.43,,,50.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.68,,,44.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,109.55,Percent of Total Billed Charges, ,35.97,,,35.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,116.9,Percent of Total Billed Charges, ,,85,,141.95,Percent of Total Billed Charges, ,,50,,83.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,113.56,Percent of Total Billed Charges,0,28.1,,,28.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,93.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,100.2,Percent of Total Billed Charges, ,43.2,,,43.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.85,,,34.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.08,,,29.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.36,,,29.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.38,,,28.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.1,,,28.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.38,,,28.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.94,,,28.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.43,,,29.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.13,,,119.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.13,,,119.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.13,,,119.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.13,,,119.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84295 - SODIUM SERUM PLASMA OR WHOLE BLOOD,84295,HCPCS,,,AY,Outpatient,,,44,11,4.81,37.4,,,34.4,,15.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.64,,,8.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.3,,,15.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.86,Percent of Total Billed Charges, ,6.15,,,6.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.8,Percent of Total Billed Charges, ,,85,,37.4,Percent of Total Billed Charges, ,,50,,22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.92,Percent of Total Billed Charges,0,4.81,,,4.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26.4,Percent of Total Billed Charges, ,14.79,,,14.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.96,,,5.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.96,,,9.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.05,,,10.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.72,,,9.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.72,,,9.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.91,,,9.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.08,,,10.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84295 - SODIUM SERUM PLASMA OR WHOLE BLOOD,84295,HCPCS,,,91,Outpatient,,,44,11,4.81,37.4,,,34.4,,15.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.64,,,8.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.3,,,15.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.86,Percent of Total Billed Charges, ,6.15,,,6.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.8,Percent of Total Billed Charges, ,,85,,37.4,Percent of Total Billed Charges, ,,50,,22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.92,Percent of Total Billed Charges,0,4.81,,,4.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26.4,Percent of Total Billed Charges, ,14.79,,,14.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.96,,,5.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.96,,,9.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.05,,,10.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.72,,,9.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.72,,,9.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.91,,,9.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.08,,,10.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84295 - SODIUM SERUM PLASMA OR WHOLE BLOOD,84295,HCPCS,,,59,Outpatient,,,44,11,4.81,37.4,,,34.4,,15.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.64,,,8.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.3,,,15.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.86,Percent of Total Billed Charges, ,6.15,,,6.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.8,Percent of Total Billed Charges, ,,85,,37.4,Percent of Total Billed Charges, ,,50,,22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.92,Percent of Total Billed Charges,0,4.81,,,4.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26.4,Percent of Total Billed Charges, ,14.79,,,14.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.96,,,5.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.96,,,9.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.05,,,10.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.72,,,9.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.72,,,9.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.91,,,9.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.08,,,10.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.4,,,20.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84436 - ASSAY OF THYROXINE TOTAL,84436,HCPCS,,,GZ,Outpatient,,,63,15.75,6.87,53.55,,,34.4,,21.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.79,,,8.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.34,,,12.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.92,,,10.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,41.33,Percent of Total Billed Charges, ,8.79,,,8.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,44.1,Percent of Total Billed Charges, ,,85,,53.55,Percent of Total Billed Charges, ,,50,,31.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,42.84,Percent of Total Billed Charges,0,6.87,,,6.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,35.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,37.8,Percent of Total Billed Charges, ,10.56,,,10.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.52,,,8.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.11,,,7.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.18,,,7.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.94,,,6.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.87,,,6.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.94,,,6.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.08,,,7.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.2,,,7.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84436 - ASSAY OF THYROXINE TOTAL,84436,HCPCS,,,GA,Outpatient,,,63,15.75,6.87,53.55,,,34.4,,21.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.79,,,8.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.34,,,12.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.92,,,10.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,41.33,Percent of Total Billed Charges, ,8.79,,,8.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,44.1,Percent of Total Billed Charges, ,,85,,53.55,Percent of Total Billed Charges, ,,50,,31.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,42.84,Percent of Total Billed Charges,0,6.87,,,6.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,35.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,37.8,Percent of Total Billed Charges, ,10.56,,,10.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.52,,,8.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.11,,,7.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.18,,,7.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.94,,,6.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.87,,,6.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.94,,,6.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.08,,,7.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.2,,,7.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84436 - ASSAY OF THYROXINE TOTAL,84436,HCPCS,,,DBM,Outpatient,,,63,15.75,6.87,53.55,,,34.4,,21.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.79,,,8.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.34,,,12.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.92,,,10.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,41.33,Percent of Total Billed Charges, ,8.79,,,8.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,44.1,Percent of Total Billed Charges, ,,85,,53.55,Percent of Total Billed Charges, ,,50,,31.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,42.84,Percent of Total Billed Charges,0,6.87,,,6.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,35.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,37.8,Percent of Total Billed Charges, ,10.56,,,10.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.52,,,8.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.11,,,7.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.18,,,7.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.94,,,6.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.87,,,6.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.94,,,6.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.08,,,7.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.2,,,7.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.43,,,26.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84439 - ASSAY OF FREE THYROXINE,84439,HCPCS,,,GZ,Outpatient,,,83,20.75,9.02,70.55,,,34.4,,28.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.54,,,11.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.17,,,16.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.34,,,14.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,54.45,Percent of Total Billed Charges, ,11.54,,,11.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,58.1,Percent of Total Billed Charges, ,,85,,70.55,Percent of Total Billed Charges, ,,50,,41.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,56.44,Percent of Total Billed Charges,0,9.02,,,9.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,46.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,49.8,Percent of Total Billed Charges, ,13.87,,,13.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.18,,,11.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.34,,,9.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.43,,,9.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.11,,,9.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.02,,,9.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.11,,,9.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.45,,,9.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84439 - ASSAY OF FREE THYROXINE,84439,HCPCS,,,GA,Outpatient,,,83,20.75,9.02,70.55,,,34.4,,28.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.54,,,11.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.17,,,16.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.34,,,14.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,54.45,Percent of Total Billed Charges, ,11.54,,,11.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,58.1,Percent of Total Billed Charges, ,,85,,70.55,Percent of Total Billed Charges, ,,50,,41.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,56.44,Percent of Total Billed Charges,0,9.02,,,9.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,46.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,49.8,Percent of Total Billed Charges, ,13.87,,,13.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.18,,,11.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.34,,,9.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.43,,,9.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.11,,,9.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.02,,,9.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.11,,,9.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.45,,,9.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84439 - ASSAY OF FREE THYROXINE,84439,HCPCS,,,91,Outpatient,,,83,20.75,9.02,70.55,,,34.4,,28.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.54,,,11.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.17,,,16.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.34,,,14.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,54.45,Percent of Total Billed Charges, ,11.54,,,11.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,58.1,Percent of Total Billed Charges, ,,85,,70.55,Percent of Total Billed Charges, ,,50,,41.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,56.44,Percent of Total Billed Charges,0,9.02,,,9.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,46.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,49.8,Percent of Total Billed Charges, ,13.87,,,13.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.18,,,11.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.34,,,9.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.43,,,9.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.11,,,9.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.02,,,9.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.11,,,9.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.45,,,9.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.25,,,38.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84443 - ASSAY OF THYROID STIMULATING HORMONE TSH,84443,HCPCS,,,GZ,Outpatient,,,154,38.5,16.8,130.9,,,34.4,,52.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.14,,,30.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.42,,,53.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.02,Percent of Total Billed Charges, ,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.8,Percent of Total Billed Charges, ,,85,,130.9,Percent of Total Billed Charges, ,,50,,77,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,104.72,Percent of Total Billed Charges,0,16.8,,,16.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,86.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,92.4,Percent of Total Billed Charges, ,51.66,,,51.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.84,,,20.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.78,,,34.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.6,,,33.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.61,,,34.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.2,,,35.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84443 - ASSAY OF THYROID STIMULATING HORMONE TSH,84443,HCPCS,,,GA,Outpatient,,,154,38.5,16.8,130.9,,,34.4,,52.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.14,,,30.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.42,,,53.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.02,Percent of Total Billed Charges, ,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.8,Percent of Total Billed Charges, ,,85,,130.9,Percent of Total Billed Charges, ,,50,,77,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,104.72,Percent of Total Billed Charges,0,16.8,,,16.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,86.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,92.4,Percent of Total Billed Charges, ,51.66,,,51.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.84,,,20.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.78,,,34.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.6,,,33.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.61,,,34.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.2,,,35.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84443 - ASSAY OF THYROID STIMULATING HORMONE TSH,84443,HCPCS,,,DBM,Outpatient,,,154,38.5,16.8,130.9,,,34.4,,52.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.14,,,30.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.42,,,53.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.02,Percent of Total Billed Charges, ,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.8,Percent of Total Billed Charges, ,,85,,130.9,Percent of Total Billed Charges, ,,50,,77,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,104.72,Percent of Total Billed Charges,0,16.8,,,16.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,86.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,92.4,Percent of Total Billed Charges, ,51.66,,,51.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.84,,,20.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.78,,,34.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.6,,,33.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.61,,,34.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.2,,,35.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84443 - ASSAY OF THYROID STIMULATING HORMONE TSH,84443,HCPCS,,,91,Outpatient,,,154,38.5,16.8,130.9,,,34.4,,52.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.14,,,30.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.42,,,53.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.02,Percent of Total Billed Charges, ,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.8,Percent of Total Billed Charges, ,,85,,130.9,Percent of Total Billed Charges, ,,50,,77,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,104.72,Percent of Total Billed Charges,0,16.8,,,16.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,86.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,92.4,Percent of Total Billed Charges, ,51.66,,,51.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.84,,,20.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.78,,,34.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.6,,,33.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.61,,,34.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.2,,,35.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.22,,,71.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84450 - TRANSFERASE ASPARTATE AMINO AST SGOT,84450,HCPCS,,,59,Outpatient,,,48,12,5.18,40.8,,,34.4,,16.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.3,,,9.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.47,,,16.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,31.49,Percent of Total Billed Charges, ,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,33.6,Percent of Total Billed Charges, ,,85,,40.8,Percent of Total Billed Charges, ,,50,,24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,32.64,Percent of Total Billed Charges,0,5.18,,,5.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,26.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,28.8,Percent of Total Billed Charges, ,15.93,,,15.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.43,,,6.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.72,,,10.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.83,,,10.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.36,,,10.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.46,,,10.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.67,,,10.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.85,,,10.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.92,,,21.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.92,,,21.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.92,,,21.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.92,,,21.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84460 - TRANSFERASE ALANINE AMINO ALT SGPT,84460,HCPCS,,,91,Outpatient,,,49,12.25,5.3,41.65,,,34.4,,16.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.52,,,9.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.85,,,16.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,32.14,Percent of Total Billed Charges, ,6.78,,,6.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,34.3,Percent of Total Billed Charges, ,,85,,41.65,Percent of Total Billed Charges, ,,50,,24.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,33.32,Percent of Total Billed Charges,0,5.3,,,5.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,27.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,29.4,Percent of Total Billed Charges, ,16.3,,,16.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.57,,,6.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.97,,,10.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.08,,,11.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.71,,,10.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.6,,,10.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.71,,,10.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.92,,,10.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.1,,,11.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.45,,,22.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.45,,,22.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.45,,,22.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.45,,,22.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84460 - TRANSFERASE ALANINE AMINO ALT SGPT,84460,HCPCS,,,59,Outpatient,,,49,12.25,5.3,41.65,,,34.4,,16.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.52,,,9.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.85,,,16.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,32.14,Percent of Total Billed Charges, ,6.78,,,6.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,34.3,Percent of Total Billed Charges, ,,85,,41.65,Percent of Total Billed Charges, ,,50,,24.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,33.32,Percent of Total Billed Charges,0,5.3,,,5.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,27.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,29.4,Percent of Total Billed Charges, ,16.3,,,16.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.57,,,6.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.97,,,10.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.08,,,11.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.71,,,10.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.6,,,10.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.71,,,10.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.92,,,10.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.1,,,11.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.45,,,22.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.45,,,22.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.45,,,22.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.45,,,22.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84466 - ASSAY OF L7383TRANSFERRIN,84466,HCPCS,,,GZ,Outpatient,,,102,25.5,12.76,86.7,,,34.4,,35.09,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.34,,,16.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.88,,,22.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.29,,,20.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,66.91,Percent of Total Billed Charges, ,16.34,,,16.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,71.4,Percent of Total Billed Charges, ,,85,,86.7,Percent of Total Billed Charges, ,,50,,51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,69.36,Percent of Total Billed Charges,0,12.76,,,12.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,57.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,61.2,Percent of Total Billed Charges, ,19.62,,,19.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.83,,,15.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.21,,,13.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.33,,,13.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.89,,,12.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.76,,,12.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.89,,,12.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.14,,,13.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.37,,,13.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.17,,,54.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,54.17,,,54.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,54.17,,,54.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,54.17,,,54.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84479 - THYROID HORM UPTK-THYROID HORMONE BINDING RATIO,84479,HCPCS,,,GZ,Outpatient,,,60,15,6.47,51,,,34.4,,20.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.36,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,42,Percent of Total Billed Charges, ,,85,,51,Percent of Total Billed Charges, ,,50,,30,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.8,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,33.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,36,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84484 - ASSAY OF TROPONIN QUANTITATIVE,84484,HCPCS,,,AY,Outpatient,,,100,25,12.47,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.97,,,15.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.38,,,22.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.83,,,19.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,15.97,,,15.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,12.47,,,12.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,19.17,,,19.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.47,,,15.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.91,,,12.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.03,,,13.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.47,,,12.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.84,,,12.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.06,,,13.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84484 - ASSAY OF TROPONIN QUANTITATIVE,84484,HCPCS,,,91,Outpatient,,,100,25,12.47,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.97,,,15.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.38,,,22.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.83,,,19.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,15.97,,,15.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,12.47,,,12.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,19.17,,,19.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.47,,,15.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.91,,,12.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.03,,,13.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.47,,,12.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.84,,,12.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.06,,,13.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84484 - ASSAY OF TROPONIN QUANTITATIVE,84484,HCPCS,,,59,Outpatient,,,100,25,12.47,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.97,,,15.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.38,,,22.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.83,,,19.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,15.97,,,15.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,12.47,,,12.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,19.17,,,19.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.47,,,15.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.91,,,12.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.03,,,13.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.47,,,12.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.84,,,12.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.06,,,13.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.73,,,41.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84520 - ASSAY OF UREA NITROGEN QUANTITATIVE,84520,HCPCS,,,AY,Outpatient,,,36,9,3.95,30.6,,,34.4,,12.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.05,,,5.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.09,,,7.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.56,,,12.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23.62,Percent of Total Billed Charges, ,5.05,,,5.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.2,Percent of Total Billed Charges, ,,85,,30.6,Percent of Total Billed Charges, ,,50,,18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24.48,Percent of Total Billed Charges,0,3.95,,,3.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21.6,Percent of Total Billed Charges, ,12.15,,,12.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.9,,,4.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.18,,,8.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.26,,,8.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.98,,,7.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.9,,,7.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.98,,,7.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.14,,,8.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.28,,,8.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84520 - ASSAY OF UREA NITROGEN QUANTITATIVE,84520,HCPCS,,,91,Outpatient,,,36,9,3.95,30.6,,,34.4,,12.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.05,,,5.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.09,,,7.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.56,,,12.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23.62,Percent of Total Billed Charges, ,5.05,,,5.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.2,Percent of Total Billed Charges, ,,85,,30.6,Percent of Total Billed Charges, ,,50,,18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24.48,Percent of Total Billed Charges,0,3.95,,,3.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21.6,Percent of Total Billed Charges, ,12.15,,,12.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.9,,,4.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.18,,,8.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.26,,,8.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.98,,,7.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.9,,,7.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.98,,,7.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.14,,,8.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.28,,,8.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84520 - ASSAY OF UREA NITROGEN QUANTITATIVE,84520,HCPCS,,,59,Outpatient,,,36,9,3.95,30.6,,,34.4,,12.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.05,,,5.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.09,,,7.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.56,,,12.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23.62,Percent of Total Billed Charges, ,5.05,,,5.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.2,Percent of Total Billed Charges, ,,85,,30.6,Percent of Total Billed Charges, ,,50,,18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24.48,Percent of Total Billed Charges,0,3.95,,,3.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21.6,Percent of Total Billed Charges, ,12.15,,,12.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.9,,,4.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.18,,,8.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.26,,,8.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.98,,,7.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.9,,,7.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.98,,,7.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.14,,,8.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.28,,,8.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.72,,,16.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84540 - ASSAY OF UREA NITROGEN URINE,84540,HCPCS,,,91,Outpatient,,,71,17.75,5.56,60.35,,,34.4,,24.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.12,,,7.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.96,,,9.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.84,,,8.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,46.58,Percent of Total Billed Charges, ,7.12,,,7.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,49.7,Percent of Total Billed Charges, ,,85,,60.35,Percent of Total Billed Charges, ,,50,,35.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,48.28,Percent of Total Billed Charges,0,5.56,,,5.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,39.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,42.6,Percent of Total Billed Charges, ,8.55,,,8.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.9,,,6.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.75,,,5.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.81,,,5.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.62,,,5.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.56,,,5.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.62,,,5.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.73,,,5.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.82,,,5.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84550 - ASSAY OF BLOOD-URIC ACID,84550,HCPCS,,,91,Outpatient,,,42,10.5,4.52,35.7,,,34.4,,14.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.78,,,5.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.11,,,8.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.37,,,14.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.55,Percent of Total Billed Charges, ,5.78,,,5.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.4,Percent of Total Billed Charges, ,,85,,35.7,Percent of Total Billed Charges, ,,50,,21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.56,Percent of Total Billed Charges,0,4.52,,,4.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,23.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,25.2,Percent of Total Billed Charges, ,13.9,,,13.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.6,,,5.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.36,,,9.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.45,,,9.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.13,,,9.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.04,,,9.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.13,,,9.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.31,,,9.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.47,,,9.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.19,,,19.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.19,,,19.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.19,,,19.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.19,,,19.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84591 - ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED,84591,HCPCS,,,59,Outpatient,,,165,41.25,17.06,140.25,,,34.4,,56.76,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.84,,,21.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.61,,,30.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.13,,,27.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,108.24,Percent of Total Billed Charges, ,21.84,,,21.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,115.5,Percent of Total Billed Charges, ,,85,,140.25,Percent of Total Billed Charges, ,,50,,82.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,112.2,Percent of Total Billed Charges,0,17.06,,,17.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,92.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,99,Percent of Total Billed Charges, ,26.23,,,26.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.16,,,21.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.66,,,17.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.83,,,17.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.23,,,17.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.06,,,17.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.23,,,17.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.57,,,17.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.87,,,17.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.32,,,45.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.32,,,45.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.32,,,45.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.32,,,45.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84702 - GONADOTROPIN CHORIONIC QUANTITATIVE,84702,HCPCS,,,GZ,Outpatient,,,138,34.5,15.05,117.3,,,34.4,,47.47,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.27,,,19.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.99,,,26.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.93,,,23.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,90.53,Percent of Total Billed Charges, ,19.27,,,19.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,96.6,Percent of Total Billed Charges, ,,85,,117.3,Percent of Total Billed Charges, ,,50,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,93.84,Percent of Total Billed Charges,0,15.05,,,15.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,77.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,82.8,Percent of Total Billed Charges, ,23.14,,,23.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.67,,,18.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.58,,,15.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.73,,,15.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.2,,,15.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.05,,,15.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.2,,,15.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.5,,,15.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.76,,,15.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.27,,,34.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.27,,,34.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.27,,,34.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.27,,,34.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84702 - GONADOTROPIN CHORIONIC QUANTITATIVE,84702,HCPCS,,,GA,Outpatient,,,138,34.5,15.05,117.3,,,34.4,,47.47,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.27,,,19.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.99,,,26.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.93,,,23.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,90.53,Percent of Total Billed Charges, ,19.27,,,19.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,96.6,Percent of Total Billed Charges, ,,85,,117.3,Percent of Total Billed Charges, ,,50,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,93.84,Percent of Total Billed Charges,0,15.05,,,15.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,77.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,82.8,Percent of Total Billed Charges, ,23.14,,,23.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.67,,,18.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.58,,,15.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.73,,,15.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.2,,,15.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.05,,,15.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.2,,,15.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.5,,,15.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.76,,,15.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.27,,,34.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.27,,,34.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.27,,,34.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.27,,,34.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
84703 - GONADOTROPIN CHORIONIC QUALITATIVE,84703,HCPCS,,,91,Outpatient,,,69,17.25,7.52,58.65,,,34.4,,23.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.62,,,9.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.5,,,13.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.91,,,23.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,45.26,Percent of Total Billed Charges, ,9.62,,,9.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,48.3,Percent of Total Billed Charges, ,,85,,58.65,Percent of Total Billed Charges, ,,50,,34.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,46.92,Percent of Total Billed Charges,0,7.52,,,7.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,38.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,41.4,Percent of Total Billed Charges, ,23.12,,,23.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.32,,,9.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.57,,,15.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.72,,,15.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.19,,,15.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.04,,,15.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.19,,,15.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.49,,,15.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.75,,,15.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.87,,,31.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,31.87,,,31.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,31.87,,,31.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,31.87,,,31.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
G0103 - PSA SCREENING,G0103,HCPCS,,,GZ,Outpatient,,,246,61.5,19.31,209.1,,,34.4,,84.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.72,,,24.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.64,,,34.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.7,,,30.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,161.38,Percent of Total Billed Charges, ,24.72,,,24.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,172.2,Percent of Total Billed Charges, ,,85,,209.1,Percent of Total Billed Charges, ,,50,,123,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,167.28,Percent of Total Billed Charges,0,19.31,,,19.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,137.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,147.6,Percent of Total Billed Charges, ,29.69,,,29.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.95,,,23.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.99,,,19.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.18,,,20.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.5,,,19.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.31,,,19.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.5,,,19.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.89,,,19.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.23,,,20.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0103 - PSA SCREENING,G0103,HCPCS,,,GA,Outpatient,,,246,61.5,19.31,209.1,,,34.4,,84.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.72,,,24.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.64,,,34.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.7,,,30.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,161.38,Percent of Total Billed Charges, ,24.72,,,24.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,172.2,Percent of Total Billed Charges, ,,85,,209.1,Percent of Total Billed Charges, ,,50,,123,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,167.28,Percent of Total Billed Charges,0,19.31,,,19.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,137.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,147.6,Percent of Total Billed Charges, ,29.69,,,29.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.95,,,23.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.99,,,19.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.18,,,20.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.5,,,19.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.31,,,19.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.5,,,19.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.89,,,19.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.23,,,20.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0480 - DRUG TEST DEF 1-7 CLASSES,G0480,HCPCS,,,GZ,Outpatient,,,286,71.5,98.38,243.1,,,34.4,,98.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,146.5,,,146.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,205.29,,,205.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.94,,,181.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,187.62,Percent of Total Billed Charges, ,146.5,,,146.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,200.2,Percent of Total Billed Charges, ,,85,,243.1,Percent of Total Billed Charges, ,,50,,143,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,194.48,Percent of Total Billed Charges,0,114.43,,,114.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,160.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,171.6,Percent of Total Billed Charges, ,175.94,,,175.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,141.93,,,141.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,118.44,,,118.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.58,,,119.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.57,,,115.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,114.43,,,114.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.57,,,115.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.86,,,117.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.87,,,119.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0480 - DRUG TEST DEF 1-7 CLASSES,G0480,HCPCS,,,GA,Outpatient,,,286,71.5,98.38,243.1,,,34.4,,98.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,146.5,,,146.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,205.29,,,205.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.94,,,181.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,187.62,Percent of Total Billed Charges, ,146.5,,,146.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,200.2,Percent of Total Billed Charges, ,,85,,243.1,Percent of Total Billed Charges, ,,50,,143,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,194.48,Percent of Total Billed Charges,0,114.43,,,114.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,160.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,171.6,Percent of Total Billed Charges, ,175.94,,,175.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,141.93,,,141.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,118.44,,,118.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.58,,,119.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.57,,,115.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,114.43,,,114.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.57,,,115.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.86,,,117.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.87,,,119.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0480 - DRUG TEST DEF 1-7 CLASSES,G0480,HCPCS,,,59,Outpatient,,,286,71.5,98.38,243.1,,,34.4,,98.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,146.5,,,146.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,205.29,,,205.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.94,,,181.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,187.62,Percent of Total Billed Charges, ,146.5,,,146.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,200.2,Percent of Total Billed Charges, ,,85,,243.1,Percent of Total Billed Charges, ,,50,,143,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,194.48,Percent of Total Billed Charges,0,114.43,,,114.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,160.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,171.6,Percent of Total Billed Charges, ,175.94,,,175.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,141.93,,,141.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,118.44,,,118.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.58,,,119.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.57,,,115.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,114.43,,,114.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.57,,,115.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.86,,,117.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.87,,,119.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0301 - LABORATORY - CHEMISTRY,0301,RC,,,,Outpatient,,,80.67,20.1675,48.4,68.57,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,52.92,Percent of Total Billed Charges, ,,,,,,,,70,,56.47,Percent of Total Billed Charges, ,,85,,68.57,Percent of Total Billed Charges, ,,,,,,,,68,,54.86,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,48.4,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
86003 - ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH,86003,HCPCS,,,GZ,Outpatient,,,23,5.75,5.22,22.16,,,34.4,,7.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.68,,,6.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.36,,,9.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.3,,,8.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15.09,Percent of Total Billed Charges, ,6.68,,,6.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16.1,Percent of Total Billed Charges, ,,85,,19.55,Percent of Total Billed Charges, ,,50,,11.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15.64,Percent of Total Billed Charges,0,5.22,,,5.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13.8,Percent of Total Billed Charges, ,8.03,,,8.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.4,,,5.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.45,,,5.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.27,,,5.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.22,,,5.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.27,,,5.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.38,,,5.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.47,,,5.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.16,,,22.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.16,,,22.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.16,,,22.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.16,,,22.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86008 - ALLERGEN SPEC IGE RECOMBINANT-PURIFIED COMPNT EA,86008,HCPCS,,,59,Outpatient,,,53,13.25,17.93,65.76,,,34.4,,18.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.95,,,22.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.15,,,32.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.51,,,28.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.77,Percent of Total Billed Charges, ,22.95,,,22.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.1,Percent of Total Billed Charges, ,,85,,45.05,Percent of Total Billed Charges, ,,50,,26.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.04,Percent of Total Billed Charges,0,17.93,,,17.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,29.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.8,Percent of Total Billed Charges, ,27.57,,,27.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.24,,,22.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.56,,,18.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.74,,,18.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.11,,,18.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.93,,,17.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.11,,,18.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.47,,,18.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.78,,,18.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.76,,,65.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.76,,,65.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.76,,,65.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.76,,,65.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86021 - ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES,86021,HCPCS,,,59,Outpatient,,,96,24,15.05,81.6,,,34.4,,33.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.27,,,19.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.99,,,26.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.93,,,23.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,62.98,Percent of Total Billed Charges, ,19.27,,,19.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,67.2,Percent of Total Billed Charges, ,,85,,81.6,Percent of Total Billed Charges, ,,50,,48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,65.28,Percent of Total Billed Charges,0,15.05,,,15.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,53.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,57.6,Percent of Total Billed Charges, ,23.14,,,23.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.67,,,18.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.58,,,15.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.73,,,15.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.2,,,15.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.05,,,15.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.2,,,15.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.5,,,15.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.76,,,15.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.83,,,63.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.83,,,63.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.83,,,63.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,63.83,,,63.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86038 - ANTINUCLEAR ANTIBODIES ANA,86038,HCPCS,,,59,Outpatient,,,42.5,10.625,12.09,51.26,,,34.4,,14.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.47,,,15.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.69,,,21.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.22,,,19.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.88,Percent of Total Billed Charges, ,15.47,,,15.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.75,Percent of Total Billed Charges, ,,85,,36.13,Percent of Total Billed Charges, ,,50,,21.25,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.9,Percent of Total Billed Charges,0,12.09,,,12.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,23.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,25.5,Percent of Total Billed Charges, ,18.59,,,18.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.99,,,14.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.51,,,12.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.63,,,12.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.21,,,12.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.09,,,12.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.21,,,12.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.45,,,12.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.66,,,12.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.26,,,51.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.26,,,51.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.26,,,51.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.26,,,51.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86140 - C-REACTIVE PROTEIN,86140,HCPCS,,,91,Outpatient,,,48,12,5.18,40.8,,,34.4,,16.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.3,,,9.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.24,,,8.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,31.49,Percent of Total Billed Charges, ,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,33.6,Percent of Total Billed Charges, ,,85,,40.8,Percent of Total Billed Charges, ,,50,,24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,32.64,Percent of Total Billed Charges,0,5.18,,,5.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,26.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,28.8,Percent of Total Billed Charges, ,7.96,,,7.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.43,,,6.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.36,,,5.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.41,,,5.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.23,,,5.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.18,,,5.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.23,,,5.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.34,,,5.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.43,,,5.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86141 - C-REACTIVE PROTEIN HIGH SENSITIVITY,86141,HCPCS,,,GZ,Outpatient,,,167,41.75,12.95,141.95,,,34.4,,57.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.58,,,16.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.24,,,23.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.59,,,20.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,109.55,Percent of Total Billed Charges, ,16.58,,,16.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,116.9,Percent of Total Billed Charges, ,,85,,141.95,Percent of Total Billed Charges, ,,50,,83.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,113.56,Percent of Total Billed Charges,0,12.95,,,12.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,93.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,100.2,Percent of Total Billed Charges, ,19.91,,,19.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.06,,,16.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.4,,,13.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.53,,,13.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.08,,,13.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.95,,,12.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.08,,,13.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.34,,,13.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.57,,,13.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.13,,,53.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.13,,,53.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.13,,,53.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.13,,,53.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86141 - C-REACTIVE PROTEIN HIGH SENSITIVITY,86141,HCPCS,,,GA,Outpatient,,,167,41.75,12.95,141.95,,,34.4,,57.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.58,,,16.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.24,,,23.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.59,,,20.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,109.55,Percent of Total Billed Charges, ,16.58,,,16.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,116.9,Percent of Total Billed Charges, ,,85,,141.95,Percent of Total Billed Charges, ,,50,,83.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,113.56,Percent of Total Billed Charges,0,12.95,,,12.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,93.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,100.2,Percent of Total Billed Charges, ,19.91,,,19.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.06,,,16.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.4,,,13.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.53,,,13.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.08,,,13.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.95,,,12.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.08,,,13.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.34,,,13.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.57,,,13.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.13,,,53.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.13,,,53.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.13,,,53.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.13,,,53.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86146 - BETA 2 GLYCOPROTEIN I ANTIBODY EACH,86146,HCPCS,,,59,Outpatient,,,146,36.5,25.45,124.1,,,34.4,,50.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.58,,,32.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.65,,,45.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.47,,,40.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,95.78,Percent of Total Billed Charges, ,32.58,,,32.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,102.2,Percent of Total Billed Charges, ,,85,,124.1,Percent of Total Billed Charges, ,,50,,73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,99.28,Percent of Total Billed Charges,0,25.45,,,25.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,81.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,87.6,Percent of Total Billed Charges, ,39.13,,,39.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.56,,,31.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.34,,,26.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.6,,,26.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.7,,,25.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.45,,,25.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.7,,,25.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.21,,,26.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.66,,,26.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,107.9,,,107.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,107.9,,,107.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,107.9,,,107.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,107.9,,,107.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86147 - CARDIOLIPIN ANTIBODY EACH IG CLASS,86147,HCPCS,,,59,Outpatient,,,87,21.75,25.45,107.9,,,34.4,,29.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.58,,,32.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.65,,,45.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.47,,,40.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.07,Percent of Total Billed Charges, ,32.58,,,32.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,60.9,Percent of Total Billed Charges, ,,85,,73.95,Percent of Total Billed Charges, ,,50,,43.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.16,Percent of Total Billed Charges,0,25.45,,,25.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,48.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.2,Percent of Total Billed Charges, ,39.13,,,39.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.56,,,31.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.34,,,26.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.6,,,26.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.7,,,25.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.45,,,25.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.7,,,25.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.21,,,26.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.66,,,26.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,107.9,,,107.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,107.9,,,107.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,107.9,,,107.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,107.9,,,107.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86200 - CYCLIC CITRULLINATED PEPTIDE ANTIBODY,86200,HCPCS,,,59,Outpatient,,,45,11.25,12.95,55.51,,,34.4,,15.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.58,,,16.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.24,,,23.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.59,,,20.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29.52,Percent of Total Billed Charges, ,16.58,,,16.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31.5,Percent of Total Billed Charges, ,,85,,38.25,Percent of Total Billed Charges, ,,50,,22.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30.6,Percent of Total Billed Charges,0,12.95,,,12.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,25.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,27,Percent of Total Billed Charges, ,19.91,,,19.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.06,,,16.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.4,,,13.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.53,,,13.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.08,,,13.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.95,,,12.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.08,,,13.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.34,,,13.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.57,,,13.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.51,,,55.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.51,,,55.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.51,,,55.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.51,,,55.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86255 - FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY,86255,HCPCS,,,59,Outpatient,,,237.35,59.3375,12.05,201.75,,,34.4,,81.65,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.43,,,15.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.61,,,21.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.16,,,19.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,155.7,Percent of Total Billed Charges, ,15.43,,,15.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,166.15,Percent of Total Billed Charges, ,,85,,201.75,Percent of Total Billed Charges, ,,50,,118.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,161.4,Percent of Total Billed Charges,0,12.05,,,12.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,132.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,142.41,Percent of Total Billed Charges, ,18.53,,,18.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.95,,,14.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.47,,,12.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.17,,,12.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.05,,,12.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.17,,,12.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.41,,,12.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.62,,,12.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.14,,,51.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.14,,,51.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.14,,,51.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.14,,,51.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86301 - IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9,86301,HCPCS,,,GZ,Outpatient,,,107,26.75,20.81,90.95,,,34.4,,36.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.64,,,26.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,37.34,,,37.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.09,,,33.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,70.19,Percent of Total Billed Charges, ,26.64,,,26.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,74.9,Percent of Total Billed Charges, ,,85,,90.95,Percent of Total Billed Charges, ,,50,,53.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,72.76,Percent of Total Billed Charges,0,20.81,,,20.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,59.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,64.2,Percent of Total Billed Charges, ,32,,,32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.81,,,25.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.02,,,21.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.81,,,20.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.02,,,21.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.43,,,21.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.8,,,21.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86304 - IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125,86304,HCPCS,,,GZ,Outpatient,,,112,28,20.81,95.2,,,34.4,,38.53,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.64,,,26.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,37.34,,,37.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.09,,,33.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,73.47,Percent of Total Billed Charges, ,26.64,,,26.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,78.4,Percent of Total Billed Charges, ,,85,,95.2,Percent of Total Billed Charges, ,,50,,56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,76.16,Percent of Total Billed Charges,0,20.81,,,20.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,62.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,67.2,Percent of Total Billed Charges, ,32,,,32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.81,,,25.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.02,,,21.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.81,,,20.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.02,,,21.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.43,,,21.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.8,,,21.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86304 - IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125,86304,HCPCS,,,GA,Outpatient,,,112,28,20.81,95.2,,,34.4,,38.53,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.64,,,26.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,37.34,,,37.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.09,,,33.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,73.47,Percent of Total Billed Charges, ,26.64,,,26.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,78.4,Percent of Total Billed Charges, ,,85,,95.2,Percent of Total Billed Charges, ,,50,,56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,76.16,Percent of Total Billed Charges,0,20.81,,,20.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,62.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,67.2,Percent of Total Billed Charges, ,32,,,32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.81,,,25.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.02,,,21.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.81,,,20.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.02,,,21.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.43,,,21.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.8,,,21.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86316 - IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE,86316,HCPCS,,,59,Outpatient,,,115,28.75,20.81,97.75,,,34.4,,39.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.64,,,26.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,37.34,,,37.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.09,,,33.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,75.44,Percent of Total Billed Charges, ,26.64,,,26.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,80.5,Percent of Total Billed Charges, ,,85,,97.75,Percent of Total Billed Charges, ,,50,,57.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,78.2,Percent of Total Billed Charges,0,20.81,,,20.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,64.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,69,Percent of Total Billed Charges, ,32,,,32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.81,,,25.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.75,,,21.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.02,,,21.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.81,,,20.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.02,,,21.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.43,,,21.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.8,,,21.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.27,,,88.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86352 - CELLULAR FUNCTION ASSAY STIMULANDDETECT BIOMARKE,86352,HCPCS,,,59,Outpatient,,,292,73,0.01,248.2,,,34.4,,100.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,243.74,,,243.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,216.02,,,216.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,191.55,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,204.4,Percent of Total Billed Charges, ,,85,,248.2,Percent of Total Billed Charges, ,,50,,146,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.56,Percent of Total Billed Charges,0,135.86,,,135.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,163.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,175.2,Percent of Total Billed Charges, ,208.88,,,208.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,140.62,,,140.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,141.97,,,141.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,137.22,,,137.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.86,,,135.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,137.22,,,137.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,139.94,,,139.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,142.31,,,142.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.6,,,1.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.6,,,1.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.6,,,1.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.6,,,1.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86359 - T CELLS TOTAL COUNT,86359,HCPCS,,,59,Outpatient,,,211,52.75,37.73,179.35,,,34.4,,72.58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.3,,,48.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.68,,,67.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.99,,,59.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,138.42,Percent of Total Billed Charges, ,48.3,,,48.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,147.7,Percent of Total Billed Charges, ,,85,,179.35,Percent of Total Billed Charges, ,,50,,105.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,143.48,Percent of Total Billed Charges,0,37.73,,,37.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,118.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,126.6,Percent of Total Billed Charges, ,58.01,,,58.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.79,,,46.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.05,,,39.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.43,,,39.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.11,,,38.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.73,,,37.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.11,,,38.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.86,,,38.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.52,,,39.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,159.99,,,159.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.99,,,159.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.99,,,159.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.99,,,159.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86666 - ANTIBODY EHRLICHIA,86666,HCPCS,,,59,Outpatient,,,83,20.75,10.18,70.55,,,34.4,,28.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.04,,,13.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.27,,,18.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.19,,,16.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,54.45,Percent of Total Billed Charges, ,13.04,,,13.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,58.1,Percent of Total Billed Charges, ,,85,,70.55,Percent of Total Billed Charges, ,,50,,41.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,56.44,Percent of Total Billed Charges,0,10.18,,,10.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,46.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,49.8,Percent of Total Billed Charges, ,15.65,,,15.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.63,,,12.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.54,,,10.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.64,,,10.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.28,,,10.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.18,,,10.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.28,,,10.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.49,,,10.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.66,,,10.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.15,,,43.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.15,,,43.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.15,,,43.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.15,,,43.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86671 - ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED,86671,HCPCS,,,59,Outpatient,,,94,23.5,12.25,79.9,,,34.4,,32.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.69,,,15.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.97,,,21.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.48,,,19.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,61.66,Percent of Total Billed Charges, ,15.69,,,15.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,65.8,Percent of Total Billed Charges, ,,85,,79.9,Percent of Total Billed Charges, ,,50,,47,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,63.92,Percent of Total Billed Charges,0,12.25,,,12.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,52.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,56.4,Percent of Total Billed Charges, ,18.83,,,18.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.2,,,15.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.68,,,12.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.8,,,12.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.37,,,12.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.25,,,12.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.37,,,12.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.62,,,12.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.83,,,12.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.03,,,52.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.03,,,52.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.03,,,52.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.03,,,52.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86701 - ANTIBODY HIV-1,86701,HCPCS,,,59,Outpatient,,,53,13.25,8.89,45.05,,,34.4,,18.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.38,,,11.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.95,,,15.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.27,,,28.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.77,Percent of Total Billed Charges, ,11.38,,,11.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.1,Percent of Total Billed Charges, ,,85,,45.05,Percent of Total Billed Charges, ,,50,,26.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.04,Percent of Total Billed Charges,0,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,29.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.8,Percent of Total Billed Charges, ,27.34,,,27.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.02,,,11.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.4,,,18.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.58,,,18.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.96,,,17.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.78,,,17.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.96,,,17.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.31,,,18.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.62,,,18.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.69,,,37.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.69,,,37.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.69,,,37.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.69,,,37.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86702 - ANTIBODY HIV-2,86702,HCPCS,,,59,Outpatient,,,81,20.25,13.52,68.85,,,34.4,,27.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.31,,,17.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.26,,,24.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.5,,,21.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,53.14,Percent of Total Billed Charges, ,17.31,,,17.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56.7,Percent of Total Billed Charges, ,,85,,68.85,Percent of Total Billed Charges, ,,50,,40.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,55.08,Percent of Total Billed Charges,0,13.52,,,13.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,45.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48.6,Percent of Total Billed Charges, ,20.79,,,20.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.77,,,16.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.99,,,13.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.13,,,14.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.66,,,13.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.52,,,13.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.66,,,13.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.93,,,13.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.16,,,14.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.35,,,57.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.35,,,57.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.35,,,57.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.35,,,57.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86704 - HEPATITIS B CORE ANTIBODY HBCAB TOTAL,86704,HCPCS,,,GZ,Outpatient,,,41,10.25,12.05,51.14,,,34.4,,14.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.43,,,15.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.61,,,21.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.16,,,19.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26.9,Percent of Total Billed Charges, ,15.43,,,15.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28.7,Percent of Total Billed Charges, ,,85,,34.85,Percent of Total Billed Charges, ,,50,,20.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,27.88,Percent of Total Billed Charges,0,12.05,,,12.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,22.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,24.6,Percent of Total Billed Charges, ,18.53,,,18.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.95,,,14.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.47,,,12.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.59,,,12.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.17,,,12.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.05,,,12.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.17,,,12.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.41,,,12.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.62,,,12.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.14,,,51.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.14,,,51.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.14,,,51.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,51.14,,,51.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86705 - HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY,86705,HCPCS,,,59,Outpatient,,,40,10,11.77,49.93,,,34.4,,13.76,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.07,,,15.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.11,,,21.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.71,,,18.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26.24,Percent of Total Billed Charges, ,15.07,,,15.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28,Percent of Total Billed Charges, ,,85,,34,Percent of Total Billed Charges, ,,50,,20,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,27.2,Percent of Total Billed Charges,0,11.77,,,11.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,22.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,24,Percent of Total Billed Charges, ,18.1,,,18.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.6,,,14.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.18,,,12.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.3,,,12.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.89,,,11.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.77,,,11.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.89,,,11.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.12,,,12.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.33,,,12.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.93,,,49.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,49.93,,,49.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,49.93,,,49.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,49.93,,,49.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86706 - HEPATITIS B SURF ANTIBODY HBSAB,86706,HCPCS,,,GZ,Outpatient,,,57,14.25,10.74,48.45,,,34.4,,19.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.75,,,13.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.26,,,19.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.08,,,17.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,37.39,Percent of Total Billed Charges, ,13.75,,,13.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,39.9,Percent of Total Billed Charges, ,,85,,48.45,Percent of Total Billed Charges, ,,50,,28.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,38.76,Percent of Total Billed Charges,0,10.74,,,10.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,31.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,34.2,Percent of Total Billed Charges, ,16.51,,,16.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.32,,,13.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.12,,,11.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.22,,,11.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.85,,,10.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.74,,,10.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.85,,,10.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.06,,,11.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.25,,,11.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.53,,,45.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.53,,,45.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.53,,,45.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.53,,,45.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86757 - ANTIBODY RICKETTSIA,86757,HCPCS,,,59,Outpatient,,,109,27.25,19.35,92.65,,,34.4,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.77,,,24.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.72,,,34.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.77,,,30.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,71.5,Percent of Total Billed Charges, ,24.77,,,24.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,76.3,Percent of Total Billed Charges, ,,85,,92.65,Percent of Total Billed Charges, ,,50,,54.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,74.12,Percent of Total Billed Charges,0,19.35,,,19.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,61.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,65.4,Percent of Total Billed Charges, ,29.75,,,29.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24,,,24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.03,,,20.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.22,,,20.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.54,,,19.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.35,,,19.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.54,,,19.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.93,,,19.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.27,,,20.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.09,,,82.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.09,,,82.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.09,,,82.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.09,,,82.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86780 - ANTIBODY TREPONEMA PALLIDUM,86780,HCPCS,,,59,Outpatient,,,78,19.5,13.24,66.3,,,34.4,,26.83,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.95,,,16.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.76,,,23.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.1,,,42.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.17,Percent of Total Billed Charges, ,16.95,,,16.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,54.6,Percent of Total Billed Charges, ,,85,,66.3,Percent of Total Billed Charges, ,,50,,39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.04,Percent of Total Billed Charges,0,13.24,,,13.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,43.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,46.8,Percent of Total Billed Charges, ,40.71,,,40.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.42,,,16.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.41,,,27.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.67,,,27.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.74,,,26.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.48,,,26.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.74,,,26.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.27,,,27.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.74,,,27.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.06,,,58.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,58.06,,,58.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,58.06,,,58.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,58.06,,,58.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86812 - HLA TYPING A-B-C SINGLE ANTIGEN,86812,HCPCS,,,GA,Outpatient,,,183,45.75,25.81,155.55,,,34.4,,62.95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.04,,,33.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.31,,,46.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,41.04,,,41.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,120.05,Percent of Total Billed Charges, ,33.04,,,33.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,128.1,Percent of Total Billed Charges, ,,85,,155.55,Percent of Total Billed Charges, ,,50,,91.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,124.44,Percent of Total Billed Charges,0,25.81,,,25.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,102.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,109.8,Percent of Total Billed Charges, ,39.68,,,39.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.01,,,32.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.71,,,26.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.97,,,26.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.07,,,26.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.81,,,25.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.07,,,26.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.58,,,26.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.04,,,27.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,109.44,,,109.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.44,,,109.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.44,,,109.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.44,,,109.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86850 - ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE,86850,HCPCS,,,59,Outpatient,,,88,22,9.77,78.91,,,34.4,,30.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.53,,,17.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,78.91,,,78.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.73,Percent of Total Billed Charges, ,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,61.6,Percent of Total Billed Charges, ,,85,,74.8,Percent of Total Billed Charges, ,,50,,44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.84,Percent of Total Billed Charges,0,9.77,,,9.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,49.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.8,Percent of Total Billed Charges, ,78.11,,,78.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.21,,,56.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.58,,,52.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.09,,,53.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.8,,,50.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.32,,,52.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.21,,,53.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.85,,,14.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.85,,,14.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.85,,,14.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.85,,,14.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86870 - ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ,86870,HCPCS,,,59,Outpatient,,,446,111.5,32.67,531.25,,,34.4,,153.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,78.22,,,78.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,531.25,,,531.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,292.58,Percent of Total Billed Charges, ,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,312.2,Percent of Total Billed Charges, ,,85,,379.1,Percent of Total Billed Charges, ,,50,,223,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,303.28,Percent of Total Billed Charges,0,283.41,,,283.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,249.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,267.6,Percent of Total Billed Charges, ,525.83,,,525.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.42,,,363.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,353.97,,,353.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,357.39,,,357.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342,,,342,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,352.26,,,352.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.25,,,358.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.67,,,32.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.67,,,32.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.67,,,32.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.67,,,32.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
86885 - ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL,86885,HCPCS,,,59,Outpatient,,,263,65.75,5.72,253.08,,,34.4,,90.47,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.27,,,10.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,172.53,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,184.1,Percent of Total Billed Charges, ,,85,,223.55,Percent of Total Billed Charges, ,,50,,131.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,178.84,Percent of Total Billed Charges,0,5.72,,,5.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,147.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,157.8,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.24,,,24.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.24,,,24.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.24,,,24.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.24,,,24.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87102 - CULTURE FNGI MOLD-YEAST PRSMPTV OTH XCPT BLOOD,87102,HCPCS,,,59,Outpatient,,,31,7.75,8.41,35.64,,,34.4,,10.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.77,,,10.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.1,,,15.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.37,,,13.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.34,Percent of Total Billed Charges, ,10.77,,,10.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21.7,Percent of Total Billed Charges, ,,85,,26.35,Percent of Total Billed Charges, ,,50,,15.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.08,Percent of Total Billed Charges,0,8.41,,,8.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18.6,Percent of Total Billed Charges, ,12.93,,,12.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.43,,,10.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.79,,,8.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.49,,,8.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.41,,,8.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.49,,,8.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.66,,,8.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.81,,,8.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87116 - CULTURE TUBERCLE-OTH ACID-FAST BACILLI ANY ISOL,87116,HCPCS,,,91,Outpatient,,,33,8.25,10.8,45.83,,,34.4,,11.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.82,,,13.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.38,,,19.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.17,,,17.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21.65,Percent of Total Billed Charges, ,13.82,,,13.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23.1,Percent of Total Billed Charges, ,,85,,28.05,Percent of Total Billed Charges, ,,50,,16.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22.44,Percent of Total Billed Charges,0,10.8,,,10.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.8,Percent of Total Billed Charges, ,16.61,,,16.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.39,,,13.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.18,,,11.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.29,,,11.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.91,,,10.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.8,,,10.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.91,,,10.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.12,,,11.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.31,,,11.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.83,,,45.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.83,,,45.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.83,,,45.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.83,,,45.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87116 - CULTURE TUBERCLE-OTH ACID-FAST BACILLI ANY ISOL,87116,HCPCS,,,59,Outpatient,,,33,8.25,10.8,45.83,,,34.4,,11.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.82,,,13.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.38,,,19.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.17,,,17.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21.65,Percent of Total Billed Charges, ,13.82,,,13.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23.1,Percent of Total Billed Charges, ,,85,,28.05,Percent of Total Billed Charges, ,,50,,16.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22.44,Percent of Total Billed Charges,0,10.8,,,10.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.8,Percent of Total Billed Charges, ,16.61,,,16.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.39,,,13.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.18,,,11.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.29,,,11.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.91,,,10.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.8,,,10.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.91,,,10.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.12,,,11.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.31,,,11.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.83,,,45.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.83,,,45.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.83,,,45.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,45.83,,,45.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87149 - CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM,87149,HCPCS,,,59,Outpatient,,,68,17,20.05,85.03,,,34.4,,23.39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.67,,,25.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.96,,,35.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.88,,,31.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,44.61,Percent of Total Billed Charges, ,25.67,,,25.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,47.6,Percent of Total Billed Charges, ,,85,,57.8,Percent of Total Billed Charges, ,,50,,34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,46.24,Percent of Total Billed Charges,0,20.05,,,20.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,38.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,40.8,Percent of Total Billed Charges, ,30.83,,,30.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.87,,,24.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.75,,,20.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.95,,,20.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.25,,,20.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.05,,,20.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.25,,,20.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.65,,,20.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21,,,21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.03,,,85.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,85.03,,,85.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,85.03,,,85.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,85.03,,,85.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87206 - SMR PRIM SRC FLUORESCENTAND-AFS BCT FNGI PARASIT,87206,HCPCS,,,59,Outpatient,,,33,8.25,5.39,28.05,,,34.4,,11.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.9,,,6.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.66,,,9.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.57,,,8.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21.65,Percent of Total Billed Charges, ,6.9,,,6.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23.1,Percent of Total Billed Charges, ,,85,,28.05,Percent of Total Billed Charges, ,,50,,16.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22.44,Percent of Total Billed Charges,0,5.39,,,5.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.8,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.68,,,6.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.58,,,5.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.63,,,5.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.44,,,5.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.39,,,5.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.44,,,5.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.55,,,5.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.65,,,5.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.78,,,22.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.78,,,22.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.78,,,22.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.78,,,22.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0302 - LABORATORY - IMMUNOLOGY,0302,RC,,,,Outpatient,,,115.84,28.96,69.5,98.46,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,75.99,Percent of Total Billed Charges, ,,,,,,,,70,,81.09,Percent of Total Billed Charges, ,,85,,98.46,Percent of Total Billed Charges, ,,,,,,,,68,,78.77,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,69.5,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
85007 - BLOOD COUNT SMEAR MCRSCP W-MNL DIFRNTL WBC COUNT,85007,HCPCS,,,GZ,Outpatient,,,32,8,3.8,27.2,,,34.4,,11.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.86,,,4.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.82,,,6.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.04,,,6.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.99,Percent of Total Billed Charges, ,4.86,,,4.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22.4,Percent of Total Billed Charges, ,,85,,27.2,Percent of Total Billed Charges, ,,50,,16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.76,Percent of Total Billed Charges,0,3.8,,,3.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.2,Percent of Total Billed Charges, ,5.84,,,5.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.71,,,4.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.93,,,3.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.97,,,3.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.8,,,3.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.91,,,3.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.98,,,3.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85007 - BLOOD COUNT SMEAR MCRSCP W-MNL DIFRNTL WBC COUNT,85007,HCPCS,,,GA,Outpatient,,,32,8,3.8,27.2,,,34.4,,11.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.86,,,4.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.82,,,6.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.04,,,6.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.99,Percent of Total Billed Charges, ,4.86,,,4.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22.4,Percent of Total Billed Charges, ,,85,,27.2,Percent of Total Billed Charges, ,,50,,16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.76,Percent of Total Billed Charges,0,3.8,,,3.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.2,Percent of Total Billed Charges, ,5.84,,,5.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.71,,,4.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.93,,,3.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.97,,,3.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.8,,,3.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.91,,,3.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.98,,,3.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85007 - BLOOD COUNT SMEAR MCRSCP W-MNL DIFRNTL WBC COUNT,85007,HCPCS,,,91,Outpatient,,,32,8,3.8,27.2,,,34.4,,11.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.86,,,4.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.82,,,6.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.04,,,6.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.99,Percent of Total Billed Charges, ,4.86,,,4.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22.4,Percent of Total Billed Charges, ,,85,,27.2,Percent of Total Billed Charges, ,,50,,16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.76,Percent of Total Billed Charges,0,3.8,,,3.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.2,Percent of Total Billed Charges, ,5.84,,,5.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.71,,,4.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.93,,,3.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.97,,,3.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.8,,,3.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.91,,,3.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.98,,,3.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85007 - BLOOD COUNT SMEAR MCRSCP W-MNL DIFRNTL WBC COUNT,85007,HCPCS,,,59,Outpatient,,,32,8,3.8,27.2,,,34.4,,11.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.86,,,4.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.82,,,6.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.04,,,6.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.99,Percent of Total Billed Charges, ,4.86,,,4.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22.4,Percent of Total Billed Charges, ,,85,,27.2,Percent of Total Billed Charges, ,,50,,16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.76,Percent of Total Billed Charges,0,3.8,,,3.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.2,Percent of Total Billed Charges, ,5.84,,,5.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.71,,,4.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.93,,,3.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.97,,,3.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.8,,,3.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.84,,,3.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.91,,,3.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.98,,,3.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.61,,,14.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85014 - BLOOD COUNT HEMATOCRIT,85014,HCPCS,,,GZ,Outpatient,,,22,5.5,2.37,18.7,,,34.4,,7.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14.43,Percent of Total Billed Charges, ,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15.4,Percent of Total Billed Charges, ,,85,,18.7,Percent of Total Billed Charges, ,,50,,11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.96,Percent of Total Billed Charges,0,2.37,,,2.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13.2,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.94,,,2.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85014 - BLOOD COUNT HEMATOCRIT,85014,HCPCS,,,AY,Outpatient,,,22,5.5,2.37,18.7,,,34.4,,7.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14.43,Percent of Total Billed Charges, ,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15.4,Percent of Total Billed Charges, ,,85,,18.7,Percent of Total Billed Charges, ,,50,,11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.96,Percent of Total Billed Charges,0,2.37,,,2.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13.2,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.94,,,2.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85014 - BLOOD COUNT HEMATOCRIT,85014,HCPCS,,,91,Outpatient,,,22,5.5,2.37,18.7,,,34.4,,7.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14.43,Percent of Total Billed Charges, ,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15.4,Percent of Total Billed Charges, ,,85,,18.7,Percent of Total Billed Charges, ,,50,,11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.96,Percent of Total Billed Charges,0,2.37,,,2.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13.2,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.94,,,2.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85014 - BLOOD COUNT HEMATOCRIT,85014,HCPCS,,,59,Outpatient,,,22,5.5,2.37,18.7,,,34.4,,7.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14.43,Percent of Total Billed Charges, ,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15.4,Percent of Total Billed Charges, ,,85,,18.7,Percent of Total Billed Charges, ,,50,,11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.96,Percent of Total Billed Charges,0,2.37,,,2.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13.2,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.94,,,2.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85018 - BLOOD COUNT HEMOGLOBIN,85018,HCPCS,,,GZ,Outpatient,,,15,3.75,2.37,12.75,,,34.4,,5.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.84,Percent of Total Billed Charges, ,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.5,Percent of Total Billed Charges, ,,85,,12.75,Percent of Total Billed Charges, ,,50,,7.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.2,Percent of Total Billed Charges,0,2.37,,,2.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.94,,,2.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85018 - BLOOD COUNT HEMOGLOBIN,85018,HCPCS,,,AY,Outpatient,,,15,3.75,2.37,12.75,,,34.4,,5.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.84,Percent of Total Billed Charges, ,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.5,Percent of Total Billed Charges, ,,85,,12.75,Percent of Total Billed Charges, ,,50,,7.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.2,Percent of Total Billed Charges,0,2.37,,,2.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.94,,,2.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85018 - BLOOD COUNT HEMOGLOBIN,85018,HCPCS,,,91,Outpatient,,,15,3.75,2.37,12.75,,,34.4,,5.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.84,Percent of Total Billed Charges, ,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.5,Percent of Total Billed Charges, ,,85,,12.75,Percent of Total Billed Charges, ,,50,,7.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.2,Percent of Total Billed Charges,0,2.37,,,2.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.94,,,2.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85018 - BLOOD COUNT HEMOGLOBIN,85018,HCPCS,,,59,Outpatient,,,15,3.75,2.37,12.75,,,34.4,,5.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.54,,,7.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.84,Percent of Total Billed Charges, ,3.03,,,3.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.5,Percent of Total Billed Charges, ,,85,,12.75,Percent of Total Billed Charges, ,,50,,7.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.2,Percent of Total Billed Charges,0,2.37,,,2.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9,Percent of Total Billed Charges, ,7.29,,,7.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.94,,,2.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.91,,,4.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.74,,,4.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.79,,,4.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.88,,,4.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.04,,,10.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85025 - BLOOD COUNT COMPLETE AUTOANDAUTO DIFRNTL WBC,85025,HCPCS,,,XE,Outpatient,,,80,20,7.77,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.94,,,13.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.71,,,24.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,7.77,,,7.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,23.89,,,23.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.64,,,9.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.08,,,16.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.24,,,16.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.54,,,15.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.01,,,16.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85025 - BLOOD COUNT COMPLETE AUTOANDAUTO DIFRNTL WBC,85025,HCPCS,,,GZ,Outpatient,,,80,20,7.77,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.94,,,13.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.71,,,24.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,7.77,,,7.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,23.89,,,23.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.64,,,9.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.08,,,16.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.24,,,16.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.54,,,15.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.01,,,16.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85025 - BLOOD COUNT COMPLETE AUTOANDAUTO DIFRNTL WBC,85025,HCPCS,,,GA,Outpatient,,,80,20,7.77,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.94,,,13.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.71,,,24.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,7.77,,,7.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,23.89,,,23.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.64,,,9.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.08,,,16.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.24,,,16.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.54,,,15.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.01,,,16.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85025 - BLOOD COUNT COMPLETE AUTOANDAUTO DIFRNTL WBC,85025,HCPCS,,,AY,Outpatient,,,80,20,7.77,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.94,,,13.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.71,,,24.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,7.77,,,7.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,23.89,,,23.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.64,,,9.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.08,,,16.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.24,,,16.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.54,,,15.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.01,,,16.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85025 - BLOOD COUNT COMPLETE AUTOANDAUTO DIFRNTL WBC,85025,HCPCS,,,91,Outpatient,,,80,20,7.77,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.94,,,13.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.71,,,24.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,7.77,,,7.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,23.89,,,23.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.64,,,9.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.08,,,16.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.24,,,16.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.54,,,15.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.01,,,16.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85025 - BLOOD COUNT COMPLETE AUTOANDAUTO DIFRNTL WBC,85025,HCPCS,,,59,Outpatient,,,80,20,7.77,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.94,,,13.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.71,,,24.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,7.77,,,7.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,23.89,,,23.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.64,,,9.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.08,,,16.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.24,,,16.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.54,,,15.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.7,,,15.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.01,,,16.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.28,,,16.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.97,,,32.97,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85027 - BLOOD COUNT COMPLETE AUTOMATED,85027,HCPCS,,,XE,Outpatient,,,80,20,6.47,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85027 - BLOOD COUNT COMPLETE AUTOMATED,85027,HCPCS,,,GZ,Outpatient,,,80,20,6.47,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85027 - BLOOD COUNT COMPLETE AUTOMATED,85027,HCPCS,,,GA,Outpatient,,,80,20,6.47,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85027 - BLOOD COUNT COMPLETE AUTOMATED,85027,HCPCS,,,AY,Outpatient,,,80,20,6.47,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85027 - BLOOD COUNT COMPLETE AUTOMATED,85027,HCPCS,,,91,Outpatient,,,80,20,6.47,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85027 - BLOOD COUNT COMPLETE AUTOMATED,85027,HCPCS,,,59,Outpatient,,,80,20,6.47,68,,,34.4,,27.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.62,,,11.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.29,,,10.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.48,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56,Percent of Total Billed Charges, ,,85,,68,Percent of Total Billed Charges, ,,50,,40,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.4,Percent of Total Billed Charges,0,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48,Percent of Total Billed Charges, ,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.76,,,6.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.47,,,6.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.53,,,6.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.66,,,6.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.78,,,6.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.47,,,27.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85046 - BLOOD COUNT RETICULOCYTES AUTO 1-GREATER THAN CELL MEAS,85046,HCPCS,,,AY,Outpatient,,,51,12.75,5.57,43.35,,,34.4,,17.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.13,,,7.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.99,,,9.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.86,,,8.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,33.46,Percent of Total Billed Charges, ,7.13,,,7.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,35.7,Percent of Total Billed Charges, ,,85,,43.35,Percent of Total Billed Charges, ,,50,,25.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,34.68,Percent of Total Billed Charges,0,5.57,,,5.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,28.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,30.6,Percent of Total Billed Charges, ,8.56,,,8.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.91,,,6.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.76,,,5.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.82,,,5.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.63,,,5.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.57,,,5.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.63,,,5.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.74,,,5.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.83,,,5.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.7,,,23.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,23.7,,,23.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,23.7,,,23.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,23.7,,,23.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85046 - BLOOD COUNT RETICULOCYTES AUTO 1-GREATER THAN CELL MEAS,85046,HCPCS,,,91,Outpatient,,,51,12.75,5.57,43.35,,,34.4,,17.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.13,,,7.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.99,,,9.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.86,,,8.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,33.46,Percent of Total Billed Charges, ,7.13,,,7.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,35.7,Percent of Total Billed Charges, ,,85,,43.35,Percent of Total Billed Charges, ,,50,,25.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,34.68,Percent of Total Billed Charges,0,5.57,,,5.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,28.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,30.6,Percent of Total Billed Charges, ,8.56,,,8.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.91,,,6.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.76,,,5.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.82,,,5.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.63,,,5.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.57,,,5.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.63,,,5.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.74,,,5.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.83,,,5.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.7,,,23.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,23.7,,,23.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,23.7,,,23.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,23.7,,,23.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85049 - BLOOD COUNT PLATELET AUTOMATED,85049,HCPCS,,,91,Outpatient,,,41,10.25,4.48,34.85,,,34.4,,14.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.74,,,5.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.12,,,7.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26.9,Percent of Total Billed Charges, ,5.74,,,5.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28.7,Percent of Total Billed Charges, ,,85,,34.85,Percent of Total Billed Charges, ,,50,,20.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,27.88,Percent of Total Billed Charges,0,4.48,,,4.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,22.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,24.6,Percent of Total Billed Charges, ,6.89,,,6.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.56,,,5.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.64,,,4.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.68,,,4.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.52,,,4.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.48,,,4.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.52,,,4.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.61,,,4.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.69,,,4.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.56,,,18.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.56,,,18.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.56,,,18.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.56,,,18.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85049 - BLOOD COUNT PLATELET AUTOMATED,85049,HCPCS,,,59,Outpatient,,,41,10.25,4.48,34.85,,,34.4,,14.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.74,,,5.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.03,,,8.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.12,,,7.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26.9,Percent of Total Billed Charges, ,5.74,,,5.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28.7,Percent of Total Billed Charges, ,,85,,34.85,Percent of Total Billed Charges, ,,50,,20.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,27.88,Percent of Total Billed Charges,0,4.48,,,4.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,22.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,24.6,Percent of Total Billed Charges, ,6.89,,,6.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.56,,,5.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.64,,,4.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.68,,,4.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.52,,,4.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.48,,,4.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.52,,,4.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.61,,,4.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.69,,,4.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.56,,,18.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.56,,,18.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.56,,,18.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.56,,,18.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85347 - COAGULATION TIME ACTIVATED,85347,HCPCS,,,91,Outpatient,,,18,4.5,4.28,16.96,,,34.4,,6.19,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.48,,,5.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.67,,,7.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.81,,,6.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11.81,Percent of Total Billed Charges, ,5.48,,,5.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12.6,Percent of Total Billed Charges, ,,85,,15.3,Percent of Total Billed Charges, ,,50,,9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12.24,Percent of Total Billed Charges,0,4.28,,,4.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10.8,Percent of Total Billed Charges, ,6.58,,,6.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.31,,,5.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.43,,,4.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.47,,,4.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.32,,,4.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.28,,,4.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.32,,,4.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.41,,,4.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.48,,,4.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.96,,,16.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.96,,,16.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.96,,,16.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.96,,,16.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85520 - HEPARIN ASSAY,85520,HCPCS,,,91,Outpatient,,,45,11.25,13.09,38.25,,,34.4,,15.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.76,,,16.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.49,,,23.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.81,,,20.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29.52,Percent of Total Billed Charges, ,16.76,,,16.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31.5,Percent of Total Billed Charges, ,,85,,38.25,Percent of Total Billed Charges, ,,50,,22.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30.6,Percent of Total Billed Charges,0,13.09,,,13.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,25.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,27,Percent of Total Billed Charges, ,20.13,,,20.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.23,,,16.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.55,,,13.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.68,,,13.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.22,,,13.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.09,,,13.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.22,,,13.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.48,,,13.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.71,,,13.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.12,,,33.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.12,,,33.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.12,,,33.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.12,,,33.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85610 - PROTHROMBIN TIME,85610,HCPCS,,,GZ,Outpatient,,,16,4,4.29,16.66,,,34.4,,5.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.49,,,5.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.7,,,7.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.64,,,13.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10.5,Percent of Total Billed Charges, ,5.49,,,5.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11.2,Percent of Total Billed Charges, ,,85,,13.6,Percent of Total Billed Charges, ,,50,,8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.88,Percent of Total Billed Charges,0,4.29,,,4.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9.6,Percent of Total Billed Charges, ,13.19,,,13.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.32,,,5.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.88,,,8.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.97,,,8.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.67,,,8.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.58,,,8.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.67,,,8.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.84,,,8.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.99,,,8.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85610 - PROTHROMBIN TIME,85610,HCPCS,,,GA,Outpatient,,,16,4,4.29,16.66,,,34.4,,5.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.49,,,5.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.7,,,7.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.64,,,13.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10.5,Percent of Total Billed Charges, ,5.49,,,5.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11.2,Percent of Total Billed Charges, ,,85,,13.6,Percent of Total Billed Charges, ,,50,,8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.88,Percent of Total Billed Charges,0,4.29,,,4.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9.6,Percent of Total Billed Charges, ,13.19,,,13.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.32,,,5.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.88,,,8.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.97,,,8.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.67,,,8.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.58,,,8.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.67,,,8.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.84,,,8.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.99,,,8.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85610 - PROTHROMBIN TIME,85610,HCPCS,,,91,Outpatient,,,16,4,4.29,16.66,,,34.4,,5.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.49,,,5.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.7,,,7.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.64,,,13.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10.5,Percent of Total Billed Charges, ,5.49,,,5.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11.2,Percent of Total Billed Charges, ,,85,,13.6,Percent of Total Billed Charges, ,,50,,8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.88,Percent of Total Billed Charges,0,4.29,,,4.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9.6,Percent of Total Billed Charges, ,13.19,,,13.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.32,,,5.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.88,,,8.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.97,,,8.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.67,,,8.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.58,,,8.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.67,,,8.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.84,,,8.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.99,,,8.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.66,,,16.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85730 - THROMBOPLASTIN TIME PARTIAL PLASMA-WHOLE BLOOD,85730,HCPCS,,,GZ,Outpatient,,,27,6.75,6.01,25.48,,,34.4,,9.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.69,,,7.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.79,,,10.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17.71,Percent of Total Billed Charges, ,7.69,,,7.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18.9,Percent of Total Billed Charges, ,,85,,22.95,Percent of Total Billed Charges, ,,50,,13.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18.36,Percent of Total Billed Charges,0,6.01,,,6.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16.2,Percent of Total Billed Charges, ,9.24,,,9.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.45,,,7.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.22,,,6.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.28,,,6.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.07,,,6.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.01,,,6.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.07,,,6.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.19,,,6.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.3,,,6.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85730 - THROMBOPLASTIN TIME PARTIAL PLASMA-WHOLE BLOOD,85730,HCPCS,,,GA,Outpatient,,,27,6.75,6.01,25.48,,,34.4,,9.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.69,,,7.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.79,,,10.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17.71,Percent of Total Billed Charges, ,7.69,,,7.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18.9,Percent of Total Billed Charges, ,,85,,22.95,Percent of Total Billed Charges, ,,50,,13.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18.36,Percent of Total Billed Charges,0,6.01,,,6.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16.2,Percent of Total Billed Charges, ,9.24,,,9.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.45,,,7.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.22,,,6.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.28,,,6.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.07,,,6.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.01,,,6.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.07,,,6.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.19,,,6.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.3,,,6.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
85730 - THROMBOPLASTIN TIME PARTIAL PLASMA-WHOLE BLOOD,85730,HCPCS,,,91,Outpatient,,,27,6.75,6.01,25.48,,,34.4,,9.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.69,,,7.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.79,,,10.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17.71,Percent of Total Billed Charges, ,7.69,,,7.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18.9,Percent of Total Billed Charges, ,,85,,22.95,Percent of Total Billed Charges, ,,50,,13.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18.36,Percent of Total Billed Charges,0,6.01,,,6.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16.2,Percent of Total Billed Charges, ,9.24,,,9.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.45,,,7.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.22,,,6.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.28,,,6.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.07,,,6.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.01,,,6.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.07,,,6.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.19,,,6.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.3,,,6.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,25.48,,,25.48,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0305 - LABORATORY - HEMATOLOGY,0305,RC,,,,Outpatient,,,38.55,9.6375,23.13,32.77,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,25.29,Percent of Total Billed Charges, ,,,,,,,,70,,26.99,Percent of Total Billed Charges, ,,85,,32.77,Percent of Total Billed Charges, ,,,,,,,,68,,26.21,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,23.13,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
87015 - CONCENTRATION INFECTIOUS AGENTS,87015,HCPCS,,,91,Outpatient,,,32,8,6.68,28.33,,,34.4,,11.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.56,,,8.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.98,,,11.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.62,,,10.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.99,Percent of Total Billed Charges, ,8.56,,,8.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22.4,Percent of Total Billed Charges, ,,85,,27.2,Percent of Total Billed Charges, ,,50,,16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.76,Percent of Total Billed Charges,0,6.68,,,6.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.2,Percent of Total Billed Charges, ,10.27,,,10.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.91,,,6.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.98,,,6.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.75,,,6.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.68,,,6.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.75,,,6.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.88,,,6.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7,,,7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.33,,,28.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.33,,,28.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.33,,,28.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.33,,,28.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87015 - CONCENTRATION INFECTIOUS AGENTS,87015,HCPCS,,,59,Outpatient,,,32,8,6.68,28.33,,,34.4,,11.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.56,,,8.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.98,,,11.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.62,,,10.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.99,Percent of Total Billed Charges, ,8.56,,,8.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22.4,Percent of Total Billed Charges, ,,85,,27.2,Percent of Total Billed Charges, ,,50,,16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.76,Percent of Total Billed Charges,0,6.68,,,6.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19.2,Percent of Total Billed Charges, ,10.27,,,10.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.29,,,8.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.91,,,6.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.98,,,6.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.75,,,6.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.68,,,6.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.75,,,6.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.88,,,6.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7,,,7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.33,,,28.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.33,,,28.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.33,,,28.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.33,,,28.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87040 - CULTURE BACTERIAL BLOOD AEROBIC W-ID ISOLATES,87040,HCPCS,,,XU,Outpatient,,,100,25,10.32,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.52,,,18.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.41,,,16.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,10.32,,,10.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,15.87,,,15.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.79,,,12.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.78,,,10.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.32,,,10.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.63,,,10.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.81,,,10.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87040 - CULTURE BACTERIAL BLOOD AEROBIC W-ID ISOLATES,87040,HCPCS,,,XE,Outpatient,,,100,25,10.32,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.52,,,18.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.41,,,16.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,10.32,,,10.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,15.87,,,15.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.79,,,12.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.78,,,10.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.32,,,10.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.63,,,10.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.81,,,10.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87040 - CULTURE BACTERIAL BLOOD AEROBIC W-ID ISOLATES,87040,HCPCS,,,AY,Outpatient,,,100,25,10.32,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.52,,,18.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.41,,,16.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,10.32,,,10.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,15.87,,,15.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.79,,,12.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.78,,,10.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.32,,,10.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.63,,,10.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.81,,,10.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87040 - CULTURE BACTERIAL BLOOD AEROBIC W-ID ISOLATES,87040,HCPCS,,,91,Outpatient,,,100,25,10.32,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.52,,,18.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.41,,,16.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,10.32,,,10.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,15.87,,,15.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.79,,,12.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.78,,,10.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.32,,,10.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.63,,,10.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.81,,,10.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87040 - CULTURE BACTERIAL BLOOD AEROBIC W-ID ISOLATES,87040,HCPCS,,,59,Outpatient,,,100,25,10.32,85,,,34.4,,34.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.52,,,18.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.41,,,16.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,13.21,,,13.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,10.32,,,10.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,15.87,,,15.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.79,,,12.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.78,,,10.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.32,,,10.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.42,,,10.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.63,,,10.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.81,,,10.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87071 - CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD-STOOL,87071,HCPCS,,,91,Outpatient,,,172,43,9.89,146.2,,,34.4,,59.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.66,,,12.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.75,,,17.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.73,,,15.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,12.66,,,12.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,9.89,,,9.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,15.21,,,15.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.26,,,12.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.24,,,10.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.99,,,9.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.89,,,9.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.99,,,9.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.19,,,10.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.36,,,10.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87071 - CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD-STOOL,87071,HCPCS,,,59,Outpatient,,,172,43,9.89,146.2,,,34.4,,59.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.66,,,12.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.75,,,17.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.73,,,15.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,12.66,,,12.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,9.89,,,9.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,15.21,,,15.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.26,,,12.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.24,,,10.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.99,,,9.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.89,,,9.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.99,,,9.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.19,,,10.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.36,,,10.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87073 - CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD-STOOL,87073,HCPCS,,,59,Outpatient,,,75,18.75,9.66,63.75,,,34.4,,25.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.36,,,12.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.33,,,17.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.36,,,15.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.2,Percent of Total Billed Charges, ,12.36,,,12.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.5,Percent of Total Billed Charges, ,,85,,63.75,Percent of Total Billed Charges, ,,50,,37.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51,Percent of Total Billed Charges,0,9.66,,,9.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,45,Percent of Total Billed Charges, ,14.85,,,14.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.98,,,11.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10,,,10,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.09,,,10.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.76,,,9.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.66,,,9.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.76,,,9.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.95,,,9.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.12,,,10.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.02,,,20.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87075 - CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISOANDID,87075,HCPCS,,,AY,Outpatient,,,87,21.75,9.47,73.95,,,34.4,,29.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.13,,,12.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17,,,17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.06,,,15.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.07,Percent of Total Billed Charges, ,12.13,,,12.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,60.9,Percent of Total Billed Charges, ,,85,,73.95,Percent of Total Billed Charges, ,,50,,43.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.16,Percent of Total Billed Charges,0,9.47,,,9.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,48.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.2,Percent of Total Billed Charges, ,14.56,,,14.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.75,,,11.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.8,,,9.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.9,,,9.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.47,,,9.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.75,,,9.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.92,,,9.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87075 - CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISOANDID,87075,HCPCS,,,91,Outpatient,,,87,21.75,9.47,73.95,,,34.4,,29.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.13,,,12.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17,,,17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.06,,,15.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.07,Percent of Total Billed Charges, ,12.13,,,12.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,60.9,Percent of Total Billed Charges, ,,85,,73.95,Percent of Total Billed Charges, ,,50,,43.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.16,Percent of Total Billed Charges,0,9.47,,,9.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,48.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.2,Percent of Total Billed Charges, ,14.56,,,14.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.75,,,11.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.8,,,9.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.9,,,9.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.47,,,9.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.75,,,9.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.92,,,9.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87075 - CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISOANDID,87075,HCPCS,,,59,Outpatient,,,87,21.75,9.47,73.95,,,34.4,,29.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.13,,,12.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17,,,17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.06,,,15.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.07,Percent of Total Billed Charges, ,12.13,,,12.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,60.9,Percent of Total Billed Charges, ,,85,,73.95,Percent of Total Billed Charges, ,,50,,43.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.16,Percent of Total Billed Charges,0,9.47,,,9.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,48.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.2,Percent of Total Billed Charges, ,14.56,,,14.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.75,,,11.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.8,,,9.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.9,,,9.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.47,,,9.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.75,,,9.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.92,,,9.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,37.1,,,37.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87076 - CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL,87076,HCPCS,,,59,Outpatient,,,127,31.75,8.08,107.95,,,34.4,,43.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.49,,,14.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.85,,,12.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,83.31,Percent of Total Billed Charges, ,10.34,,,10.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,88.9,Percent of Total Billed Charges, ,,85,,107.95,Percent of Total Billed Charges, ,,50,,63.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,86.36,Percent of Total Billed Charges,0,8.08,,,8.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,71.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,76.2,Percent of Total Billed Charges, ,12.42,,,12.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.02,,,10.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.36,,,8.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.44,,,8.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.16,,,8.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.08,,,8.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.16,,,8.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.32,,,8.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.46,,,8.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87077 - CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL,87077,HCPCS,,,AY,Outpatient,,,74,18.5,8.08,62.9,,,34.4,,25.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.49,,,14.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.69,,,25.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.54,Percent of Total Billed Charges, ,10.34,,,10.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.8,Percent of Total Billed Charges, ,,85,,62.9,Percent of Total Billed Charges, ,,50,,37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.32,Percent of Total Billed Charges,0,8.08,,,8.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,41.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,44.4,Percent of Total Billed Charges, ,24.85,,,24.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.02,,,10.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.73,,,16.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.89,,,16.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.32,,,16.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.16,,,16.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.32,,,16.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.64,,,16.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.93,,,16.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87077 - CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL,87077,HCPCS,,,91,Outpatient,,,74,18.5,8.08,62.9,,,34.4,,25.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.49,,,14.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.69,,,25.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.54,Percent of Total Billed Charges, ,10.34,,,10.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.8,Percent of Total Billed Charges, ,,85,,62.9,Percent of Total Billed Charges, ,,50,,37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.32,Percent of Total Billed Charges,0,8.08,,,8.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,41.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,44.4,Percent of Total Billed Charges, ,24.85,,,24.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.02,,,10.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.73,,,16.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.89,,,16.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.32,,,16.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.16,,,16.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.32,,,16.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.64,,,16.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.93,,,16.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87077 - CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL,87077,HCPCS,,,59,Outpatient,,,74,18.5,8.08,62.9,,,34.4,,25.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.34,,,10.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.49,,,14.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.69,,,25.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.54,Percent of Total Billed Charges, ,10.34,,,10.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.8,Percent of Total Billed Charges, ,,85,,62.9,Percent of Total Billed Charges, ,,50,,37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.32,Percent of Total Billed Charges,0,8.08,,,8.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,41.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,44.4,Percent of Total Billed Charges, ,24.85,,,24.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.02,,,10.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.73,,,16.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.89,,,16.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.32,,,16.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.16,,,16.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.32,,,16.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.64,,,16.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.93,,,16.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87081 - CUL PRSMPTV PTHGNC ORGANISM SCRN W-COLONY ESTIMJ,87081,HCPCS,,,59,Outpatient,,,64,16,6.63,54.4,,,34.4,,22.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.49,,,8.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.9,,,11.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.54,,,10.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,41.98,Percent of Total Billed Charges, ,8.49,,,8.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,44.8,Percent of Total Billed Charges, ,,85,,54.4,Percent of Total Billed Charges, ,,50,,32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,43.52,Percent of Total Billed Charges,0,6.63,,,6.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,35.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,38.4,Percent of Total Billed Charges, ,10.19,,,10.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.23,,,8.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.86,,,6.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.93,,,6.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.63,,,6.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.7,,,6.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.83,,,6.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.94,,,6.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.13,,,28.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.13,,,28.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.13,,,28.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,28.13,,,28.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87086 - CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE,87086,HCPCS,,,GZ,Outpatient,,,34,8.5,8.07,34.24,,,34.4,,11.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.33,,,10.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.49,,,14.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.83,,,12.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,22.3,Percent of Total Billed Charges, ,10.33,,,10.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23.8,Percent of Total Billed Charges, ,,85,,28.9,Percent of Total Billed Charges, ,,50,,17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,23.12,Percent of Total Billed Charges,0,8.07,,,8.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,19.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,20.4,Percent of Total Billed Charges, ,12.41,,,12.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.01,,,10.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.35,,,8.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.43,,,8.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.15,,,8.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.07,,,8.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.15,,,8.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.31,,,8.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.45,,,8.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87086 - CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE,87086,HCPCS,,,GA,Outpatient,,,34,8.5,8.07,34.24,,,34.4,,11.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.33,,,10.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.49,,,14.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.83,,,12.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,22.3,Percent of Total Billed Charges, ,10.33,,,10.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23.8,Percent of Total Billed Charges, ,,85,,28.9,Percent of Total Billed Charges, ,,50,,17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,23.12,Percent of Total Billed Charges,0,8.07,,,8.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,19.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,20.4,Percent of Total Billed Charges, ,12.41,,,12.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.01,,,10.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.35,,,8.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.43,,,8.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.15,,,8.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.07,,,8.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.15,,,8.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.31,,,8.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.45,,,8.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.24,,,34.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87088 - CULTURE BCT ISOLANDPRSMPTV ID ISOLATE EA URINE,87088,HCPCS,,,GZ,Outpatient,,,74,18.5,8.09,62.9,,,34.4,,25.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.35,,,10.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.86,,,12.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.54,Percent of Total Billed Charges, ,10.35,,,10.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.8,Percent of Total Billed Charges, ,,85,,62.9,Percent of Total Billed Charges, ,,50,,37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.32,Percent of Total Billed Charges,0,8.09,,,8.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,41.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,44.4,Percent of Total Billed Charges, ,12.44,,,12.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.03,,,10.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.37,,,8.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.45,,,8.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.09,,,8.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.33,,,8.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.47,,,8.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87088 - CULTURE BCT ISOLANDPRSMPTV ID ISOLATE EA URINE,87088,HCPCS,,,GA,Outpatient,,,74,18.5,8.09,62.9,,,34.4,,25.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.35,,,10.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.86,,,12.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.54,Percent of Total Billed Charges, ,10.35,,,10.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.8,Percent of Total Billed Charges, ,,85,,62.9,Percent of Total Billed Charges, ,,50,,37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.32,Percent of Total Billed Charges,0,8.09,,,8.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,41.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,44.4,Percent of Total Billed Charges, ,12.44,,,12.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.03,,,10.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.37,,,8.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.45,,,8.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.09,,,8.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.33,,,8.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.47,,,8.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87088 - CULTURE BCT ISOLANDPRSMPTV ID ISOLATE EA URINE,87088,HCPCS,,,59,Outpatient,,,74,18.5,8.09,62.9,,,34.4,,25.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.35,,,10.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.86,,,12.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.54,Percent of Total Billed Charges, ,10.35,,,10.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.8,Percent of Total Billed Charges, ,,85,,62.9,Percent of Total Billed Charges, ,,50,,37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.32,Percent of Total Billed Charges,0,8.09,,,8.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,41.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,44.4,Percent of Total Billed Charges, ,12.44,,,12.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.03,,,10.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.37,,,8.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.45,,,8.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.09,,,8.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.17,,,8.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.33,,,8.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.47,,,8.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.3,,,34.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87101 - CUL FNGI MOLD-YEAST PRSMPTV ID SKN HAIR-NAIL,87101,HCPCS,,,91,Outpatient,,,51,12.75,7.71,43.35,,,34.4,,17.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.87,,,9.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.83,,,13.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.26,,,12.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,33.46,Percent of Total Billed Charges, ,9.87,,,9.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,35.7,Percent of Total Billed Charges, ,,85,,43.35,Percent of Total Billed Charges, ,,50,,25.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,34.68,Percent of Total Billed Charges,0,7.71,,,7.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,28.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,30.6,Percent of Total Billed Charges, ,11.85,,,11.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.56,,,9.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.98,,,7.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.06,,,8.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.79,,,7.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.71,,,7.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.79,,,7.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.94,,,7.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.08,,,8.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87147 - CULTURE TYPING IMMUNOLOGIC OTH-THN IMMUNOFLUORES,87147,HCPCS,,,59,Outpatient,,,23,5.75,5.18,21.95,,,34.4,,7.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.3,,,9.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.24,,,8.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15.09,Percent of Total Billed Charges, ,6.64,,,6.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16.1,Percent of Total Billed Charges, ,,85,,19.55,Percent of Total Billed Charges, ,,50,,11.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15.64,Percent of Total Billed Charges,0,5.18,,,5.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13.8,Percent of Total Billed Charges, ,7.96,,,7.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.43,,,6.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.36,,,5.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.41,,,5.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.23,,,5.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.18,,,5.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.23,,,5.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.34,,,5.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.43,,,5.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.95,,,21.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87181 - SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ,87181,HCPCS,,,59,Outpatient,,,46,11.5,4.75,39.1,,,34.4,,15.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.09,,,6.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.55,,,7.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,30.18,Percent of Total Billed Charges, ,6.09,,,6.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,32.2,Percent of Total Billed Charges, ,,85,,39.1,Percent of Total Billed Charges, ,,50,,23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,31.28,Percent of Total Billed Charges,0,4.75,,,4.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,25.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,27.6,Percent of Total Billed Charges, ,7.3,,,7.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.9,,,5.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.92,,,4.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.96,,,4.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.8,,,4.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.75,,,4.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.8,,,4.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.89,,,4.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.98,,,4.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87184 - SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD,87184,HCPCS,,,59,Outpatient,,,42,10.5,7.48,35.7,,,34.4,,14.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.58,,,9.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.41,,,13.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.89,,,11.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.55,Percent of Total Billed Charges, ,9.58,,,9.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.4,Percent of Total Billed Charges, ,,85,,35.7,Percent of Total Billed Charges, ,,50,,21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.56,Percent of Total Billed Charges,0,7.48,,,7.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,23.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,25.2,Percent of Total Billed Charges, ,11.5,,,11.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.28,,,9.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.74,,,7.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.82,,,7.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.55,,,7.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.48,,,7.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.55,,,7.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.7,,,7.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.84,,,7.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.25,,,29.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.25,,,29.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.25,,,29.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.25,,,29.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87185 - SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ,87185,HCPCS,,,59,Outpatient,,,20,5,4.75,20.14,,,34.4,,6.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.09,,,6.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.55,,,7.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13.12,Percent of Total Billed Charges, ,6.09,,,6.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14,Percent of Total Billed Charges, ,,85,,17,Percent of Total Billed Charges, ,,50,,10,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13.6,Percent of Total Billed Charges,0,4.75,,,4.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12,Percent of Total Billed Charges, ,7.3,,,7.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.9,,,5.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.92,,,4.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.96,,,4.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.8,,,4.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.75,,,4.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.8,,,4.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.89,,,4.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.98,,,4.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.14,,,20.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87186 - SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO-AGAR DILUTJ,87186,HCPCS,,,91,Outpatient,,,79,19.75,8.65,67.15,,,34.4,,27.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.07,,,11.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.51,,,15.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.75,,,13.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.82,Percent of Total Billed Charges, ,11.07,,,11.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,55.3,Percent of Total Billed Charges, ,,85,,67.15,Percent of Total Billed Charges, ,,50,,39.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.72,Percent of Total Billed Charges,0,8.65,,,8.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,47.4,Percent of Total Billed Charges, ,13.3,,,13.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.73,,,10.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.95,,,8.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.04,,,9.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.74,,,8.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.65,,,8.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.74,,,8.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.91,,,8.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.06,,,9.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87186 - SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO-AGAR DILUTJ,87186,HCPCS,,,59,Outpatient,,,79,19.75,8.65,67.15,,,34.4,,27.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.07,,,11.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.51,,,15.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.75,,,13.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.82,Percent of Total Billed Charges, ,11.07,,,11.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,55.3,Percent of Total Billed Charges, ,,85,,67.15,Percent of Total Billed Charges, ,,50,,39.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.72,Percent of Total Billed Charges,0,8.65,,,8.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,44.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,47.4,Percent of Total Billed Charges, ,13.3,,,13.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.73,,,10.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.95,,,8.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.04,,,9.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.74,,,8.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.65,,,8.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.74,,,8.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.91,,,8.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.06,,,9.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,24.47,,,24.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87205 - SMR PRIM SRC GRAM-GIEMSA STAIN BCT FUNGI-CELL,87205,HCPCS,,,91,Outpatient,,,39,9.75,4.27,33.15,,,34.4,,13.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.47,,,5.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.67,,,7.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.79,,,6.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,25.58,Percent of Total Billed Charges, ,5.47,,,5.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,27.3,Percent of Total Billed Charges, ,,85,,33.15,Percent of Total Billed Charges, ,,50,,19.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,26.52,Percent of Total Billed Charges,0,4.27,,,4.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,21.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,23.4,Percent of Total Billed Charges, ,6.57,,,6.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.3,,,5.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.42,,,4.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.46,,,4.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.31,,,4.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.27,,,4.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.31,,,4.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.4,,,4.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.47,,,4.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87205 - SMR PRIM SRC GRAM-GIEMSA STAIN BCT FUNGI-CELL,87205,HCPCS,,,59,Outpatient,,,39,9.75,4.27,33.15,,,34.4,,13.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.47,,,5.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.67,,,7.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.79,,,6.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,25.58,Percent of Total Billed Charges, ,5.47,,,5.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,27.3,Percent of Total Billed Charges, ,,85,,33.15,Percent of Total Billed Charges, ,,50,,19.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,26.52,Percent of Total Billed Charges,0,4.27,,,4.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,21.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,23.4,Percent of Total Billed Charges, ,6.57,,,6.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.3,,,5.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.42,,,4.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.46,,,4.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.31,,,4.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.27,,,4.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.31,,,4.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.4,,,4.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.47,,,4.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87206 - SMR PRIM SRC FLUORESCENTAND-AFS BCT FNGI PARASIT,87206,HCPCS,,,59,Outpatient,,,68.87,17.2175,5.39,58.54,,,34.4,,23.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.9,,,6.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.66,,,9.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.57,,,8.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,45.18,Percent of Total Billed Charges, ,6.9,,,6.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,48.21,Percent of Total Billed Charges, ,,85,,58.54,Percent of Total Billed Charges, ,,50,,34.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,46.83,Percent of Total Billed Charges,0,5.39,,,5.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,38.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,41.32,Percent of Total Billed Charges, ,8.29,,,8.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.68,,,6.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.58,,,5.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.63,,,5.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.44,,,5.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.39,,,5.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.44,,,5.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.55,,,5.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.65,,,5.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.78,,,22.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.78,,,22.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.78,,,22.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.78,,,22.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87210 - SMR PRIM SRC WET MOUNT NFCT AGT,87210,HCPCS,,,TL,Outpatient,,,56,14,5.82,47.6,,,34.4,,19.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.45,,,7.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.43,,,10.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.51,,,18.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,36.74,Percent of Total Billed Charges, ,7.45,,,7.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,39.2,Percent of Total Billed Charges, ,,85,,47.6,Percent of Total Billed Charges, ,,50,,28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,38.08,Percent of Total Billed Charges,0,5.82,,,5.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,31.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,33.6,Percent of Total Billed Charges, ,17.9,,,17.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.21,,,7.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.05,,,12.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.16,,,12.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.76,,,11.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.64,,,11.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.76,,,11.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.99,,,11.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.19,,,12.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.12,,,18.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87254 - VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA,87254,HCPCS,,,59,Outpatient,,,67,16.75,19.56,56.95,,,34.4,,23.05,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.04,,,25.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.08,,,35.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.1,,,31.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.95,Percent of Total Billed Charges, ,25.04,,,25.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.9,Percent of Total Billed Charges, ,,85,,56.95,Percent of Total Billed Charges, ,,50,,33.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,45.56,Percent of Total Billed Charges,0,19.56,,,19.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,37.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,40.2,Percent of Total Billed Charges, ,30.07,,,30.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.26,,,24.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.24,,,20.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.44,,,20.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.76,,,19.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.56,,,19.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.76,,,19.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.15,,,20.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.49,,,20.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.76,,,20.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87305 - IAAD IA ASPERGILLUS,87305,HCPCS,,,91,Outpatient,,,102,25.5,11.98,86.7,,,34.4,,35.09,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.5,,,21.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.05,,,19.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,66.91,Percent of Total Billed Charges, ,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,71.4,Percent of Total Billed Charges, ,,85,,86.7,Percent of Total Billed Charges, ,,50,,51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,69.36,Percent of Total Billed Charges,0,11.98,,,11.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,57.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,61.2,Percent of Total Billed Charges, ,18.42,,,18.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.86,,,14.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.4,,,12.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.52,,,12.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.98,,,11.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.34,,,12.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.55,,,12.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.64,,,38.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.64,,,38.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.64,,,38.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.64,,,38.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87305 - IAAD IA ASPERGILLUS,87305,HCPCS,,,59,Outpatient,,,102,25.5,11.98,86.7,,,34.4,,35.09,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.5,,,21.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.05,,,19.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,66.91,Percent of Total Billed Charges, ,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,71.4,Percent of Total Billed Charges, ,,85,,86.7,Percent of Total Billed Charges, ,,50,,51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,69.36,Percent of Total Billed Charges,0,11.98,,,11.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,57.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,61.2,Percent of Total Billed Charges, ,18.42,,,18.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.86,,,14.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.4,,,12.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.52,,,12.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.98,,,11.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.34,,,12.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.55,,,12.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.64,,,38.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.64,,,38.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.64,,,38.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.64,,,38.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87324 - IAAD IA CLOSTRIDIUM DIFFICILE TOXIN,87324,HCPCS,,,91,Outpatient,,,38,9.5,11.98,38.22,,,34.4,,13.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.5,,,21.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.05,,,19.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24.93,Percent of Total Billed Charges, ,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26.6,Percent of Total Billed Charges, ,,85,,32.3,Percent of Total Billed Charges, ,,50,,19,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25.84,Percent of Total Billed Charges,0,11.98,,,11.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,21.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,22.8,Percent of Total Billed Charges, ,18.42,,,18.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.86,,,14.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.4,,,12.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.52,,,12.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.98,,,11.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.34,,,12.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.55,,,12.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87324 - IAAD IA CLOSTRIDIUM DIFFICILE TOXIN,87324,HCPCS,,,59,Outpatient,,,38,9.5,11.98,38.22,,,34.4,,13.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.5,,,21.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.05,,,19.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24.93,Percent of Total Billed Charges, ,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26.6,Percent of Total Billed Charges, ,,85,,32.3,Percent of Total Billed Charges, ,,50,,19,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25.84,Percent of Total Billed Charges,0,11.98,,,11.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,21.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,22.8,Percent of Total Billed Charges, ,18.42,,,18.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.86,,,14.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.4,,,12.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.52,,,12.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.98,,,11.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.34,,,12.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.55,,,12.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87340 - IAAD IA HEPATITIS B SURFACE ANTIGEN,87340,HCPCS,,,GZ,Outpatient,,,35,8.75,10.33,43.81,,,34.4,,12.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.23,,,13.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.52,,,18.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.42,,,16.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,22.96,Percent of Total Billed Charges, ,13.23,,,13.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,24.5,Percent of Total Billed Charges, ,,85,,29.75,Percent of Total Billed Charges, ,,50,,17.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,23.8,Percent of Total Billed Charges,0,10.33,,,10.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,19.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21,Percent of Total Billed Charges, ,15.88,,,15.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.82,,,12.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.69,,,10.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.79,,,10.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.43,,,10.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.33,,,10.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.43,,,10.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.64,,,10.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.82,,,10.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87340 - IAAD IA HEPATITIS B SURFACE ANTIGEN,87340,HCPCS,,,AY,Outpatient,,,35,8.75,10.33,43.81,,,34.4,,12.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.23,,,13.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.52,,,18.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.42,,,16.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,22.96,Percent of Total Billed Charges, ,13.23,,,13.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,24.5,Percent of Total Billed Charges, ,,85,,29.75,Percent of Total Billed Charges, ,,50,,17.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,23.8,Percent of Total Billed Charges,0,10.33,,,10.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,19.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21,Percent of Total Billed Charges, ,15.88,,,15.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.82,,,12.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.69,,,10.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.79,,,10.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.43,,,10.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.33,,,10.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.43,,,10.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.64,,,10.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.82,,,10.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.81,,,43.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87385 - IAAD IA HISTOPLASM CAPSULATUM,87385,HCPCS,,,59,Outpatient,,,67,16.75,13.25,56.95,,,34.4,,23.05,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.97,,,16.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.76,,,23.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.07,,,21.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.95,Percent of Total Billed Charges, ,16.97,,,16.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.9,Percent of Total Billed Charges, ,,85,,56.95,Percent of Total Billed Charges, ,,50,,33.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,45.56,Percent of Total Billed Charges,0,13.25,,,13.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,37.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,40.2,Percent of Total Billed Charges, ,20.37,,,20.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.44,,,16.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.71,,,13.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.85,,,13.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.38,,,13.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.25,,,13.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.38,,,13.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.65,,,13.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.88,,,13.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87389 - IAAD IA HIV-1 AG W-HIV-1 AND HIV-2 ANTBDY SINGLE,87389,HCPCS,,,59,Outpatient,,,81,20.25,24.08,101.34,,,34.4,,27.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.83,,,30.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.19,,,43.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,76.57,,,76.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,53.14,Percent of Total Billed Charges, ,30.83,,,30.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56.7,Percent of Total Billed Charges, ,,85,,68.85,Percent of Total Billed Charges, ,,50,,40.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,55.08,Percent of Total Billed Charges,0,24.08,,,24.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,45.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,48.6,Percent of Total Billed Charges, ,74.05,,,74.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.87,,,29.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,49.85,,,49.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.33,,,50.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.64,,,48.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.16,,,48.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.64,,,48.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.6,,,49.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.45,,,50.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.34,,,101.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,101.34,,,101.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,101.34,,,101.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,101.34,,,101.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87449 - IAAD IA NOT OTHERWISE SPECIFIED EACH ORGANISM,87449,HCPCS,,,59,Outpatient,,,170,42.5,11.98,144.5,,,34.4,,58.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.5,,,21.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38.1,,,38.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,111.52,Percent of Total Billed Charges, ,15.34,,,15.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,119,Percent of Total Billed Charges, ,,85,,144.5,Percent of Total Billed Charges, ,,50,,85,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,115.6,Percent of Total Billed Charges,0,11.98,,,11.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,95.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,102,Percent of Total Billed Charges, ,36.84,,,36.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.86,,,14.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.8,,,24.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.04,,,25.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.2,,,24.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.96,,,23.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.2,,,24.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.68,,,24.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.1,,,25.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87468 - IADNA ANAPLASMA PHAGOCYTOPHILUM AMPLIFED PRB TQ,87468,HCPCS,,,59,Outpatient,,,88,22,30.27,104.22,,,34.4,,30.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,40.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.79,,,55.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.73,Percent of Total Billed Charges, ,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,61.6,Percent of Total Billed Charges, ,,85,,74.8,Percent of Total Billed Charges, ,,50,,44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.84,Percent of Total Billed Charges,0,35.09,,,35.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,49.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.8,Percent of Total Billed Charges, ,53.95,,,53.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.52,,,43.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.67,,,36.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.09,,,35.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.14,,,36.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.76,,,36.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87469 - IADNA BABESIA MICROTI AMPLIFIED PROBE TECHNIQUE,87469,HCPCS,,,59,Outpatient,,,88,22,30.27,104.22,,,34.4,,30.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,40.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.79,,,55.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.73,Percent of Total Billed Charges, ,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,61.6,Percent of Total Billed Charges, ,,85,,74.8,Percent of Total Billed Charges, ,,50,,44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.84,Percent of Total Billed Charges,0,35.09,,,35.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,49.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.8,Percent of Total Billed Charges, ,53.95,,,53.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.52,,,43.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.67,,,36.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.09,,,35.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.14,,,36.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.76,,,36.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87478 - IADNA BORRELIA MIYAMOTOI AMPLIFIED PRB TECHNIQUE,87478,HCPCS,,,59,Outpatient,,,88,22,30.27,104.22,,,34.4,,30.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,40.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.79,,,55.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.73,Percent of Total Billed Charges, ,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,61.6,Percent of Total Billed Charges, ,,85,,74.8,Percent of Total Billed Charges, ,,50,,44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.84,Percent of Total Billed Charges,0,35.09,,,35.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,49.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.8,Percent of Total Billed Charges, ,53.95,,,53.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.52,,,43.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.67,,,36.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.09,,,35.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.14,,,36.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.76,,,36.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87484 - IADNA EHRLICHIA CHAFFEENSIS AMPLIFIED PROBE TQ,87484,HCPCS,,,59,Outpatient,,,88,22,30.27,104.22,,,34.4,,30.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,40.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.79,,,55.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.73,Percent of Total Billed Charges, ,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,61.6,Percent of Total Billed Charges, ,,85,,74.8,Percent of Total Billed Charges, ,,50,,44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.84,Percent of Total Billed Charges,0,35.09,,,35.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,49.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.8,Percent of Total Billed Charges, ,53.95,,,53.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.52,,,43.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.67,,,36.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.09,,,35.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.14,,,36.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.76,,,36.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,104.22,,,104.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87493 - INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE,87493,HCPCS,,,59,Outpatient,,,149,37.25,37.27,154.29,,,34.4,,51.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.72,,,47.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,66.87,,,66.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.26,,,59.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,97.74,Percent of Total Billed Charges, ,47.72,,,47.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,104.3,Percent of Total Billed Charges, ,,85,,126.65,Percent of Total Billed Charges, ,,50,,74.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,101.32,Percent of Total Billed Charges,0,37.27,,,37.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,83.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,89.4,Percent of Total Billed Charges, ,57.3,,,57.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.23,,,46.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38.57,,,38.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.95,,,38.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.64,,,37.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.27,,,37.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.64,,,37.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.39,,,38.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.04,,,39.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.29,,,154.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,154.29,,,154.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,154.29,,,154.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,154.29,,,154.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87497 - IADNA CYTOMEGALOVIRUS QUANTIFICATION,87497,HCPCS,,,59,Outpatient,,,146,36.5,42.84,181.67,,,34.4,,50.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,76.87,,,76.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.12,,,68.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,95.78,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,102.2,Percent of Total Billed Charges, ,,85,,124.1,Percent of Total Billed Charges, ,,50,,73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,99.28,Percent of Total Billed Charges,0,42.84,,,42.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,81.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,87.6,Percent of Total Billed Charges, ,65.87,,,65.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.14,,,53.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.34,,,44.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.77,,,44.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.27,,,43.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.84,,,42.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.27,,,43.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.13,,,44.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.87,,,44.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87498 - IADNA ENTEROVIRUS AMPLIF PROBE AND REVRSE TRNSCRIP,87498,HCPCS,,,59,Outpatient,,,121,30.25,35.09,150.49,,,34.4,,41.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.96,,,62.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.79,,,55.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,79.38,Percent of Total Billed Charges, ,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,84.7,Percent of Total Billed Charges, ,,85,,102.85,Percent of Total Billed Charges, ,,50,,60.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,82.28,Percent of Total Billed Charges,0,35.09,,,35.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,67.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,72.6,Percent of Total Billed Charges, ,53.95,,,53.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.52,,,43.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.67,,,36.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.09,,,35.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.14,,,36.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.76,,,36.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.49,,,150.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,150.49,,,150.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,150.49,,,150.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,150.49,,,150.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87507 - IADNA-DNA-RNA GI PTHGN MULTIPLEX PROBE TQ 12-25,87507,HCPCS,,,GZ,Outpatient,,,1350,337.5,0.01,1684.52,,,34.4,,464.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,747.71,,,747.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,662.68,,,662.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,885.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,945,Percent of Total Billed Charges, ,,85,,1147.5,Percent of Total Billed Charges, ,,50,,675,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,918,Percent of Total Billed Charges,0,416.78,,,416.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,756,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,810,Percent of Total Billed Charges, ,640.8,,,640.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,431.37,,,431.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,435.54,,,435.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,420.95,,,420.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,416.78,,,416.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,420.95,,,420.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,429.28,,,429.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,436.58,,,436.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1684.52,,,1684.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1684.52,,,1684.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1684.52,,,1684.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1684.52,,,1684.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87517 - IADNA HEPATITIS B VIRUS QUANTIFICATION,87517,HCPCS,,,59,Outpatient,,,250,62.5,42.84,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,76.87,,,76.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.12,,,68.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,50,,125,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,170,Percent of Total Billed Charges,0,42.84,,,42.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,65.87,,,65.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.14,,,53.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.34,,,44.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.77,,,44.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.27,,,43.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.84,,,42.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.27,,,43.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.13,,,44.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.87,,,44.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87535 - IADNA HIV-1 AMPLIFIED PROBE AND REVERSE TRANSCRPJ,87535,HCPCS,,,59,Outpatient,,,209,52.25,35.09,177.65,,,34.4,,71.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.96,,,62.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.79,,,55.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,137.1,Percent of Total Billed Charges, ,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,146.3,Percent of Total Billed Charges, ,,85,,177.65,Percent of Total Billed Charges, ,,50,,104.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,142.12,Percent of Total Billed Charges,0,35.09,,,35.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,117.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,125.4,Percent of Total Billed Charges, ,53.95,,,53.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.52,,,43.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.67,,,36.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.09,,,35.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.14,,,36.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.76,,,36.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87556 - IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB,87556,HCPCS,,,59,Outpatient,,,213,53.25,41.68,181.05,,,34.4,,73.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.36,,,53.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,74.77,,,74.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,66.27,,,66.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,139.73,Percent of Total Billed Charges, ,53.36,,,53.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,149.1,Percent of Total Billed Charges, ,,85,,181.05,Percent of Total Billed Charges, ,,50,,106.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,144.84,Percent of Total Billed Charges,0,41.68,,,41.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,119.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,127.8,Percent of Total Billed Charges, ,64.08,,,64.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.7,,,51.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.14,,,43.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.56,,,43.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.1,,,42.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.68,,,41.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.1,,,42.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.93,,,42.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.66,,,43.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87633 - IADNA RESPIRATRY PROBE AND REV TRNSCR 12-25 TARGET,87633,HCPCS,,,GZ,Outpatient,,,1068,267,0.01,1325.36,,,34.4,,367.39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,747.71,,,747.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1325.36,,,1325.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,700.61,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,747.6,Percent of Total Billed Charges, ,,85,,907.8,Percent of Total Billed Charges, ,,50,,534,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,726.24,Percent of Total Billed Charges,0,416.78,,,416.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,598.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,640.8,Percent of Total Billed Charges, ,1281.6,,,1281.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,862.73,,,862.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.07,,,871.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,841.9,,,841.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,833.56,,,833.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,841.9,,,841.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,858.57,,,858.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,873.15,,,873.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87633 - IADNA RESPIRATRY PROBE AND REV TRNSCR 12-25 TARGET,87633,HCPCS,,,91,Outpatient,,,1068,267,0.01,1325.36,,,34.4,,367.39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,747.71,,,747.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1325.36,,,1325.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,700.61,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,747.6,Percent of Total Billed Charges, ,,85,,907.8,Percent of Total Billed Charges, ,,50,,534,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,726.24,Percent of Total Billed Charges,0,416.78,,,416.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,598.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,640.8,Percent of Total Billed Charges, ,1281.6,,,1281.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,862.73,,,862.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.07,,,871.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,841.9,,,841.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,833.56,,,833.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,841.9,,,841.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,858.57,,,858.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,873.15,,,873.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87633 - IADNA RESPIRATRY PROBE AND REV TRNSCR 12-25 TARGET,87633,HCPCS,,,59,Outpatient,,,1068,267,0.01,1325.36,,,34.4,,367.39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,747.71,,,747.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1325.36,,,1325.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,700.61,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,747.6,Percent of Total Billed Charges, ,,85,,907.8,Percent of Total Billed Charges, ,,50,,534,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,726.24,Percent of Total Billed Charges,0,416.78,,,416.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,598.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,640.8,Percent of Total Billed Charges, ,1281.6,,,1281.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,862.73,,,862.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.07,,,871.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,841.9,,,841.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,833.56,,,833.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,841.9,,,841.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,858.57,,,858.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,873.15,,,873.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,719.87,,,719.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87640 - IADNA S AUREUS AMPLIFIED PROBE TQ,87640,HCPCS,,,59,Outpatient,,,156,39,35.09,150.49,,,34.4,,53.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.96,,,62.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.79,,,55.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,102.34,Percent of Total Billed Charges, ,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,109.2,Percent of Total Billed Charges, ,,85,,132.6,Percent of Total Billed Charges, ,,50,,78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,106.08,Percent of Total Billed Charges,0,35.09,,,35.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,87.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,93.6,Percent of Total Billed Charges, ,53.95,,,53.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.52,,,43.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.67,,,36.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.09,,,35.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.44,,,35.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.14,,,36.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.76,,,36.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.49,,,150.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,150.49,,,150.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,150.49,,,150.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,150.49,,,150.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87651 - IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ,87651,HCPCS,,,91,Outpatient,,,119,29.75,35.09,148.86,,,34.4,,40.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.96,,,62.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,111.59,,,111.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,78.06,Percent of Total Billed Charges, ,44.92,,,44.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,83.3,Percent of Total Billed Charges, ,,85,,101.15,Percent of Total Billed Charges, ,,50,,59.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,80.92,Percent of Total Billed Charges,0,35.09,,,35.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,66.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,71.4,Percent of Total Billed Charges, ,107.9,,,107.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.52,,,43.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,72.64,,,72.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.34,,,73.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.88,,,70.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.18,,,70.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.88,,,70.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.29,,,72.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.51,,,73.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.86,,,148.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87799 - IADNA NOS QUANTIFICATION EACH ORGANISM,87799,HCPCS,,,59,Outpatient,,,241.5,60.375,42.84,205.28,,,34.4,,83.08,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,76.87,,,76.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.12,,,68.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,158.42,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,169.05,Percent of Total Billed Charges, ,,85,,205.28,Percent of Total Billed Charges, ,,50,,120.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,164.22,Percent of Total Billed Charges,0,42.84,,,42.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,135.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,144.9,Percent of Total Billed Charges, ,65.87,,,65.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.14,,,53.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.34,,,44.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.77,,,44.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.27,,,43.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.84,,,42.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.27,,,43.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.13,,,44.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.87,,,44.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.67,,,181.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87804 - IAADIADOO INFLUENZA,87804,HCPCS,,,59,Outpatient,,,107,26.75,16.55,90.95,,,34.4,,36.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.19,,,21.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.7,,,29.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.63,,,52.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,70.19,Percent of Total Billed Charges, ,21.19,,,21.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,74.9,Percent of Total Billed Charges, ,,85,,90.95,Percent of Total Billed Charges, ,,50,,53.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,72.76,Percent of Total Billed Charges,0,16.55,,,16.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,59.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,64.2,Percent of Total Billed Charges, ,50.89,,,50.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.53,,,20.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.26,,,34.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.59,,,34.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.43,,,33.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.1,,,33.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.43,,,33.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.09,,,34.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.67,,,34.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.98,,,36.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.98,,,36.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.98,,,36.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.98,,,36.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87899 - IAADIADOO NOT OTHERWISE SPECIFIED,87899,HCPCS,,,59,Outpatient,,,51,12.75,16.07,51.1,,,34.4,,17.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.57,,,20.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.84,,,28.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,51.1,,,51.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,33.46,Percent of Total Billed Charges, ,20.57,,,20.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,35.7,Percent of Total Billed Charges, ,,85,,43.35,Percent of Total Billed Charges, ,,50,,25.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,34.68,Percent of Total Billed Charges,0,16.07,,,16.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,28.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,30.6,Percent of Total Billed Charges, ,49.42,,,49.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.93,,,19.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.26,,,33.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.59,,,33.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.46,,,32.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.14,,,32.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.46,,,32.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.1,,,33.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.67,,,33.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.22,,,38.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
87900 - NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION,87900,HCPCS,,,59,Outpatient,,,448,112,130.35,558.89,,,34.4,,154.11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,166.88,,,166.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.85,,,233.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.26,,,207.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,293.89,Percent of Total Billed Charges, ,166.88,,,166.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,313.6,Percent of Total Billed Charges, ,,85,,380.8,Percent of Total Billed Charges, ,,50,,224,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,304.64,Percent of Total Billed Charges,0,130.35,,,130.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,250.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,268.8,Percent of Total Billed Charges, ,200.41,,,200.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,161.68,,,161.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,134.91,,,134.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,136.22,,,136.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.65,,,131.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.35,,,130.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.65,,,131.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,134.26,,,134.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,136.54,,,136.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,558.89,,,558.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,558.89,,,558.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,558.89,,,558.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,558.89,,,558.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,0306,RC,,,,Outpatient,,,181.39,45.3475,108.83,154.18,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,118.99,Percent of Total Billed Charges, ,,,,,,,,70,,126.97,Percent of Total Billed Charges, ,,85,,154.18,Percent of Total Billed Charges, ,,,,,,,,68,,123.35,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,108.83,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
81001 - URNLS DIP STICK-TABLET REAGENT AUTO MICROSCOPY,81001,HCPCS,,,59,Outpatient,,,40.06,10.015,3.17,34.05,,,34.4,,13.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.05,,,4.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.69,,,5.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.04,,,5.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26.28,Percent of Total Billed Charges, ,4.05,,,4.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28.04,Percent of Total Billed Charges, ,,85,,34.05,Percent of Total Billed Charges, ,,50,,20.03,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,27.24,Percent of Total Billed Charges,0,3.17,,,3.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,22.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,24.04,Percent of Total Billed Charges, ,4.87,,,4.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.93,,,3.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.28,,,3.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.31,,,3.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.2,,,3.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.17,,,3.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.2,,,3.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.27,,,3.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.32,,,3.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.42,,,13.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,13.42,,,13.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,13.42,,,13.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,13.42,,,13.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81003 - URNLS DIP STICK-TABLET RGNT AUTO W-O MICROSCOPY,81003,HCPCS,,,XE,Outpatient,,,54,13.5,2.25,45.9,,,34.4,,18.58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.89,,,2.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.03,,,4.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.16,,,7.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,35.42,Percent of Total Billed Charges, ,2.89,,,2.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.8,Percent of Total Billed Charges, ,,85,,45.9,Percent of Total Billed Charges, ,,50,,27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.72,Percent of Total Billed Charges,0,2.25,,,2.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,30.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,32.4,Percent of Total Billed Charges, ,6.92,,,6.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.8,,,2.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.66,,,4.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.7,,,4.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.5,,,4.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.64,,,4.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.71,,,4.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81003 - URNLS DIP STICK-TABLET RGNT AUTO W-O MICROSCOPY,81003,HCPCS,,,91,Outpatient,,,54,13.5,2.25,45.9,,,34.4,,18.58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.89,,,2.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.03,,,4.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.16,,,7.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,35.42,Percent of Total Billed Charges, ,2.89,,,2.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.8,Percent of Total Billed Charges, ,,85,,45.9,Percent of Total Billed Charges, ,,50,,27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.72,Percent of Total Billed Charges,0,2.25,,,2.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,30.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,32.4,Percent of Total Billed Charges, ,6.92,,,6.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.8,,,2.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.66,,,4.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.7,,,4.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.5,,,4.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.64,,,4.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.71,,,4.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81003 - URNLS DIP STICK-TABLET RGNT AUTO W-O MICROSCOPY,81003,HCPCS,,,59,Outpatient,,,53.82,13.455,2.25,45.75,,,34.4,,18.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.89,,,2.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.03,,,4.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.16,,,7.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,35.31,Percent of Total Billed Charges, ,2.89,,,2.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,37.67,Percent of Total Billed Charges, ,,85,,45.75,Percent of Total Billed Charges, ,,50,,26.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,36.6,Percent of Total Billed Charges,0,2.25,,,2.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,30.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,32.29,Percent of Total Billed Charges, ,6.92,,,6.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.8,,,2.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.66,,,4.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.7,,,4.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.5,,,4.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.55,,,4.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.64,,,4.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.71,,,4.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.5,,,9.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81025 - URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,81025,HCPCS,,,91,Outpatient,,,58,14.5,8.61,49.3,,,34.4,,19.95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.03,,,11.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.46,,,15.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.69,,,13.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,38.05,Percent of Total Billed Charges, ,11.03,,,11.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,40.6,Percent of Total Billed Charges, ,,85,,49.3,Percent of Total Billed Charges, ,,50,,29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,39.44,Percent of Total Billed Charges,0,8.61,,,8.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,32.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,34.8,Percent of Total Billed Charges, ,13.24,,,13.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.68,,,10.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.91,,,8.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9,,,9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.61,,,8.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.87,,,8.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.02,,,9.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.82,,,26.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.82,,,26.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.82,,,26.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,26.82,,,26.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0307 - LABORATORY - UROLOGY,0307,RC,,,,Outpatient,,,47.18,11.795,28.31,40.1,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,30.95,Percent of Total Billed Charges, ,,,,,,,,70,,33.03,Percent of Total Billed Charges, ,,85,,40.1,Percent of Total Billed Charges, ,,,,,,,,68,,32.08,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,28.31,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
81235 - EGFR GENE ANALYSIS COMMON VARIANTS,81235,HCPCS,,,59,Outpatient,,,811,202.75,278.98,883.69,,,34.4,,278.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,415.53,,,415.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,582.3,,,582.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,516.08,,,516.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,532.02,Percent of Total Billed Charges, ,415.53,,,415.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,567.7,Percent of Total Billed Charges, ,,85,,689.35,Percent of Total Billed Charges, ,,50,,405.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,551.48,Percent of Total Billed Charges,0,324.58,,,324.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,454.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,486.6,Percent of Total Billed Charges, ,499.04,,,499.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,402.58,,,402.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.94,,,335.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.19,,,339.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,327.83,,,327.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,324.58,,,324.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,327.83,,,327.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,334.32,,,334.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,340,,,340,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,883.69,,,883.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,883.69,,,883.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,883.69,,,883.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,883.69,,,883.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81240 - F2 GENE ANALYSIS 20210G GREATER THAN A VARIANT,81240,HCPCS,,,GZ,Outpatient,,,160,40,55.04,136,,,34.4,,55.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,84.1,,,84.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,117.85,,,117.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.45,,,104.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,104.96,Percent of Total Billed Charges, ,84.1,,,84.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,112,Percent of Total Billed Charges, ,,85,,136,Percent of Total Billed Charges, ,,50,,80,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,108.8,Percent of Total Billed Charges,0,65.69,,,65.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,89.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,96,Percent of Total Billed Charges, ,101,,,101,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.48,,,81.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.99,,,67.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.65,,,68.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.35,,,66.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.69,,,65.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.35,,,66.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.81,,,68.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.51,,,91.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.51,,,91.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.51,,,91.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.51,,,91.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81240 - F2 GENE ANALYSIS 20210G GREATER THAN A VARIANT,81240,HCPCS,,,59,Outpatient,,,160,40,55.04,136,,,34.4,,55.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,84.1,,,84.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,117.85,,,117.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.45,,,104.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,104.96,Percent of Total Billed Charges, ,84.1,,,84.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,112,Percent of Total Billed Charges, ,,85,,136,Percent of Total Billed Charges, ,,50,,80,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,108.8,Percent of Total Billed Charges,0,65.69,,,65.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,89.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,96,Percent of Total Billed Charges, ,101,,,101,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.48,,,81.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.99,,,67.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.65,,,68.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.35,,,66.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.69,,,65.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.35,,,66.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.81,,,68.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.51,,,91.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.51,,,91.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.51,,,91.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,91.51,,,91.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81241 - F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT,81241,HCPCS,,,GZ,Outpatient,,,184,46,63.3,173.21,,,34.4,,63.3,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.93,,,93.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,131.62,,,131.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,116.66,,,116.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,120.7,Percent of Total Billed Charges, ,93.93,,,93.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,128.8,Percent of Total Billed Charges, ,,85,,156.4,Percent of Total Billed Charges, ,,50,,92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,125.12,Percent of Total Billed Charges,0,73.37,,,73.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,103.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,110.4,Percent of Total Billed Charges, ,112.81,,,112.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91,,,91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,75.94,,,75.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.67,,,76.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.1,,,74.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.37,,,73.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.1,,,74.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.57,,,75.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.86,,,76.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,173.21,,,173.21,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,173.21,,,173.21,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,173.21,,,173.21,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,173.21,,,173.21,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81263 - IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS,81263,HCPCS,,,59,Outpatient,,,727,181.75,250.09,617.95,,,34.4,,250.09,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,377.05,,,377.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,528.37,,,528.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,468.29,,,468.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,476.91,Percent of Total Billed Charges, ,377.05,,,377.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,508.9,Percent of Total Billed Charges, ,,85,,617.95,Percent of Total Billed Charges, ,,50,,363.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,494.36,Percent of Total Billed Charges,0,294.52,,,294.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,407.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,436.2,Percent of Total Billed Charges, ,452.82,,,452.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,365.3,,,365.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,304.83,,,304.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,307.77,,,307.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.47,,,297.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,294.52,,,294.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.47,,,297.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,303.36,,,303.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,308.51,,,308.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,574.34,,,574.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,574.34,,,574.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,574.34,,,574.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,574.34,,,574.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81275 - KRAS GENE ANALYSIS VARIANTS IN EXON 2,81275,HCPCS,,,GZ,Outpatient,,,557,139.25,191.61,695.25,,,34.4,,191.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,247.41,,,247.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,346.68,,,346.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,307.27,,,307.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,365.39,Percent of Total Billed Charges, ,247.41,,,247.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,389.9,Percent of Total Billed Charges, ,,85,,473.45,Percent of Total Billed Charges, ,,50,,278.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,378.76,Percent of Total Billed Charges,0,193.25,,,193.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,311.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,334.2,Percent of Total Billed Charges, ,297.12,,,297.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,239.7,,,239.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.01,,,200.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.95,,,201.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.18,,,195.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.25,,,193.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.18,,,195.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.05,,,199.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.43,,,202.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,695.25,,,695.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,695.25,,,695.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,695.25,,,695.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,695.25,,,695.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81275 - KRAS GENE ANALYSIS VARIANTS IN EXON 2,81275,HCPCS,,,59,Outpatient,,,390,97.5,134.16,695.25,,,34.4,,134.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,247.41,,,247.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,346.68,,,346.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,307.27,,,307.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,255.84,Percent of Total Billed Charges, ,247.41,,,247.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,273,Percent of Total Billed Charges, ,,85,,331.5,Percent of Total Billed Charges, ,,50,,195,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,265.2,Percent of Total Billed Charges,0,193.25,,,193.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,218.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,234,Percent of Total Billed Charges, ,297.12,,,297.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,239.7,,,239.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.01,,,200.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.95,,,201.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.18,,,195.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.25,,,193.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.18,,,195.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.05,,,199.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.43,,,202.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,695.25,,,695.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,695.25,,,695.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,695.25,,,695.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,695.25,,,695.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81276 - KRAS GENE ANALYSIS ADDITIONAL VARIANT(S),81276,HCPCS,,,GZ,Outpatient,,,484,121,166.5,585.65,,,34.4,,166.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,247.41,,,247.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,346.68,,,346.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,307.27,,,307.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,317.5,Percent of Total Billed Charges, ,247.41,,,247.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,338.8,Percent of Total Billed Charges, ,,85,,411.4,Percent of Total Billed Charges, ,,50,,242,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,329.12,Percent of Total Billed Charges,0,193.25,,,193.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,271.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,290.4,Percent of Total Billed Charges, ,297.12,,,297.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,239.7,,,239.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.01,,,200.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.95,,,201.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.18,,,195.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.25,,,193.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.18,,,195.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.05,,,199.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.43,,,202.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,585.65,,,585.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,585.65,,,585.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,585.65,,,585.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,585.65,,,585.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81279 - JAK2 TARGETED SEQUENCE ANALYSIS,81279,HCPCS,,,91,Outpatient,,,463,115.75,0.01,550.04,,,34.4,,159.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,332.25,,,332.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.47,,,294.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,303.73,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,324.1,Percent of Total Billed Charges, ,,85,,393.55,Percent of Total Billed Charges, ,,50,,231.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,314.84,Percent of Total Billed Charges,0,185.2,,,185.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,259.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,277.8,Percent of Total Billed Charges, ,284.75,,,284.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,191.68,,,191.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.53,,,193.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,187.05,,,187.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,185.2,,,185.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,187.05,,,187.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.76,,,190.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194,,,194,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,550.04,,,550.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,550.04,,,550.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,550.04,,,550.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,550.04,,,550.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81376 - HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA,81376,HCPCS,,,59,Outpatient,,,298,74.5,102.51,371.22,,,34.4,,102.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,156.47,,,156.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,219.25,,,219.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,194.33,,,194.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,195.49,Percent of Total Billed Charges, ,156.47,,,156.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,208.6,Percent of Total Billed Charges, ,,85,,253.3,Percent of Total Billed Charges, ,,50,,149,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,202.64,Percent of Total Billed Charges,0,122.22,,,122.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,166.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.8,Percent of Total Billed Charges, ,187.91,,,187.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.59,,,151.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.5,,,126.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.72,,,127.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.44,,,123.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.22,,,122.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.44,,,123.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,125.89,,,125.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.03,,,128.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,371.22,,,371.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.22,,,371.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.22,,,371.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.22,,,371.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81450 - HEMATOLYMPHOID NEO-DO GSAP 5-50DNA-DNAANDRNA ALYS,81450,HCPCS,,,59,Outpatient,,,2172,543,0.01,1846.2,,,34.4,,747.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1362.58,,,1362.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1207.65,,,1207.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1424.83,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1520.4,Percent of Total Billed Charges, ,,85,,1846.2,Percent of Total Billed Charges, ,,50,,1086,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1476.96,Percent of Total Billed Charges,0,759.53,,,759.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1216.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1303.2,Percent of Total Billed Charges, ,1167.78,,,1167.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,786.11,,,786.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,793.71,,,793.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,767.13,,,767.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,759.53,,,759.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,767.13,,,767.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,782.32,,,782.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,795.61,,,795.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81459 - SO NEO GSAP DNA ALYS-DNAANDRNA CPY NMBR MCRSTL INS,81459,HCPCS,,,59,Outpatient,,,8750,2187.5,0.01,7437.5,,,34.4,,3010,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,4068.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5740,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6125,Percent of Total Billed Charges, ,,85,,7437.5,Percent of Total Billed Charges, ,,50,,4375,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5950,Percent of Total Billed Charges,0,,50,,4375,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4900,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5250,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
81596 - NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR,81596,HCPCS,,,GZ,Outpatient,,,276,69,0.01,234.6,,,34.4,,94.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,129.5,,,129.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,114.78,,,114.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,181.06,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,193.2,Percent of Total Billed Charges, ,,85,,234.6,Percent of Total Billed Charges, ,,50,,138,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,187.68,Percent of Total Billed Charges,0,72.19,,,72.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,154.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,165.6,Percent of Total Billed Charges, ,110.99,,,110.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,74.72,,,74.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.44,,,75.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.91,,,72.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.19,,,72.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.91,,,72.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.36,,,74.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.62,,,75.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
88271 - MOLECULAR CYTOGENETICS DNA PROBE EACH,88271,HCPCS,,,59,Outpatient,,,9.17,2.2925,3.15,90.85,,,34.4,,3.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.42,,,27.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38.42,,,38.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.06,,,34.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.02,Percent of Total Billed Charges, ,27.42,,,27.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6.42,Percent of Total Billed Charges, ,,85,,7.79,Percent of Total Billed Charges, ,,50.1,,4.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6.24,Percent of Total Billed Charges,0,21.42,,,21.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56.1,,5.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5.5,Percent of Total Billed Charges, ,32.93,,,32.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.57,,,26.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.17,,,22.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.38,,,22.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.63,,,21.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.42,,,21.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.63,,,21.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.06,,,22.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.44,,,22.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88275 - MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL,88275,HCPCS,,,59,Outpatient,,,43.33,10.8325,14.91,170.33,,,34.4,,14.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,65.54,,,65.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,91.83,,,91.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.39,,,81.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.42,Percent of Total Billed Charges, ,65.54,,,65.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.33,Percent of Total Billed Charges, ,,85,,36.83,Percent of Total Billed Charges, ,,50,,21.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.46,Percent of Total Billed Charges,0,51.19,,,51.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26,Percent of Total Billed Charges, ,78.7,,,78.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.5,,,63.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.98,,,52.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.49,,,53.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.7,,,51.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.19,,,51.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.7,,,51.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.73,,,52.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.62,,,53.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.33,,,170.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.33,,,170.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.33,,,170.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.33,,,170.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88302 - LEVEL II SURG PATHOLOGY GROSSANDMICROSCOPIC EXAM,88302,HCPCS,,,59,Outpatient,,,173,43.25,22.99,147.05,,,34.4,,59.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.88,,,28.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.32,,,45.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,57.97,,,57.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,113.49,Percent of Total Billed Charges, ,28.88,,,28.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,121.1,Percent of Total Billed Charges, ,,85,,147.05,Percent of Total Billed Charges, ,,50,,86.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,117.64,Percent of Total Billed Charges,0,22.99,,,22.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,96.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.8,Percent of Total Billed Charges, ,57.38,,,57.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.98,,,27.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38.63,,,38.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39,,,39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.69,,,37.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.32,,,37.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.69,,,37.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.44,,,38.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.09,,,39.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.01,,,62.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.01,,,62.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.01,,,62.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.01,,,62.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88305 - LEVEL IV SURG PATHOLOGY GROSSANDMICROSCOPIC EXAM,88305,HCPCS,,,91,Outpatient,,,231,57.75,49.47,196.35,,,34.4,,79.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.07,,,62.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,78.91,,,78.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,151.54,Percent of Total Billed Charges, ,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,161.7,Percent of Total Billed Charges, ,,85,,196.35,Percent of Total Billed Charges, ,,50,,115.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.08,Percent of Total Billed Charges,0,49.47,,,49.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,138.6,Percent of Total Billed Charges, ,78.11,,,78.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.21,,,56.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.58,,,52.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.09,,,53.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.8,,,50.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.32,,,52.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.21,,,53.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88305 - LEVEL IV SURG PATHOLOGY GROSSANDMICROSCOPIC EXAM,88305,HCPCS,,,59,Outpatient,,,231,57.75,49.47,196.35,,,34.4,,79.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.07,,,62.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,78.91,,,78.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,151.54,Percent of Total Billed Charges, ,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,161.7,Percent of Total Billed Charges, ,,85,,196.35,Percent of Total Billed Charges, ,,50,,115.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.08,Percent of Total Billed Charges,0,49.47,,,49.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,138.6,Percent of Total Billed Charges, ,78.11,,,78.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.21,,,56.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.58,,,52.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.09,,,53.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.8,,,50.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.32,,,52.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.21,,,53.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88307 - LEVEL V SURG PATHOLOGY GROSSANDMICROSCOPIC EXAM,88307,HCPCS,,,59,Outpatient,,,598,149.5,157.41,531.25,,,34.4,,205.71,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,373.73,,,373.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,531.25,,,531.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,392.29,Percent of Total Billed Charges, ,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,418.6,Percent of Total Billed Charges, ,,85,,508.3,Percent of Total Billed Charges, ,,50,,299,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,406.64,Percent of Total Billed Charges,0,283.41,,,283.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,334.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,358.8,Percent of Total Billed Charges, ,525.83,,,525.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.42,,,363.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,353.97,,,353.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,357.39,,,357.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342,,,342,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,352.26,,,352.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.25,,,358.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.41,,,157.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,157.41,,,157.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,157.41,,,157.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,157.41,,,157.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88309 - LEVEL VI SURG PATHOLOGY GROSSANDMICROSCOPIC EXAM,88309,HCPCS,,,59,Outpatient,,,1004,251,136.62,1206.44,,,34.4,,345.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,898.7,,,898.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,532.68,,,532.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1206.44,,,1206.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,658.62,Percent of Total Billed Charges, ,898.7,,,898.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,702.8,Percent of Total Billed Charges, ,,85,,853.4,Percent of Total Billed Charges, ,,50,,502,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,682.72,Percent of Total Billed Charges,0,628.2,,,628.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,562.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,602.4,Percent of Total Billed Charges, ,1194.11,,,1194.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,870.69,,,870.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,803.84,,,803.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,811.61,,,811.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.43,,,784.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,776.66,,,776.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.43,,,784.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,799.96,,,799.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,813.55,,,813.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,136.62,,,136.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,136.62,,,136.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,136.62,,,136.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,136.62,,,136.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88312 - SPECIAL STAIN GROUP 1 MICROORGANISMS IANDR,88312,HCPCS,,,59,Outpatient,,,225,56.25,38.61,191.25,,,34.4,,77.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,158.31,,,158.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,78.91,,,78.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,147.6,Percent of Total Billed Charges, ,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,157.5,Percent of Total Billed Charges, ,,85,,191.25,Percent of Total Billed Charges, ,,50,,112.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,153,Percent of Total Billed Charges,0,49.47,,,49.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,126,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,135,Percent of Total Billed Charges, ,78.11,,,78.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.21,,,56.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.58,,,52.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.09,,,53.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.8,,,50.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.32,,,52.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.21,,,53.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88329 - PATHOLOGY CONSULTATION DURING SURGERY,88329,HCPCS,,,59,Outpatient,,,113,28.25,33.43,96.05,,,34.4,,38.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.31,,,39.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.95,,,63.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,74.13,Percent of Total Billed Charges, ,39.31,,,39.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,79.1,Percent of Total Billed Charges, ,,85,,96.05,Percent of Total Billed Charges, ,,50,,56.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,76.84,Percent of Total Billed Charges,0,33.43,,,33.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,63.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,67.8,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.08,,,38.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
88331 - PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1ST SPEC,88331,HCPCS,,,59,Outpatient,,,279,69.75,74.49,253.08,,,34.4,,95.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,74.49,,,74.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,183.02,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,195.3,Percent of Total Billed Charges, ,,85,,237.15,Percent of Total Billed Charges, ,,50,,139.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,189.72,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,156.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,167.4,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
88333 - PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,88333,HCPCS,,,59,Outpatient,,,1334,333.5,57.92,1206.44,,,34.4,,458.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,898.7,,,898.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.98,,,58.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1206.44,,,1206.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,875.1,Percent of Total Billed Charges, ,898.7,,,898.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,933.8,Percent of Total Billed Charges, ,,85,,1133.9,Percent of Total Billed Charges, ,,50,,667,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,907.12,Percent of Total Billed Charges,0,628.2,,,628.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,747.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,800.4,Percent of Total Billed Charges, ,1194.11,,,1194.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,870.69,,,870.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,803.84,,,803.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,811.61,,,811.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.43,,,784.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,776.66,,,776.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.43,,,784.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,799.96,,,799.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,813.55,,,813.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.92,,,57.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.92,,,57.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.92,,,57.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,57.92,,,57.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88341 - IMHCHEM-IMCYTCHM EA ADDL SINGLE ANTB STAIN PX,88341,HCPCS,,,XU,Outpatient,,,212,53,0.01,180.2,,,34.4,,72.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.88,,,63.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,110.51,,,110.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,139.07,Percent of Total Billed Charges, ,63.88,,,63.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,148.4,Percent of Total Billed Charges, ,,85,,180.2,Percent of Total Billed Charges, ,,50,,106,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,144.16,Percent of Total Billed Charges,0,64.6,,,64.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,118.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,127.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.89,,,61.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88341 - IMHCHEM-IMCYTCHM EA ADDL SINGLE ANTB STAIN PX,88341,HCPCS,,,91,Outpatient,,,212,53,0.01,180.2,,,34.4,,72.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.88,,,63.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,110.51,,,110.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,139.07,Percent of Total Billed Charges, ,63.88,,,63.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,148.4,Percent of Total Billed Charges, ,,85,,180.2,Percent of Total Billed Charges, ,,50,,106,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,144.16,Percent of Total Billed Charges,0,64.6,,,64.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,118.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,127.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.89,,,61.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88341 - IMHCHEM-IMCYTCHM EA ADDL SINGLE ANTB STAIN PX,88341,HCPCS,,,59,Outpatient,,,211.42,52.855,0.01,179.71,,,34.4,,72.73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.88,,,63.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,110.51,,,110.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,138.69,Percent of Total Billed Charges, ,63.88,,,63.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,147.99,Percent of Total Billed Charges, ,,85,,179.71,Percent of Total Billed Charges, ,,50,,105.71,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,143.77,Percent of Total Billed Charges,0,64.6,,,64.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,118.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,126.85,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.89,,,61.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,119.57,,,119.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88342 - IMHCHEM-IMCYTCHM 1ST SINGLE ANTB STAIN PROCEDURE,88342,HCPCS,,,XU,Outpatient,,,337,84.25,115.93,286.45,,,34.4,,115.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,121.69,,,121.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,221.07,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,235.9,Percent of Total Billed Charges, ,,85,,286.45,Percent of Total Billed Charges, ,,50,,168.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,229.16,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,188.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,202.2,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88342 - IMHCHEM-IMCYTCHM 1ST SINGLE ANTB STAIN PROCEDURE,88342,HCPCS,,,91,Outpatient,,,337,84.25,115.93,286.45,,,34.4,,115.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,121.69,,,121.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,221.07,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,235.9,Percent of Total Billed Charges, ,,85,,286.45,Percent of Total Billed Charges, ,,50,,168.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,229.16,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,188.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,202.2,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88342 - IMHCHEM-IMCYTCHM 1ST SINGLE ANTB STAIN PROCEDURE,88342,HCPCS,,,59,Outpatient,,,336.26,84.065,115.67,285.82,,,34.4,,115.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,121.69,,,121.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,220.59,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,235.38,Percent of Total Billed Charges, ,,85,,285.82,Percent of Total Billed Charges, ,,50,,168.13,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,228.66,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,188.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,201.76,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.61,,,117.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88360 - M-PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,88360,HCPCS,,,XU,Outpatient,,,329,82.25,113.18,279.65,,,34.4,,113.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,145.29,,,145.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,215.82,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,230.3,Percent of Total Billed Charges, ,,85,,279.65,Percent of Total Billed Charges, ,,50,,164.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,223.72,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,184.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,197.4,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.25,,,177.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,177.25,,,177.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,177.25,,,177.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,177.25,,,177.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88360 - M-PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,88360,HCPCS,,,59,Outpatient,,,368.81,92.2025,126.87,313.49,,,34.4,,126.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,145.29,,,145.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,241.94,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,258.17,Percent of Total Billed Charges, ,,85,,313.49,Percent of Total Billed Charges, ,,50,,184.41,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,250.79,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,206.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,221.29,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.25,,,177.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,177.25,,,177.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,177.25,,,177.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,177.25,,,177.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88361 - M-PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,88361,HCPCS,,,59,Outpatient,,,446,111.5,140.93,531.25,,,34.4,,153.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,140.93,,,140.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,531.25,,,531.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,292.58,Percent of Total Billed Charges, ,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,312.2,Percent of Total Billed Charges, ,,85,,379.1,Percent of Total Billed Charges, ,,50,,223,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,303.28,Percent of Total Billed Charges,0,283.41,,,283.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,249.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,267.6,Percent of Total Billed Charges, ,525.83,,,525.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.42,,,363.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,353.97,,,353.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,357.39,,,357.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342,,,342,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,352.26,,,352.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.25,,,358.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,250.61,,,250.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,250.61,,,250.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,250.61,,,250.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,250.61,,,250.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88367 - M-PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN,88367,HCPCS,,,59,Outpatient,,,462.05,115.5125,145.89,531.25,,,34.4,,158.95,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,145.89,,,145.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,531.25,,,531.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,303.1,Percent of Total Billed Charges, ,375.12,,,375.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,323.44,Percent of Total Billed Charges, ,,85,,392.74,Percent of Total Billed Charges, ,,50,,231.03,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,314.19,Percent of Total Billed Charges,0,283.41,,,283.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,258.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,277.23,Percent of Total Billed Charges, ,525.83,,,525.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.42,,,363.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,353.97,,,353.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,357.39,,,357.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342,,,342,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,345.42,,,345.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,352.26,,,352.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.25,,,358.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,502.67,,,502.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,502.67,,,502.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,502.67,,,502.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,502.67,,,502.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88373 - M-PHMTRC ALYS ISH QUANT-SEMIQ CPTR PER SPEC EACH,88373,HCPCS,,,59,Outpatient,,,175.21,43.8025,0.01,148.93,,,34.4,,60.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.16,,,50.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,80.1,,,80.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,114.94,Percent of Total Billed Charges, ,50.16,,,50.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,122.65,Percent of Total Billed Charges, ,,85,,148.93,Percent of Total Billed Charges, ,,50,,87.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,119.14,Percent of Total Billed Charges,0,47.28,,,47.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,98.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,105.13,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.6,,,48.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.64,,,102.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,102.64,,,102.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,102.64,,,102.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,102.64,,,102.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88374 - M-PHMTRC ALYS ISH QUANT-SEMIQ CPTR EACH MULTIPRB,88374,HCPCS,,,59,Outpatient,,,738.85,184.7125,143.5,628.02,,,34.4,,254.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,517.78,,,517.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,484.69,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,517.2,Percent of Total Billed Charges, ,,85,,628.02,Percent of Total Billed Charges, ,,50,,369.43,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,502.42,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,413.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,443.31,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,420.76,,,420.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,420.76,,,420.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,420.76,,,420.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,420.76,,,420.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88377 - M-PHMTRC ALYS ISH QUANT-SEMIQ MNL EACH MULTIPRB,88377,HCPCS,,,59,Outpatient,,,874,218.5,143.5,742.9,,,34.4,,300.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,624.56,,,624.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,573.34,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,611.8,Percent of Total Billed Charges, ,,85,,742.9,Percent of Total Billed Charges, ,,50,,437,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,594.32,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,489.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,524.4,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.59,,,391.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,391.59,,,391.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,391.59,,,391.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,391.59,,,391.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88381 - MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,88381,HCPCS,,,59,Outpatient,,,367,91.75,0.01,395.6,,,34.4,,126.25,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,154.81,,,154.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,340.83,,,340.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,240.75,Percent of Total Billed Charges, ,154.81,,,154.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,256.9,Percent of Total Billed Charges, ,,85,,311.95,Percent of Total Billed Charges, ,,50,,183.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,249.56,Percent of Total Billed Charges,0,156.99,,,156.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,205.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,220.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,149.98,,,149.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,395.6,,,395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,395.6,,,395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,395.6,,,395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,395.6,,,395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0310 - LABORATORY PATHOLOGY - GENERAL CLASSIFICATION,0310,RC,,,,Outpatient,,,382.29,95.5725,229.37,324.95,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,250.78,Percent of Total Billed Charges, ,,,,,,,,70,,267.6,Percent of Total Billed Charges, ,,85,,324.95,Percent of Total Billed Charges, ,,,,,,,,68,,259.96,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,229.37,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
88112 - CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C-V,88112,HCPCS,,,59,Outpatient,,,512,128,49.47,435.2,,,34.4,,176.13,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,71.4,,,71.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,78.91,,,78.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,335.87,Percent of Total Billed Charges, ,58.01,,,58.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,358.4,Percent of Total Billed Charges, ,,85,,435.2,Percent of Total Billed Charges, ,,50,,256,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,348.16,Percent of Total Billed Charges,0,49.47,,,49.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,286.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,307.2,Percent of Total Billed Charges, ,78.11,,,78.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.21,,,56.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.58,,,52.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.09,,,53.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.8,,,50.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.31,,,51.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.32,,,52.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.21,,,53.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,165.96,,,165.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,165.96,,,165.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,165.96,,,165.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,165.96,,,165.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88141 - CYTP CERVICAL-VAGINAL REQ INTERP PHYSICIAN,88141,HCPCS,,,91,Outpatient,,,101,25.25,0.01,85.85,,,34.4,,34.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.35,,,40.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,66.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70.7,Percent of Total Billed Charges, ,,85,,85.85,Percent of Total Billed Charges, ,,50,,50.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68.68,Percent of Total Billed Charges,0,26.35,,,26.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
88141 - CYTP CERVICAL-VAGINAL REQ INTERP PHYSICIAN,88141,HCPCS,,,59,Outpatient,,,101,25.25,0.01,85.85,,,34.4,,34.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.35,,,40.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,66.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70.7,Percent of Total Billed Charges, ,,85,,85.85,Percent of Total Billed Charges, ,,50,,50.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68.68,Percent of Total Billed Charges,0,26.35,,,26.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,56.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
88172 - CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,88172,HCPCS,,,59,Outpatient,,,303,75.75,35.38,257.55,,,34.4,,104.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.38,,,35.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.08,,,253.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,198.77,Percent of Total Billed Charges, ,181.99,,,181.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,212.1,Percent of Total Billed Charges, ,,85,,257.55,Percent of Total Billed Charges, ,,50,,151.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,206.04,Percent of Total Billed Charges,0,143.5,,,143.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,169.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,181.8,Percent of Total Billed Charges, ,250.49,,,250.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.32,,,176.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,168.62,,,168.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.25,,,170.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.92,,,162.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,164.55,,,164.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.81,,,167.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.66,,,170.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.08,,,157.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,157.08,,,157.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,157.08,,,157.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,157.08,,,157.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88261 - CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING,88261,HCPCS,,,59,Outpatient,,,915,228.75,264.34,777.75,,,34.4,,314.76,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,338.42,,,338.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,474.22,,,474.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,420.3,,,420.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,600.24,Percent of Total Billed Charges, ,338.42,,,338.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,640.5,Percent of Total Billed Charges, ,,85,,777.75,Percent of Total Billed Charges, ,,50,,457.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,622.2,Percent of Total Billed Charges,0,264.34,,,264.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,512.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,549,Percent of Total Billed Charges, ,406.42,,,406.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,327.87,,,327.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,273.59,,,273.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,276.24,,,276.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,266.98,,,266.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.34,,,264.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,266.98,,,266.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,272.27,,,272.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,276.9,,,276.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,749.57,,,749.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,749.57,,,749.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,749.57,,,749.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,749.57,,,749.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88271 - MOLECULAR CYTOGENETICS DNA PROBE EACH,88271,HCPCS,,,59,Outpatient,,,250,62.5,21.42,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.42,,,27.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38.42,,,38.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.06,,,34.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,27.42,,,27.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,50,,125,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,170,Percent of Total Billed Charges,0,21.42,,,21.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,32.93,,,32.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.57,,,26.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.17,,,22.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.38,,,22.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.63,,,21.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.42,,,21.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.63,,,21.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.06,,,22.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.44,,,22.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
88275 - MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL,88275,HCPCS,,,59,Outpatient,,,384,96,51.19,326.4,,,34.4,,132.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,65.54,,,65.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,91.83,,,91.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.39,,,81.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,251.9,Percent of Total Billed Charges, ,65.54,,,65.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,268.8,Percent of Total Billed Charges, ,,85,,326.4,Percent of Total Billed Charges, ,,50,,192,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,261.12,Percent of Total Billed Charges,0,51.19,,,51.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,215.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,230.4,Percent of Total Billed Charges, ,78.7,,,78.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.5,,,63.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.98,,,52.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.49,,,53.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.7,,,51.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.19,,,51.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.7,,,51.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.73,,,52.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.62,,,53.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.33,,,170.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.33,,,170.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.33,,,170.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.33,,,170.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0311 - LABORATORY PATHOLOGY - CYTOLOGY,0311,RC,,,,Outpatient,,,339.22,84.805,203.53,288.34,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,222.53,Percent of Total Billed Charges, ,,,,,,,,70,,237.45,Percent of Total Billed Charges, ,,85,,288.34,Percent of Total Billed Charges, ,,,,,,,,68,,230.67,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,203.53,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
23350 - INJECTION SHOULDER ARTHROGRAPHY- CT-MRI ARTHG,23350,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23350 - INJECTION SHOULDER ARTHROGRAPHY- CT-MRI ARTHG,23350,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23350 - INJECTION SHOULDER ARTHROGRAPHY- CT-MRI ARTHG,23350,HCPCS,,,50,Outpatient,,,1450,362.5,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,951.2,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1015,Percent of Total Billed Charges, ,,85,,1232.5,Percent of Total Billed Charges, ,,50,,725,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,986,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,812,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,870,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49465 - CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE,49465,HCPCS,,,XU,Outpatient,,,775,193.75,229.81,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,378.81,,,378.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,378.81,,,378.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,366.94,,,366.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49465 - CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE,49465,HCPCS,,,XP,Outpatient,,,775,193.75,229.81,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,378.81,,,378.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,378.81,,,378.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,366.94,,,366.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49465 - CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE,49465,HCPCS,,,FY,Outpatient,,,775,193.75,229.81,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,378.81,,,378.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,378.81,,,378.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,366.94,,,366.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58340 - CATH AND SALINE-CONTRAST SONOHYSTER-HYSTEROSALPI,58340,HCPCS,,,52,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62302 - MYELOGRAPHY VIA LUMBAR INJECTION RSANDI CERVICAL,62302,HCPCS,,,52,Outpatient,,,6355,1588.75,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1201.63,,,1201.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4168.88,Percent of Total Billed Charges, ,1201.63,,,1201.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4448.5,Percent of Total Billed Charges, ,,85,,5401.75,Percent of Total Billed Charges, ,,50,,3177.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4321.4,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3558.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3813,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1163.96,,,1163.96,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62304 - MYELOGRAPHY VIA LUMBAR INJECT RSANDI LUMBOSACRAL,62304,HCPCS,,,74,Outpatient,,,6361,1590.25,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1201.63,,,1201.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4172.82,Percent of Total Billed Charges, ,1201.63,,,1201.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4452.7,Percent of Total Billed Charges, ,,85,,5406.85,Percent of Total Billed Charges, ,,50,,3180.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4325.48,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3562.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3816.6,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1163.96,,,1163.96,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62304 - MYELOGRAPHY VIA LUMBAR INJECT RSANDI LUMBOSACRAL,62304,HCPCS,,,52,Outpatient,,,6349,1587.25,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1201.63,,,1201.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.94,Percent of Total Billed Charges, ,1201.63,,,1201.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4444.3,Percent of Total Billed Charges, ,,85,,5396.65,Percent of Total Billed Charges, ,,50,,3174.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4317.32,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3555.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3809.4,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1163.96,,,1163.96,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70100 - RADIOLOGIC EXAMINATION MANDIPLE PRTL LESS THAN 4 VIEWS,70100,HCPCS,,,FY,Outpatient,,,164,41,47.52,139.4,,,34.4,,56.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,107.58,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.8,Percent of Total Billed Charges, ,,85,,139.4,Percent of Total Billed Charges, ,,50,,82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,111.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,91.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,98.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70110 - RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,70110,HCPCS,,,FY,Outpatient,,,387,96.75,77.22,328.95,,,34.4,,133.13,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,253.87,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,270.9,Percent of Total Billed Charges, ,,85,,328.95,Percent of Total Billed Charges, ,,50,,193.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,263.16,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,216.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,232.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70140 - RADEX FACIAL BONES LESS THAN 3 VIEWS,70140,HCPCS,,,PO,Outpatient,,,164,41,56.42,139.4,,,34.4,,56.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,107.58,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.8,Percent of Total Billed Charges, ,,85,,139.4,Percent of Total Billed Charges, ,,50,,82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,111.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,91.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,98.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70150 - RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,70150,HCPCS,,,FY,Outpatient,,,297,74.25,53.46,252.45,,,34.4,,102.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.83,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.9,Percent of Total Billed Charges, ,,85,,252.45,Percent of Total Billed Charges, ,,50,,148.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.96,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,166.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,70160,HCPCS,,,FY,Outpatient,,,297,74.25,68.31,252.45,,,34.4,,102.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.83,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.9,Percent of Total Billed Charges, ,,85,,252.45,Percent of Total Billed Charges, ,,50,,148.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,166.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70200 - RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,70200,HCPCS,,,FY,Outpatient,,,387,96.75,41.58,328.95,,,34.4,,133.13,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,253.87,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,270.9,Percent of Total Billed Charges, ,,85,,328.95,Percent of Total Billed Charges, ,,50,,193.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,263.16,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,216.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,232.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70210 - RADEX SINUSES PARANASAL LESS THAN 3 VIEWS,70210,HCPCS,,,PO,Outpatient,,,252,63,41.58,214.2,,,34.4,,86.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,165.31,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,176.4,Percent of Total Billed Charges, ,,85,,214.2,Percent of Total Billed Charges, ,,50,,126,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,171.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,141.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,151.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70220 - RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,70220,HCPCS,,,PO,Outpatient,,,297,74.25,83.36,252.45,,,34.4,,102.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.83,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.9,Percent of Total Billed Charges, ,,85,,252.45,Percent of Total Billed Charges, ,,50,,148.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,166.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70220 - RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,70220,HCPCS,,,FY,Outpatient,,,297,74.25,83.36,252.45,,,34.4,,102.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.83,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.9,Percent of Total Billed Charges, ,,85,,252.45,Percent of Total Billed Charges, ,,50,,148.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,166.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70250 - RADIOLOGIC EXAMINATION SKULL 4LESS THAN VIEWS,70250,HCPCS,,,PO,Outpatient,,,375,93.75,65.34,318.75,,,34.4,,129,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,246,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,262.5,Percent of Total Billed Charges, ,,85,,318.75,Percent of Total Billed Charges, ,,50,,187.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,255,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,210,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,225,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70250 - RADIOLOGIC EXAMINATION SKULL 4LESS THAN VIEWS,70250,HCPCS,,,FY,Outpatient,,,375,93.75,65.34,318.75,,,34.4,,129,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,246,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,262.5,Percent of Total Billed Charges, ,,85,,318.75,Percent of Total Billed Charges, ,,50,,187.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,255,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,210,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,225,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70330 - RADEX TEMPOROMANDBLE JT OPN AND CLSD MOUTH BILAT,70330,HCPCS,,,50,Outpatient,,,246,61.5,65.34,209.1,,,34.4,,84.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,161.38,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,172.2,Percent of Total Billed Charges, ,,85,,209.1,Percent of Total Billed Charges, ,,50,,123,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,167.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,137.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,147.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70360 - RADIOLOGIC EXAMINATION NECK SOFT TISSUE,70360,HCPCS,,,PO,Outpatient,,,168,42,29.7,142.8,,,34.4,,57.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,110.21,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,117.6,Percent of Total Billed Charges, ,,85,,142.8,Percent of Total Billed Charges, ,,50,,84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,114.24,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,94.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,100.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.7,,,29.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.7,,,29.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.7,,,29.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.7,,,29.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70360 - RADIOLOGIC EXAMINATION NECK SOFT TISSUE,70360,HCPCS,,,FY,Outpatient,,,168,42,29.7,142.8,,,34.4,,57.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,110.21,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,117.6,Percent of Total Billed Charges, ,,85,,142.8,Percent of Total Billed Charges, ,,50,,84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,114.24,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,94.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,100.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.7,,,29.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.7,,,29.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.7,,,29.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,29.7,,,29.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71100 - RADEX RIBS UNILATERAL 2 VIEWS,71100,HCPCS,,,RT,Outpatient,,,297,74.25,50.49,252.45,,,34.4,,102.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.83,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.9,Percent of Total Billed Charges, ,,85,,252.45,Percent of Total Billed Charges, ,,50,,148.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,166.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71100 - RADEX RIBS UNILATERAL 2 VIEWS,71100,HCPCS,,,LT,Outpatient,,,297,74.25,50.49,252.45,,,34.4,,102.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.83,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.9,Percent of Total Billed Charges, ,,85,,252.45,Percent of Total Billed Charges, ,,50,,148.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,166.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71101 - RADEX RIBS UNI W-POSTEROANT CH MINIMUM 3 VIEWS,71101,HCPCS,,,RT,Outpatient,,,313,78.25,50.49,266.05,,,34.4,,107.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,205.33,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,219.1,Percent of Total Billed Charges, ,,85,,266.05,Percent of Total Billed Charges, ,,50,,156.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,212.84,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,175.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,187.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71101 - RADEX RIBS UNI W-POSTEROANT CH MINIMUM 3 VIEWS,71101,HCPCS,,,LT,Outpatient,,,313,78.25,50.49,266.05,,,34.4,,107.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,205.33,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,219.1,Percent of Total Billed Charges, ,,85,,266.05,Percent of Total Billed Charges, ,,50,,156.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,212.84,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,175.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,187.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71101 - RADEX RIBS UNI W-POSTEROANT CH MINIMUM 3 VIEWS,71101,HCPCS,,,FY,Outpatient,,,313,78.25,50.49,266.05,,,34.4,,107.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,205.33,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,219.1,Percent of Total Billed Charges, ,,85,,266.05,Percent of Total Billed Charges, ,,50,,156.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,212.84,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,175.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,187.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71101 - RADEX RIBS UNI W-POSTEROANT CH MINIMUM 3 VIEWS,71101,HCPCS,,,76,Outpatient,,,313,78.25,50.49,266.05,,,34.4,,107.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,205.33,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,219.1,Percent of Total Billed Charges, ,,85,,266.05,Percent of Total Billed Charges, ,,50,,156.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,212.84,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,175.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,187.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71110 - RADEX RIBS BILATERAL 3 VIEWS,71110,HCPCS,,,FY,Outpatient,,,338,84.5,74.25,287.3,,,34.4,,116.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,221.73,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,236.6,Percent of Total Billed Charges, ,,85,,287.3,Percent of Total Billed Charges, ,,50,,169,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,229.84,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,189.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,202.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71110 - RADEX RIBS BILATERAL 3 VIEWS,71110,HCPCS,,,50,Outpatient,,,338,84.5,74.25,287.3,,,34.4,,116.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,221.73,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,236.6,Percent of Total Billed Charges, ,,85,,287.3,Percent of Total Billed Charges, ,,50,,169,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,229.84,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,189.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,202.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71111 - RADEX RIBS BI W-POSTEROANT CH MINIMUM 4 VIEWS,71111,HCPCS,,,PO,Outpatient,,,345,86.25,95.04,293.25,,,34.4,,118.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,226.32,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,241.5,Percent of Total Billed Charges, ,,85,,293.25,Percent of Total Billed Charges, ,,50,,172.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,234.6,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,193.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,207,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71111 - RADEX RIBS BI W-POSTEROANT CH MINIMUM 4 VIEWS,71111,HCPCS,,,FY,Outpatient,,,345,86.25,95.04,293.25,,,34.4,,118.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,226.32,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,241.5,Percent of Total Billed Charges, ,,85,,293.25,Percent of Total Billed Charges, ,,50,,172.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,234.6,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,193.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,207,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71120 - RADEX STERNUM MINIMUM 2 VIEWS,71120,HCPCS,,,52,Outpatient,,,297,74.25,41.58,252.45,,,34.4,,102.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.83,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.9,Percent of Total Billed Charges, ,,85,,252.45,Percent of Total Billed Charges, ,,50,,148.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,166.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72020 - RADEX SPINE 1 VIEW SPECIFY LEVEL,72020,HCPCS,,,FY,Outpatient,,,281,70.25,83.16,238.85,,,34.4,,96.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,184.34,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,196.7,Percent of Total Billed Charges, ,,85,,238.85,Percent of Total Billed Charges, ,,50,,140.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,191.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,157.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,168.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72040 - RADEX SPINE CERVICAL 2 OR 3 VIEWS,72040,HCPCS,,,XU,Outpatient,,,344,86,83.16,292.4,,,34.4,,118.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,225.66,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,240.8,Percent of Total Billed Charges, ,,85,,292.4,Percent of Total Billed Charges, ,,50,,172,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,233.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,192.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,206.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72040 - RADEX SPINE CERVICAL 2 OR 3 VIEWS,72040,HCPCS,,,PO,Outpatient,,,344,86,83.16,292.4,,,34.4,,118.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,225.66,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,240.8,Percent of Total Billed Charges, ,,85,,292.4,Percent of Total Billed Charges, ,,50,,172,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,233.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,192.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,206.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72040 - RADEX SPINE CERVICAL 2 OR 3 VIEWS,72040,HCPCS,,,FY,Outpatient,,,344,86,83.16,292.4,,,34.4,,118.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,225.66,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,240.8,Percent of Total Billed Charges, ,,85,,292.4,Percent of Total Billed Charges, ,,50,,172,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,233.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,192.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,206.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72050 - RADEX SPINE CERVICAL 4 OR 5 VIEWS,72050,HCPCS,,,PO,Outpatient,,,364,91,95.04,309.4,,,34.4,,125.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72050 - RADEX SPINE CERVICAL 4 OR 5 VIEWS,72050,HCPCS,,,FY,Outpatient,,,364,91,95.04,309.4,,,34.4,,125.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72070 - RADEX SPINE THORACIC 2 VIEWS,72070,HCPCS,,,PO,Outpatient,,,278,69.5,71.28,236.3,,,34.4,,95.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,182.37,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,194.6,Percent of Total Billed Charges, ,,85,,236.3,Percent of Total Billed Charges, ,,50,,139,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,189.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,155.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,166.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72070 - RADEX SPINE THORACIC 2 VIEWS,72070,HCPCS,,,FY,Outpatient,,,278,69.5,71.28,236.3,,,34.4,,95.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,182.37,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,194.6,Percent of Total Billed Charges, ,,85,,236.3,Percent of Total Billed Charges, ,,50,,139,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,189.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,155.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,166.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72072 - RADEX SPINE THORACIC 3 VIEWS,72072,HCPCS,,,FY,Outpatient,,,354,88.5,83.16,300.9,,,34.4,,121.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,232.22,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,247.8,Percent of Total Billed Charges, ,,85,,300.9,Percent of Total Billed Charges, ,,50,,177,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,240.72,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,198.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,212.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72074 - RADEX SPINE THORACIC MINIMUM 4 VIEWS,72074,HCPCS,,,FY,Outpatient,,,366,91.5,95.04,311.1,,,34.4,,125.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,240.1,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,256.2,Percent of Total Billed Charges, ,,85,,311.1,Percent of Total Billed Charges, ,,50,,183,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,248.88,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,204.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,219.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72080 - RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS,72080,HCPCS,,,XU,Outpatient,,,292,73,77.22,248.2,,,34.4,,100.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,191.55,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,204.4,Percent of Total Billed Charges, ,,85,,248.2,Percent of Total Billed Charges, ,,50,,146,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.56,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,163.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,175.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72080 - RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS,72080,HCPCS,,,PO,Outpatient,,,292,73,77.22,248.2,,,34.4,,100.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,191.55,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,204.4,Percent of Total Billed Charges, ,,85,,248.2,Percent of Total Billed Charges, ,,50,,146,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.56,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,163.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,175.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72080 - RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS,72080,HCPCS,,,FY,Outpatient,,,292,73,77.22,248.2,,,34.4,,100.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,191.55,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,204.4,Percent of Total Billed Charges, ,,85,,248.2,Percent of Total Billed Charges, ,,50,,146,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.56,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,163.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,175.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72082 - RADEX ENTIR THRC LMBR CRV SAC SPI W-SKULL 2-3 VW,72082,HCPCS,,,FY,Outpatient,,,209,52.25,71.9,177.65,,,34.4,,71.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,137.1,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,146.3,Percent of Total Billed Charges, ,,85,,177.65,Percent of Total Billed Charges, ,,50,,104.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,142.12,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,117.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,125.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.23,,,127.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,127.23,,,127.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,127.23,,,127.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,127.23,,,127.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72100 - RADEX SPINE LUMBOSACRAL 2-3 VIEWS,72100,HCPCS,,,PO,Outpatient,,,397,99.25,83.16,337.45,,,34.4,,136.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,260.43,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,277.9,Percent of Total Billed Charges, ,,85,,337.45,Percent of Total Billed Charges, ,,50,,198.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,269.96,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,222.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,238.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72100 - RADEX SPINE LUMBOSACRAL 2-3 VIEWS,72100,HCPCS,,,FY,Outpatient,,,397,99.25,83.16,337.45,,,34.4,,136.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,260.43,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,277.9,Percent of Total Billed Charges, ,,85,,337.45,Percent of Total Billed Charges, ,,50,,198.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,269.96,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,222.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,238.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72110 - RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,72110,HCPCS,,,PO,Outpatient,,,461,115.25,101.1,391.85,,,34.4,,158.58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,302.42,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,322.7,Percent of Total Billed Charges, ,,85,,391.85,Percent of Total Billed Charges, ,,50,,230.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,313.48,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,258.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,276.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72110 - RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,72110,HCPCS,,,FY,Outpatient,,,461,115.25,101.1,391.85,,,34.4,,158.58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,302.42,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,322.7,Percent of Total Billed Charges, ,,85,,391.85,Percent of Total Billed Charges, ,,50,,230.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,313.48,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,258.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,276.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72114 - RADEX SPINE LUMBSCRL COMPL W-BENDING VIEWS MIN 6,72114,HCPCS,,,FY,Outpatient,,,478,119.5,101.1,406.3,,,34.4,,164.43,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,313.57,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,334.6,Percent of Total Billed Charges, ,,85,,406.3,Percent of Total Billed Charges, ,,50,,239,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,325.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,267.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,286.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,133.65,,,133.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,133.65,,,133.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,133.65,,,133.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,133.65,,,133.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72120 - RADEX SPINE LUMBOSACRAL ONLY BENDING 2-3 VIEWS,72120,HCPCS,,,XU,Outpatient,,,318,79.5,98.01,270.3,,,34.4,,109.39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,208.61,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,222.6,Percent of Total Billed Charges, ,,85,,270.3,Percent of Total Billed Charges, ,,50,,159,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,216.24,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,178.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,190.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72120 - RADEX SPINE LUMBOSACRAL ONLY BENDING 2-3 VIEWS,72120,HCPCS,,,XP,Outpatient,,,318,79.5,98.01,270.3,,,34.4,,109.39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,208.61,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,222.6,Percent of Total Billed Charges, ,,85,,270.3,Percent of Total Billed Charges, ,,50,,159,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,216.24,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,178.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,190.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72120 - RADEX SPINE LUMBOSACRAL ONLY BENDING 2-3 VIEWS,72120,HCPCS,,,PO,Outpatient,,,318,79.5,98.01,270.3,,,34.4,,109.39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,208.61,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,222.6,Percent of Total Billed Charges, ,,85,,270.3,Percent of Total Billed Charges, ,,50,,159,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,216.24,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,178.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,190.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72120 - RADEX SPINE LUMBOSACRAL ONLY BENDING 2-3 VIEWS,72120,HCPCS,,,FY,Outpatient,,,318,79.5,98.01,270.3,,,34.4,,109.39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,208.61,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,222.6,Percent of Total Billed Charges, ,,85,,270.3,Percent of Total Billed Charges, ,,50,,159,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,216.24,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,178.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,190.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72120 - RADEX SPINE LUMBOSACRAL ONLY BENDING 2-3 VIEWS,72120,HCPCS,,,76,Outpatient,,,318,79.5,98.01,270.3,,,34.4,,109.39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,208.61,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,222.6,Percent of Total Billed Charges, ,,85,,270.3,Percent of Total Billed Charges, ,,50,,159,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,216.24,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,178.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,190.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72170 - RADIOLOGIC EXAMINATION PELVIS 1-2 VIEWS,72170,HCPCS,,,XU,Outpatient,,,324,81,62.37,275.4,,,34.4,,111.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,212.54,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,226.8,Percent of Total Billed Charges, ,,85,,275.4,Percent of Total Billed Charges, ,,50,,162,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,220.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,181.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,194.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72170 - RADIOLOGIC EXAMINATION PELVIS 1-2 VIEWS,72170,HCPCS,,,XP,Outpatient,,,324,81,62.37,275.4,,,34.4,,111.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,212.54,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,226.8,Percent of Total Billed Charges, ,,85,,275.4,Percent of Total Billed Charges, ,,50,,162,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,220.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,181.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,194.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72170 - RADIOLOGIC EXAMINATION PELVIS 1-2 VIEWS,72170,HCPCS,,,PO,Outpatient,,,324,81,62.37,275.4,,,34.4,,111.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,212.54,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,226.8,Percent of Total Billed Charges, ,,85,,275.4,Percent of Total Billed Charges, ,,50,,162,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,220.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,181.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,194.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72170 - RADIOLOGIC EXAMINATION PELVIS 1-2 VIEWS,72170,HCPCS,,,FY,Outpatient,,,324,81,62.37,275.4,,,34.4,,111.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,212.54,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,226.8,Percent of Total Billed Charges, ,,85,,275.4,Percent of Total Billed Charges, ,,50,,162,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,220.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,181.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,194.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72170 - RADIOLOGIC EXAMINATION PELVIS 1-2 VIEWS,72170,HCPCS,,,77,Outpatient,,,324,81,62.37,275.4,,,34.4,,111.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,212.54,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,226.8,Percent of Total Billed Charges, ,,85,,275.4,Percent of Total Billed Charges, ,,50,,162,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,220.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,181.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,194.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72170 - RADIOLOGIC EXAMINATION PELVIS 1-2 VIEWS,72170,HCPCS,,,76,Outpatient,,,324,81,62.37,275.4,,,34.4,,111.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,212.54,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,226.8,Percent of Total Billed Charges, ,,85,,275.4,Percent of Total Billed Charges, ,,50,,162,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,220.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,181.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,194.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.37,,,62.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72190 - RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,72190,HCPCS,,,PO,Outpatient,,,339,84.75,98.01,288.15,,,34.4,,116.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,222.38,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,237.3,Percent of Total Billed Charges, ,,85,,288.15,Percent of Total Billed Charges, ,,50,,169.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,230.52,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,189.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,203.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72190 - RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,72190,HCPCS,,,FY,Outpatient,,,339,84.75,98.01,288.15,,,34.4,,116.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,222.38,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,237.3,Percent of Total Billed Charges, ,,85,,288.15,Percent of Total Billed Charges, ,,50,,169.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,230.52,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,189.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,203.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72200 - RADIOLOGIC EXAMINATION SACROILIAC JNTS LESS THAN 3 VIEWS,72200,HCPCS,,,PO,Outpatient,,,328,82,41.58,278.8,,,34.4,,112.83,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,215.17,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,229.6,Percent of Total Billed Charges, ,,85,,278.8,Percent of Total Billed Charges, ,,50,,164,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,223.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,183.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,196.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72200 - RADIOLOGIC EXAMINATION SACROILIAC JNTS LESS THAN 3 VIEWS,72200,HCPCS,,,FY,Outpatient,,,328,82,41.58,278.8,,,34.4,,112.83,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,215.17,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,229.6,Percent of Total Billed Charges, ,,85,,278.8,Percent of Total Billed Charges, ,,50,,164,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,223.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,183.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,196.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,41.58,,,41.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72220 - RADEX SACRUM AND COCCYX MINIMUM 2 VIEWS,72220,HCPCS,,,PO,Outpatient,,,314,78.5,50.49,266.9,,,34.4,,108.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,205.98,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,219.8,Percent of Total Billed Charges, ,,85,,266.9,Percent of Total Billed Charges, ,,50,,157,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,213.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,175.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,188.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72220 - RADEX SACRUM AND COCCYX MINIMUM 2 VIEWS,72220,HCPCS,,,76,Outpatient,,,314,78.5,50.49,266.9,,,34.4,,108.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,205.98,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,219.8,Percent of Total Billed Charges, ,,85,,266.9,Percent of Total Billed Charges, ,,50,,157,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,213.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,175.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,188.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72240 - MYELOGRAPHY CERVICAL RSANDI,72240,HCPCS,,,XU,Outpatient,,,6361,1590.25,711.13,5406.85,,,34.4,,2188.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1153.77,,,1153.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4172.82,Percent of Total Billed Charges, ,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4452.7,Percent of Total Billed Charges, ,,85,,5406.85,Percent of Total Billed Charges, ,,50,,3180.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4325.48,Percent of Total Billed Charges,0,879.67,,,879.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3562.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3816.6,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,711.13,,,711.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73000 - RADEX CLAVICLE COMPLETE,73000,HCPCS,,,RT,Outpatient,,,273,68.25,44.55,232.05,,,34.4,,93.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,179.09,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,191.1,Percent of Total Billed Charges, ,,85,,232.05,Percent of Total Billed Charges, ,,50,,136.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,185.64,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,152.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,163.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73000 - RADEX CLAVICLE COMPLETE,73000,HCPCS,,,LT,Outpatient,,,273,68.25,44.55,232.05,,,34.4,,93.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,179.09,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,191.1,Percent of Total Billed Charges, ,,85,,232.05,Percent of Total Billed Charges, ,,50,,136.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,185.64,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,152.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,163.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73000 - RADEX CLAVICLE COMPLETE,73000,HCPCS,,,50,Outpatient,,,381,95.25,44.55,323.85,,,34.4,,131.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,249.94,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,266.7,Percent of Total Billed Charges, ,,85,,323.85,Percent of Total Billed Charges, ,,50,,190.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,259.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,213.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,228.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73010 - RADEX SCAPULA COMPLETE,73010,HCPCS,,,RT,Outpatient,,,296,74,53.46,251.6,,,34.4,,101.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.18,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.2,Percent of Total Billed Charges, ,,85,,251.6,Percent of Total Billed Charges, ,,50,,148,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,165.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,177.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73010 - RADEX SCAPULA COMPLETE,73010,HCPCS,,,LT,Outpatient,,,296,74,53.46,251.6,,,34.4,,101.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.18,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.2,Percent of Total Billed Charges, ,,85,,251.6,Percent of Total Billed Charges, ,,50,,148,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,165.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,177.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73010 - RADEX SCAPULA COMPLETE,73010,HCPCS,,,50,Outpatient,,,444,111,53.46,377.4,,,34.4,,152.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,291.26,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,310.8,Percent of Total Billed Charges, ,,85,,377.4,Percent of Total Billed Charges, ,,50,,222,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,301.92,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,248.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,266.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73020 - RADEX SHOULDER 1 VIEW,73020,HCPCS,,,XP,Outpatient,,,222,55.5,38.61,188.7,,,34.4,,76.37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,145.63,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,155.4,Percent of Total Billed Charges, ,,85,,188.7,Percent of Total Billed Charges, ,,50,,111,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,150.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,124.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,133.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73020 - RADEX SHOULDER 1 VIEW,73020,HCPCS,,,RT,Outpatient,,,222,55.5,38.61,188.7,,,34.4,,76.37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,145.63,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,155.4,Percent of Total Billed Charges, ,,85,,188.7,Percent of Total Billed Charges, ,,50,,111,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,150.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,124.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,133.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73020 - RADEX SHOULDER 1 VIEW,73020,HCPCS,,,LT,Outpatient,,,222,55.5,38.61,188.7,,,34.4,,76.37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,145.63,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,155.4,Percent of Total Billed Charges, ,,85,,188.7,Percent of Total Billed Charges, ,,50,,111,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,150.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,124.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,133.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73020 - RADEX SHOULDER 1 VIEW,73020,HCPCS,,,50,Outpatient,,,332,83,38.61,282.2,,,34.4,,114.21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,217.79,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,232.4,Percent of Total Billed Charges, ,,85,,282.2,Percent of Total Billed Charges, ,,50,,166,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,225.76,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,185.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73030 - RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,73030,HCPCS,,,RT,Outpatient,,,296,74,59.4,251.6,,,34.4,,101.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.2,Percent of Total Billed Charges, ,,85,,251.6,Percent of Total Billed Charges, ,,50,,148,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,165.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,177.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73030 - RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,73030,HCPCS,,,LT,Outpatient,,,296,74,59.4,251.6,,,34.4,,101.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.2,Percent of Total Billed Charges, ,,85,,251.6,Percent of Total Billed Charges, ,,50,,148,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,165.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,177.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73030 - RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,73030,HCPCS,,,77,Outpatient,,,296,74,59.4,251.6,,,34.4,,101.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.2,Percent of Total Billed Charges, ,,85,,251.6,Percent of Total Billed Charges, ,,50,,148,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,165.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,177.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73030 - RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,73030,HCPCS,,,76,Outpatient,,,296,74,59.4,251.6,,,34.4,,101.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.2,Percent of Total Billed Charges, ,,85,,251.6,Percent of Total Billed Charges, ,,50,,148,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,165.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,177.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73030 - RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,73030,HCPCS,,,50,Outpatient,,,444,111,59.4,377.4,,,34.4,,152.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,291.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,310.8,Percent of Total Billed Charges, ,,85,,377.4,Percent of Total Billed Charges, ,,50,,222,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,301.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,248.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,266.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73050 - RADEX A-C JOINTS BI W-WO WEIGHTED DISTRCJ,73050,HCPCS,,,RT,Outpatient,,,277,69.25,77.22,235.45,,,34.4,,95.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,181.71,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,193.9,Percent of Total Billed Charges, ,,85,,235.45,Percent of Total Billed Charges, ,,50,,138.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,188.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,155.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,166.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73050 - RADEX A-C JOINTS BI W-WO WEIGHTED DISTRCJ,73050,HCPCS,,,LT,Outpatient,,,277,69.25,77.22,235.45,,,34.4,,95.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,181.71,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,193.9,Percent of Total Billed Charges, ,,85,,235.45,Percent of Total Billed Charges, ,,50,,138.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,188.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,155.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,166.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73060 - RADEX HUMERUS MINIMUM 2 VIEWS,73060,HCPCS,,,RT,Outpatient,,,277,69.25,65.34,235.45,,,34.4,,95.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,181.71,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,193.9,Percent of Total Billed Charges, ,,85,,235.45,Percent of Total Billed Charges, ,,50,,138.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,188.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,155.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,166.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73060 - RADEX HUMERUS MINIMUM 2 VIEWS,73060,HCPCS,,,LT,Outpatient,,,277,69.25,65.34,235.45,,,34.4,,95.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,181.71,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,193.9,Percent of Total Billed Charges, ,,85,,235.45,Percent of Total Billed Charges, ,,50,,138.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,188.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,155.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,166.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73060 - RADEX HUMERUS MINIMUM 2 VIEWS,73060,HCPCS,,,50,Outpatient,,,415,103.75,65.34,352.75,,,34.4,,142.76,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,272.24,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,290.5,Percent of Total Billed Charges, ,,85,,352.75,Percent of Total Billed Charges, ,,50,,207.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,282.2,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,232.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,249,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73070 - RADEX ELBOW 2 VIEWS,73070,HCPCS,,,RT,Outpatient,,,235,58.75,53.46,199.75,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,50,,117.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,159.8,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73070 - RADEX ELBOW 2 VIEWS,73070,HCPCS,,,LT,Outpatient,,,235,58.75,53.46,199.75,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,50,,117.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,159.8,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73070 - RADEX ELBOW 2 VIEWS,73070,HCPCS,,,77,Outpatient,,,235,58.75,53.46,199.75,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,50,,117.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,159.8,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73070 - RADEX ELBOW 2 VIEWS,73070,HCPCS,,,76,Outpatient,,,235,58.75,53.46,199.75,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,50,,117.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,159.8,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73070 - RADEX ELBOW 2 VIEWS,73070,HCPCS,,,50,Outpatient,,,353,88.25,53.46,300.05,,,34.4,,121.43,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,231.57,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,247.1,Percent of Total Billed Charges, ,,85,,300.05,Percent of Total Billed Charges, ,,50,,176.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,240.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,197.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,211.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73080 - RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,73080,HCPCS,,,RT,Outpatient,,,253,63.25,56.43,215.05,,,34.4,,87.03,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,165.97,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,177.1,Percent of Total Billed Charges, ,,85,,215.05,Percent of Total Billed Charges, ,,50,,126.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,172.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,141.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,151.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73080 - RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,73080,HCPCS,,,LT,Outpatient,,,253,63.25,56.43,215.05,,,34.4,,87.03,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,165.97,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,177.1,Percent of Total Billed Charges, ,,85,,215.05,Percent of Total Billed Charges, ,,50,,126.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,172.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,141.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,151.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73080 - RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,73080,HCPCS,,,50,Outpatient,,,379,94.75,56.43,322.15,,,34.4,,130.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,248.62,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,265.3,Percent of Total Billed Charges, ,,85,,322.15,Percent of Total Billed Charges, ,,50,,189.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,257.72,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,212.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,227.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73090 - RADEX FOREARM 2 VIEWS,73090,HCPCS,,,XP,Outpatient,,,284,71,56.43,241.4,,,34.4,,97.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.3,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.8,Percent of Total Billed Charges, ,,85,,241.4,Percent of Total Billed Charges, ,,50,,142,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,193.12,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,159.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,170.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73090 - RADEX FOREARM 2 VIEWS,73090,HCPCS,,,RT,Outpatient,,,284,71,56.43,241.4,,,34.4,,97.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.3,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.8,Percent of Total Billed Charges, ,,85,,241.4,Percent of Total Billed Charges, ,,50,,142,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,193.12,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,159.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,170.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73090 - RADEX FOREARM 2 VIEWS,73090,HCPCS,,,LT,Outpatient,,,284,71,56.43,241.4,,,34.4,,97.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.3,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.8,Percent of Total Billed Charges, ,,85,,241.4,Percent of Total Billed Charges, ,,50,,142,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,193.12,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,159.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,170.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73090 - RADEX FOREARM 2 VIEWS,73090,HCPCS,,,77,Outpatient,,,284,71,56.43,241.4,,,34.4,,97.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.3,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.8,Percent of Total Billed Charges, ,,85,,241.4,Percent of Total Billed Charges, ,,50,,142,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,193.12,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,159.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,170.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73090 - RADEX FOREARM 2 VIEWS,73090,HCPCS,,,76,Outpatient,,,284,71,56.43,241.4,,,34.4,,97.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.3,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.8,Percent of Total Billed Charges, ,,85,,241.4,Percent of Total Billed Charges, ,,50,,142,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,193.12,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,159.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,170.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73090 - RADEX FOREARM 2 VIEWS,73090,HCPCS,,,50,Outpatient,,,426,106.5,56.43,362.1,,,34.4,,146.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,279.46,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,298.2,Percent of Total Billed Charges, ,,85,,362.1,Percent of Total Billed Charges, ,,50,,213,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,289.68,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,238.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,255.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73092 - RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,73092,HCPCS,,,LT,Outpatient,,,301,75.25,95.04,255.85,,,34.4,,103.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,197.46,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,210.7,Percent of Total Billed Charges, ,,85,,255.85,Percent of Total Billed Charges, ,,50,,150.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,204.68,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,168.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,180.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73100 - RADEX WRIST 2 VIEWS,73100,HCPCS,,,XU,Outpatient,,,194,48.5,56.43,164.9,,,34.4,,66.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,127.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,135.8,Percent of Total Billed Charges, ,,85,,164.9,Percent of Total Billed Charges, ,,50,,97,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,131.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,108.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,116.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73100 - RADEX WRIST 2 VIEWS,73100,HCPCS,,,RT,Outpatient,,,194,48.5,56.43,164.9,,,34.4,,66.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,127.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,135.8,Percent of Total Billed Charges, ,,85,,164.9,Percent of Total Billed Charges, ,,50,,97,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,131.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,108.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,116.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73100 - RADEX WRIST 2 VIEWS,73100,HCPCS,,,LT,Outpatient,,,196.86,49.215,56.43,167.33,,,34.4,,67.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,129.14,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,137.8,Percent of Total Billed Charges, ,,85,,167.33,Percent of Total Billed Charges, ,,50,,98.43,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,133.86,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,110.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,118.12,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73100 - RADEX WRIST 2 VIEWS,73100,HCPCS,,,77,Outpatient,,,194,48.5,56.43,164.9,,,34.4,,66.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,127.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,135.8,Percent of Total Billed Charges, ,,85,,164.9,Percent of Total Billed Charges, ,,50,,97,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,131.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,108.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,116.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73100 - RADEX WRIST 2 VIEWS,73100,HCPCS,,,76,Outpatient,,,194,48.5,56.43,164.9,,,34.4,,66.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,127.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,135.8,Percent of Total Billed Charges, ,,85,,164.9,Percent of Total Billed Charges, ,,50,,97,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,131.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,108.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,116.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73100 - RADEX WRIST 2 VIEWS,73100,HCPCS,,,50,Outpatient,,,292,73,56.43,248.2,,,34.4,,100.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,191.55,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,204.4,Percent of Total Billed Charges, ,,85,,248.2,Percent of Total Billed Charges, ,,50,,146,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.56,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,163.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,175.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,56.43,,,56.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73110 - RADEX WRIST COMPLETE MINIMUM 3 VIEWS,73110,HCPCS,,,RT,Outpatient,,,243,60.75,68.31,206.55,,,34.4,,83.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,159.41,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,170.1,Percent of Total Billed Charges, ,,85,,206.55,Percent of Total Billed Charges, ,,50,,121.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,165.24,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,136.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,145.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73110 - RADEX WRIST COMPLETE MINIMUM 3 VIEWS,73110,HCPCS,,,LT,Outpatient,,,243,60.75,68.31,206.55,,,34.4,,83.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,159.41,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,170.1,Percent of Total Billed Charges, ,,85,,206.55,Percent of Total Billed Charges, ,,50,,121.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,165.24,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,136.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,145.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73110 - RADEX WRIST COMPLETE MINIMUM 3 VIEWS,73110,HCPCS,,,76,Outpatient,,,243,60.75,68.31,206.55,,,34.4,,83.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,159.41,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,170.1,Percent of Total Billed Charges, ,,85,,206.55,Percent of Total Billed Charges, ,,50,,121.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,165.24,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,136.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,145.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73110 - RADEX WRIST COMPLETE MINIMUM 3 VIEWS,73110,HCPCS,,,50,Outpatient,,,365,91.25,68.31,310.25,,,34.4,,125.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,239.44,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,255.5,Percent of Total Billed Charges, ,,85,,310.25,Percent of Total Billed Charges, ,,50,,182.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,248.2,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,204.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,219,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73120 - RADEX HAND 2 VIEWS,73120,HCPCS,,,RT,Outpatient,,,236,59,50.49,200.6,,,34.4,,81.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.82,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,165.2,Percent of Total Billed Charges, ,,85,,200.6,Percent of Total Billed Charges, ,,50,,118,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,160.48,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,132.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73120 - RADEX HAND 2 VIEWS,73120,HCPCS,,,LT,Outpatient,,,236,59,50.49,200.6,,,34.4,,81.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.82,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,165.2,Percent of Total Billed Charges, ,,85,,200.6,Percent of Total Billed Charges, ,,50,,118,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,160.48,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,132.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73120 - RADEX HAND 2 VIEWS,73120,HCPCS,,,50,Outpatient,,,344,86,50.49,292.4,,,34.4,,118.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,225.66,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,240.8,Percent of Total Billed Charges, ,,85,,292.4,Percent of Total Billed Charges, ,,50,,172,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,233.92,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,192.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,206.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73130 - RADEX HAND MINIMUM 3 VIEWS,73130,HCPCS,,,RT,Outpatient,,,265,66.25,74.25,225.25,,,34.4,,91.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,173.84,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,185.5,Percent of Total Billed Charges, ,,85,,225.25,Percent of Total Billed Charges, ,,50,,132.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,180.2,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,148.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,159,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73130 - RADEX HAND MINIMUM 3 VIEWS,73130,HCPCS,,,LT,Outpatient,,,265,66.25,74.25,225.25,,,34.4,,91.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,173.84,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,185.5,Percent of Total Billed Charges, ,,85,,225.25,Percent of Total Billed Charges, ,,50,,132.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,180.2,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,148.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,159,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73130 - RADEX HAND MINIMUM 3 VIEWS,73130,HCPCS,,,FY,Outpatient,,,397,99.25,74.25,337.45,,,34.4,,136.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,260.43,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,277.9,Percent of Total Billed Charges, ,,85,,337.45,Percent of Total Billed Charges, ,,50,,198.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,269.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,222.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,238.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73130 - RADEX HAND MINIMUM 3 VIEWS,73130,HCPCS,,,76,Outpatient,,,265,66.25,74.25,225.25,,,34.4,,91.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,173.84,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,185.5,Percent of Total Billed Charges, ,,85,,225.25,Percent of Total Billed Charges, ,,50,,132.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,180.2,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,148.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,159,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73130 - RADEX HAND MINIMUM 3 VIEWS,73130,HCPCS,,,50,Outpatient,,,397,99.25,74.25,337.45,,,34.4,,136.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,260.43,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,277.9,Percent of Total Billed Charges, ,,85,,337.45,Percent of Total Billed Charges, ,,50,,198.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,269.96,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,222.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,238.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73140 - RADEX FINGR MINIMUM 2 VIEWS,73140,HCPCS,,,XU,Outpatient,,,226,56.5,47.52,192.1,,,34.4,,77.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,148.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,158.2,Percent of Total Billed Charges, ,,85,,192.1,Percent of Total Billed Charges, ,,50,,113,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,153.68,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,126.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,135.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73140 - RADEX FINGR MINIMUM 2 VIEWS,73140,HCPCS,,,RT,Outpatient,,,226,56.5,47.52,192.1,,,34.4,,77.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,148.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,158.2,Percent of Total Billed Charges, ,,85,,192.1,Percent of Total Billed Charges, ,,50,,113,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,153.68,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,126.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,135.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73140 - RADEX FINGR MINIMUM 2 VIEWS,73140,HCPCS,,,LT,Outpatient,,,226,56.5,47.52,192.1,,,34.4,,77.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,148.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,158.2,Percent of Total Billed Charges, ,,85,,192.1,Percent of Total Billed Charges, ,,50,,113,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,153.68,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,126.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,135.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73140 - RADEX FINGR MINIMUM 2 VIEWS,73140,HCPCS,,,77,Outpatient,,,226,56.5,47.52,192.1,,,34.4,,77.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,148.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,158.2,Percent of Total Billed Charges, ,,85,,192.1,Percent of Total Billed Charges, ,,50,,113,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,153.68,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,126.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,135.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73140 - RADEX FINGR MINIMUM 2 VIEWS,73140,HCPCS,,,76,Outpatient,,,226,56.5,47.52,192.1,,,34.4,,77.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,148.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,158.2,Percent of Total Billed Charges, ,,85,,192.1,Percent of Total Billed Charges, ,,50,,113,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,153.68,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,126.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,135.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73501 - RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,73501,HCPCS,,,XP,Outpatient,,,177,44.25,55.98,150.45,,,34.4,,60.89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.11,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.9,Percent of Total Billed Charges, ,,85,,150.45,Percent of Total Billed Charges, ,,50,,88.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,120.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73501 - RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,73501,HCPCS,,,RT,Outpatient,,,177,44.25,55.98,150.45,,,34.4,,60.89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.11,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.9,Percent of Total Billed Charges, ,,85,,150.45,Percent of Total Billed Charges, ,,50,,88.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,120.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73501 - RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,73501,HCPCS,,,LT,Outpatient,,,177,44.25,55.98,150.45,,,34.4,,60.89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.11,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.9,Percent of Total Billed Charges, ,,85,,150.45,Percent of Total Billed Charges, ,,50,,88.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,120.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73501 - RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,73501,HCPCS,,,76,Outpatient,,,177,44.25,55.98,150.45,,,34.4,,60.89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.11,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.9,Percent of Total Billed Charges, ,,85,,150.45,Percent of Total Billed Charges, ,,50,,88.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,120.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.98,,,55.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73502 - RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,73502,HCPCS,,,XU,Outpatient,,,163,40.75,56.07,138.55,,,34.4,,56.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,106.93,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.1,Percent of Total Billed Charges, ,,85,,138.55,Percent of Total Billed Charges, ,,50,,81.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,110.84,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,91.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,97.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73502 - RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,73502,HCPCS,,,RT,Outpatient,,,163,40.75,56.07,138.55,,,34.4,,56.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,106.93,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.1,Percent of Total Billed Charges, ,,85,,138.55,Percent of Total Billed Charges, ,,50,,81.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,110.84,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,91.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,97.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73502 - RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,73502,HCPCS,,,LT,Outpatient,,,163,40.75,56.07,138.55,,,34.4,,56.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,106.93,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.1,Percent of Total Billed Charges, ,,85,,138.55,Percent of Total Billed Charges, ,,50,,81.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,110.84,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,91.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,97.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73502 - RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,73502,HCPCS,,,77,Outpatient,,,163,40.75,56.07,138.55,,,34.4,,56.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,106.93,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.1,Percent of Total Billed Charges, ,,85,,138.55,Percent of Total Billed Charges, ,,50,,81.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,110.84,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,91.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,97.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73502 - RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,73502,HCPCS,,,76,Outpatient,,,163,40.75,56.07,138.55,,,34.4,,56.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,106.93,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.1,Percent of Total Billed Charges, ,,85,,138.55,Percent of Total Billed Charges, ,,50,,81.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,110.84,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,91.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,97.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.68,,,82.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73521 - RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,73521,HCPCS,,,PO,Outpatient,,,209,52.25,71.9,177.65,,,34.4,,71.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,137.1,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,146.3,Percent of Total Billed Charges, ,,85,,177.65,Percent of Total Billed Charges, ,,50,,104.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,142.12,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,117.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,125.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.72,,,77.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.72,,,77.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.72,,,77.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.72,,,77.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73521 - RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,73521,HCPCS,,,50,Outpatient,,,209,52.25,71.9,177.65,,,34.4,,71.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,137.1,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,146.3,Percent of Total Billed Charges, ,,85,,177.65,Percent of Total Billed Charges, ,,50,,104.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,142.12,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,117.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,125.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.72,,,77.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.72,,,77.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.72,,,77.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.72,,,77.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73522 - RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,73522,HCPCS,,,PO,Outpatient,,,230,57.5,79.12,195.5,,,34.4,,79.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,150.88,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,161,Percent of Total Billed Charges, ,,85,,195.5,Percent of Total Billed Charges, ,,50,,115,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,156.4,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,128.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,138,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.57,,,92.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,92.57,,,92.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,92.57,,,92.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,92.57,,,92.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73522 - RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,73522,HCPCS,,,FY,Outpatient,,,230,57.5,79.12,195.5,,,34.4,,79.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,150.88,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,161,Percent of Total Billed Charges, ,,85,,195.5,Percent of Total Billed Charges, ,,50,,115,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,156.4,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,128.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,138,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.57,,,92.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,92.57,,,92.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,92.57,,,92.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,92.57,,,92.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73523 - RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS,73523,HCPCS,,,FY,Outpatient,,,399,99.75,101.1,339.15,,,34.4,,137.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,261.74,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,279.3,Percent of Total Billed Charges, ,,85,,339.15,Percent of Total Billed Charges, ,,50,,199.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,271.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,223.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,239.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,111.35,,,111.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,111.35,,,111.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,111.35,,,111.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,111.35,,,111.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73551 - RADIOLOGIC EXAMINATION FEMUR 1 VIEW,73551,HCPCS,,,RT,Outpatient,,,177,44.25,53.01,150.45,,,34.4,,60.89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.11,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.9,Percent of Total Billed Charges, ,,85,,150.45,Percent of Total Billed Charges, ,,50,,88.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,120.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.01,,,53.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.01,,,53.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.01,,,53.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.01,,,53.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73551 - RADIOLOGIC EXAMINATION FEMUR 1 VIEW,73551,HCPCS,,,LT,Outpatient,,,177,44.25,53.01,150.45,,,34.4,,60.89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.11,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.9,Percent of Total Billed Charges, ,,85,,150.45,Percent of Total Billed Charges, ,,50,,88.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,120.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.01,,,53.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.01,,,53.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.01,,,53.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.01,,,53.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73552 - RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,73552,HCPCS,,,RT,Outpatient,,,176.87,44.2175,60.84,150.34,,,34.4,,60.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.03,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.81,Percent of Total Billed Charges, ,,85,,150.34,Percent of Total Billed Charges, ,,50,,88.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,120.27,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.05,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.12,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73552 - RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,73552,HCPCS,,,LT,Outpatient,,,177,44.25,60.89,150.45,,,34.4,,60.89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.11,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.9,Percent of Total Billed Charges, ,,85,,150.45,Percent of Total Billed Charges, ,,50,,88.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,120.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73552 - RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,73552,HCPCS,,,50,Outpatient,,,253,63.25,62.9,215.05,,,34.4,,87.03,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,165.97,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,177.1,Percent of Total Billed Charges, ,,85,,215.05,Percent of Total Billed Charges, ,,50,,126.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,172.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,141.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,151.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,62.9,,,62.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73560 - RADIOLOGIC EXAMINATION KNEE 1-2 VIEWS,73560,HCPCS,,,RT,Outpatient,,,333,83.25,74.25,283.05,,,34.4,,114.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,218.45,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,233.1,Percent of Total Billed Charges, ,,85,,283.05,Percent of Total Billed Charges, ,,50,,166.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,226.44,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,186.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73560 - RADIOLOGIC EXAMINATION KNEE 1-2 VIEWS,73560,HCPCS,,,LT,Outpatient,,,333,83.25,74.25,283.05,,,34.4,,114.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,218.45,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,233.1,Percent of Total Billed Charges, ,,85,,283.05,Percent of Total Billed Charges, ,,50,,166.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,226.44,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,186.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73560 - RADIOLOGIC EXAMINATION KNEE 1-2 VIEWS,73560,HCPCS,,,FY,Outpatient,,,483.91,120.9775,74.25,411.32,,,34.4,,166.47,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,317.44,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,338.74,Percent of Total Billed Charges, ,,85,,411.32,Percent of Total Billed Charges, ,,50,,241.96,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,329.06,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,270.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,290.35,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73560 - RADIOLOGIC EXAMINATION KNEE 1-2 VIEWS,73560,HCPCS,,,77,Outpatient,,,333,83.25,74.25,283.05,,,34.4,,114.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,218.45,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,233.1,Percent of Total Billed Charges, ,,85,,283.05,Percent of Total Billed Charges, ,,50,,166.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,226.44,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,186.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73560 - RADIOLOGIC EXAMINATION KNEE 1-2 VIEWS,73560,HCPCS,,,76,Outpatient,,,333,83.25,74.25,283.05,,,34.4,,114.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,218.45,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,233.1,Percent of Total Billed Charges, ,,85,,283.05,Percent of Total Billed Charges, ,,50,,166.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,226.44,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,186.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73560 - RADIOLOGIC EXAMINATION KNEE 1-2 VIEWS,73560,HCPCS,,,50,Outpatient,,,499,124.75,74.25,424.15,,,34.4,,171.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,327.34,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,349.3,Percent of Total Billed Charges, ,,85,,424.15,Percent of Total Billed Charges, ,,50,,249.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,339.32,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,279.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,299.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73562 - RADIOLOGIC EXAMINATION KNEE 3 VIEWS,73562,HCPCS,,,XU,Outpatient,,,352,88,83.36,299.2,,,34.4,,121.09,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,230.91,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,246.4,Percent of Total Billed Charges, ,,85,,299.2,Percent of Total Billed Charges, ,,50,,176,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,239.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,197.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,211.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73562 - RADIOLOGIC EXAMINATION KNEE 3 VIEWS,73562,HCPCS,,,RT,Outpatient,,,362.07,90.5175,83.36,307.76,,,34.4,,124.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,237.52,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,253.45,Percent of Total Billed Charges, ,,85,,307.76,Percent of Total Billed Charges, ,,50,,181.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,246.21,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,202.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,217.24,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73562 - RADIOLOGIC EXAMINATION KNEE 3 VIEWS,73562,HCPCS,,,LT,Outpatient,,,381.31,95.3275,83.36,324.11,,,34.4,,131.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,250.14,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,266.92,Percent of Total Billed Charges, ,,85,,324.11,Percent of Total Billed Charges, ,,50,,190.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,259.29,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,213.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,228.79,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73562 - RADIOLOGIC EXAMINATION KNEE 3 VIEWS,73562,HCPCS,,,50,Outpatient,,,527,131.75,83.36,447.95,,,34.4,,181.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,345.71,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,368.9,Percent of Total Billed Charges, ,,85,,447.95,Percent of Total Billed Charges, ,,50,,263.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,358.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,295.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,316.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,103.95,,,103.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73564 - RADIOLOGIC EXAM KNEE COMPLETE 4-MORE VIEWS,73564,HCPCS,,,RT,Outpatient,,,358,89.5,101.1,304.3,,,34.4,,123.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,234.85,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,250.6,Percent of Total Billed Charges, ,,85,,304.3,Percent of Total Billed Charges, ,,50,,179,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,243.44,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,200.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,214.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73564 - RADIOLOGIC EXAM KNEE COMPLETE 4-MORE VIEWS,73564,HCPCS,,,LT,Outpatient,,,358,89.5,101.1,304.3,,,34.4,,123.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,234.85,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,250.6,Percent of Total Billed Charges, ,,85,,304.3,Percent of Total Billed Charges, ,,50,,179,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,243.44,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,200.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,214.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73564 - RADIOLOGIC EXAM KNEE COMPLETE 4-MORE VIEWS,73564,HCPCS,,,50,Outpatient,,,537,134.25,101.1,456.45,,,34.4,,184.73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,352.27,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,375.9,Percent of Total Billed Charges, ,,85,,456.45,Percent of Total Billed Charges, ,,50,,268.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,365.16,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,300.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,322.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,109.89,,,109.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73565 - RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,73565,HCPCS,,,FY,Outpatient,,,352,88,65.34,299.2,,,34.4,,121.09,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,230.91,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,246.4,Percent of Total Billed Charges, ,,85,,299.2,Percent of Total Billed Charges, ,,50,,176,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,239.36,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,197.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,211.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73590 - RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,73590,HCPCS,,,RT,Outpatient,,,338,84.5,74.25,287.3,,,34.4,,116.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,221.73,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,236.6,Percent of Total Billed Charges, ,,85,,287.3,Percent of Total Billed Charges, ,,50,,169,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,229.84,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,189.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,202.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73590 - RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,73590,HCPCS,,,LT,Outpatient,,,338,84.5,74.25,287.3,,,34.4,,116.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,221.73,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,236.6,Percent of Total Billed Charges, ,,85,,287.3,Percent of Total Billed Charges, ,,50,,169,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,229.84,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,189.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,202.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73590 - RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,73590,HCPCS,,,50,Outpatient,,,506,126.5,74.25,430.1,,,34.4,,174.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,331.94,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,354.2,Percent of Total Billed Charges, ,,85,,430.1,Percent of Total Billed Charges, ,,50,,253,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,344.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,283.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,303.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73592 - RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,73592,HCPCS,,,RT,Outpatient,,,319,79.75,80.19,271.15,,,34.4,,109.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,209.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,223.3,Percent of Total Billed Charges, ,,85,,271.15,Percent of Total Billed Charges, ,,50,,159.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,216.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,178.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,191.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73592 - RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,73592,HCPCS,,,LT,Outpatient,,,319,79.75,80.19,271.15,,,34.4,,109.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,209.26,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,223.3,Percent of Total Billed Charges, ,,85,,271.15,Percent of Total Billed Charges, ,,50,,159.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,216.92,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,178.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,191.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73592 - RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,73592,HCPCS,,,50,Outpatient,,,479,119.75,80.19,407.15,,,34.4,,164.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,314.22,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,335.3,Percent of Total Billed Charges, ,,85,,407.15,Percent of Total Billed Charges, ,,50,,239.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,325.72,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,268.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,287.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,80.19,,,80.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73600 - RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,73600,HCPCS,,,RT,Outpatient,,,364,91,83.36,309.4,,,34.4,,125.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73600 - RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,73600,HCPCS,,,LT,Outpatient,,,364,91,83.36,309.4,,,34.4,,125.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73600 - RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,73600,HCPCS,,,FY,Outpatient,,,364,91,83.36,309.4,,,34.4,,125.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73600 - RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,73600,HCPCS,,,77,Outpatient,,,364,91,83.36,309.4,,,34.4,,125.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73600 - RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,73600,HCPCS,,,76,Outpatient,,,364,91,83.36,309.4,,,34.4,,125.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73600 - RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,73600,HCPCS,,,50,Outpatient,,,546,136.5,83.36,464.1,,,34.4,,187.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,358.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,382.2,Percent of Total Billed Charges, ,,85,,464.1,Percent of Total Billed Charges, ,,50,,273,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,371.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,305.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,327.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73610 - RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,73610,HCPCS,,,RT,Outpatient,,,395,98.75,53.46,335.75,,,34.4,,135.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,259.12,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,276.5,Percent of Total Billed Charges, ,,85,,335.75,Percent of Total Billed Charges, ,,50,,197.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,268.6,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,221.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,237,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73610 - RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,73610,HCPCS,,,LT,Outpatient,,,395,98.75,53.46,335.75,,,34.4,,135.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,259.12,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,276.5,Percent of Total Billed Charges, ,,85,,335.75,Percent of Total Billed Charges, ,,50,,197.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,268.6,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,221.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,237,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73610 - RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,73610,HCPCS,,,FY,Outpatient,,,395,98.75,53.46,335.75,,,34.4,,135.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,259.12,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,276.5,Percent of Total Billed Charges, ,,85,,335.75,Percent of Total Billed Charges, ,,50,,197.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,268.6,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,221.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,237,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73610 - RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,73610,HCPCS,,,76,Outpatient,,,395,98.75,53.46,335.75,,,34.4,,135.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,259.12,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,276.5,Percent of Total Billed Charges, ,,85,,335.75,Percent of Total Billed Charges, ,,50,,197.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,268.6,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,221.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,237,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73610 - RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,73610,HCPCS,,,50,Outpatient,,,592,148,53.46,503.2,,,34.4,,203.65,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,388.35,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,414.4,Percent of Total Billed Charges, ,,85,,503.2,Percent of Total Billed Charges, ,,50,,296,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,402.56,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,331.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,355.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.46,,,53.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73620 - RADIOLOGIC EXAMINATION FOOT 2 VIEWS,73620,HCPCS,,,RT,Outpatient,,,232,58,68.31,197.2,,,34.4,,79.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,152.19,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,162.4,Percent of Total Billed Charges, ,,85,,197.2,Percent of Total Billed Charges, ,,50,,116,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.76,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,139.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73620 - RADIOLOGIC EXAMINATION FOOT 2 VIEWS,73620,HCPCS,,,LT,Outpatient,,,232,58,68.31,197.2,,,34.4,,79.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,152.19,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,162.4,Percent of Total Billed Charges, ,,85,,197.2,Percent of Total Billed Charges, ,,50,,116,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.76,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,139.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73620 - RADIOLOGIC EXAMINATION FOOT 2 VIEWS,73620,HCPCS,,,76,Outpatient,,,232,58,68.31,197.2,,,34.4,,79.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,152.19,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,162.4,Percent of Total Billed Charges, ,,85,,197.2,Percent of Total Billed Charges, ,,50,,116,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.76,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,139.2,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73620 - RADIOLOGIC EXAMINATION FOOT 2 VIEWS,73620,HCPCS,,,50,Outpatient,,,348,87,68.31,295.8,,,34.4,,119.71,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,228.29,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,243.6,Percent of Total Billed Charges, ,,85,,295.8,Percent of Total Billed Charges, ,,50,,174,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,236.64,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,194.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,208.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73630 - RADEX FOOT COMPLETE MINIMUM 3 VIEWS,73630,HCPCS,,,XP,Outpatient,,,406,101.5,83.16,345.1,,,34.4,,139.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,266.34,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,284.2,Percent of Total Billed Charges, ,,85,,345.1,Percent of Total Billed Charges, ,,50,,203,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,276.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,227.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,243.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73630 - RADEX FOOT COMPLETE MINIMUM 3 VIEWS,73630,HCPCS,,,RT,Outpatient,,,406,101.5,83.16,345.1,,,34.4,,139.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,266.34,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,284.2,Percent of Total Billed Charges, ,,85,,345.1,Percent of Total Billed Charges, ,,50,,203,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,276.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,227.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,243.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73630 - RADEX FOOT COMPLETE MINIMUM 3 VIEWS,73630,HCPCS,,,LT,Outpatient,,,406,101.5,83.16,345.1,,,34.4,,139.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,266.34,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,284.2,Percent of Total Billed Charges, ,,85,,345.1,Percent of Total Billed Charges, ,,50,,203,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,276.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,227.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,243.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73630 - RADEX FOOT COMPLETE MINIMUM 3 VIEWS,73630,HCPCS,,,FY,Outpatient,,,406,101.5,83.16,345.1,,,34.4,,139.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,266.34,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,284.2,Percent of Total Billed Charges, ,,85,,345.1,Percent of Total Billed Charges, ,,50,,203,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,276.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,227.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,243.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73630 - RADEX FOOT COMPLETE MINIMUM 3 VIEWS,73630,HCPCS,,,76,Outpatient,,,406,101.5,83.16,345.1,,,34.4,,139.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,266.34,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,284.2,Percent of Total Billed Charges, ,,85,,345.1,Percent of Total Billed Charges, ,,50,,203,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,276.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,227.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,243.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73630 - RADEX FOOT COMPLETE MINIMUM 3 VIEWS,73630,HCPCS,,,50,Outpatient,,,608,152,83.16,516.8,,,34.4,,209.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,398.85,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,425.6,Percent of Total Billed Charges, ,,85,,516.8,Percent of Total Billed Charges, ,,50,,304,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,413.44,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,340.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,364.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73650 - RADEX CALCANEUS MINIMUM 2 VIEWS,73650,HCPCS,,,RT,Outpatient,,,214,53.5,38.61,181.9,,,34.4,,73.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,140.38,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,149.8,Percent of Total Billed Charges, ,,85,,181.9,Percent of Total Billed Charges, ,,50,,107,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,145.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,119.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,128.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73650 - RADEX CALCANEUS MINIMUM 2 VIEWS,73650,HCPCS,,,LT,Outpatient,,,214,53.5,38.61,181.9,,,34.4,,73.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,140.38,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,149.8,Percent of Total Billed Charges, ,,85,,181.9,Percent of Total Billed Charges, ,,50,,107,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,145.52,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,119.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,128.4,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73650 - RADEX CALCANEUS MINIMUM 2 VIEWS,73650,HCPCS,,,50,Outpatient,,,321,80.25,38.61,272.85,,,34.4,,110.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,210.58,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,224.7,Percent of Total Billed Charges, ,,85,,272.85,Percent of Total Billed Charges, ,,50,,160.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,218.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,179.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,192.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73660 - RADEX TOE MINIMUM 2 VIEWS,73660,HCPCS,,,XU,Outpatient,,,346,86.5,38.61,294.1,,,34.4,,119.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,226.98,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,242.2,Percent of Total Billed Charges, ,,85,,294.1,Percent of Total Billed Charges, ,,50,,173,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,235.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,193.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,207.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73660 - RADEX TOE MINIMUM 2 VIEWS,73660,HCPCS,,,RT,Outpatient,,,231,57.75,38.61,196.35,,,34.4,,79.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,151.54,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,161.7,Percent of Total Billed Charges, ,,85,,196.35,Percent of Total Billed Charges, ,,50,,115.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,138.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73660 - RADEX TOE MINIMUM 2 VIEWS,73660,HCPCS,,,LT,Outpatient,,,231,57.75,38.61,196.35,,,34.4,,79.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,151.54,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,161.7,Percent of Total Billed Charges, ,,85,,196.35,Percent of Total Billed Charges, ,,50,,115.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,138.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73660 - RADEX TOE MINIMUM 2 VIEWS,73660,HCPCS,,,77,Outpatient,,,231,57.75,38.61,196.35,,,34.4,,79.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,151.54,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,161.7,Percent of Total Billed Charges, ,,85,,196.35,Percent of Total Billed Charges, ,,50,,115.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.08,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,129.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,138.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73660 - RADEX TOE MINIMUM 2 VIEWS,73660,HCPCS,,,50,Outpatient,,,346,86.5,38.61,294.1,,,34.4,,119.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,226.98,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,242.2,Percent of Total Billed Charges, ,,85,,294.1,Percent of Total Billed Charges, ,,50,,173,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,235.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,193.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,207.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.61,,,38.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74018 - RADIOLOGIC EXAM ABDOMEN 1 VIEW,74018,HCPCS,,,XU,Outpatient,,,178,44.5,60.17,151.3,,,34.4,,61.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.77,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,124.6,Percent of Total Billed Charges, ,,85,,151.3,Percent of Total Billed Charges, ,,50,,89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,121.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74018 - RADIOLOGIC EXAM ABDOMEN 1 VIEW,74018,HCPCS,,,PO,Outpatient,,,178,44.5,60.17,151.3,,,34.4,,61.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.77,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,124.6,Percent of Total Billed Charges, ,,85,,151.3,Percent of Total Billed Charges, ,,50,,89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,121.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74018 - RADIOLOGIC EXAM ABDOMEN 1 VIEW,74018,HCPCS,,,FY,Outpatient,,,178,44.5,60.17,151.3,,,34.4,,61.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.77,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,124.6,Percent of Total Billed Charges, ,,85,,151.3,Percent of Total Billed Charges, ,,50,,89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,121.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74018 - RADIOLOGIC EXAM ABDOMEN 1 VIEW,74018,HCPCS,,,77,Outpatient,,,178,44.5,60.17,151.3,,,34.4,,61.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.77,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,124.6,Percent of Total Billed Charges, ,,85,,151.3,Percent of Total Billed Charges, ,,50,,89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,121.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74018 - RADIOLOGIC EXAM ABDOMEN 1 VIEW,74018,HCPCS,,,76,Outpatient,,,178,44.5,60.17,151.3,,,34.4,,61.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.77,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,124.6,Percent of Total Billed Charges, ,,85,,151.3,Percent of Total Billed Charges, ,,50,,89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,121.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74018 - RADIOLOGIC EXAM ABDOMEN 1 VIEW,74018,HCPCS,,,52,Outpatient,,,178,44.5,60.17,151.3,,,34.4,,61.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.77,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,124.6,Percent of Total Billed Charges, ,,85,,151.3,Percent of Total Billed Charges, ,,50,,89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,121.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,99.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,60.17,,,60.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74019 - RADIOLOGIC EXAM ABDOMEN 2 VIEWS,74019,HCPCS,,,XP,Outpatient,,,234,58.5,72.05,198.9,,,34.4,,80.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,153.5,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,163.8,Percent of Total Billed Charges, ,,85,,198.9,Percent of Total Billed Charges, ,,50,,117,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,159.12,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,131.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,140.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74019 - RADIOLOGIC EXAM ABDOMEN 2 VIEWS,74019,HCPCS,,,PO,Outpatient,,,234,58.5,72.05,198.9,,,34.4,,80.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,153.5,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,163.8,Percent of Total Billed Charges, ,,85,,198.9,Percent of Total Billed Charges, ,,50,,117,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,159.12,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,131.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,140.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74019 - RADIOLOGIC EXAM ABDOMEN 2 VIEWS,74019,HCPCS,,,FY,Outpatient,,,234,58.5,72.05,198.9,,,34.4,,80.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,153.5,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,163.8,Percent of Total Billed Charges, ,,85,,198.9,Percent of Total Billed Charges, ,,50,,117,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,159.12,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,131.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,140.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.05,,,72.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74022 - RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES,74022,HCPCS,,,FY,Outpatient,,,582,145.5,95.04,494.7,,,34.4,,200.21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,381.79,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,407.4,Percent of Total Billed Charges, ,,85,,494.7,Percent of Total Billed Charges, ,,50,,291,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,395.76,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,325.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,349.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,95.04,,,95.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74220 - RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY,74220,HCPCS,,,52,Outpatient,,,440,110,106.92,374,,,34.4,,151.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,288.07,,,288.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,288.64,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,308,Percent of Total Billed Charges, ,,85,,374,Percent of Total Billed Charges, ,,50,,220,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,299.2,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,246.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,264,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74230 - RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY,74230,HCPCS,,,59,Outpatient,,,380,95,86.13,3030,,,34.4,,130.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,288.07,,,288.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,249.28,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,266,Percent of Total Billed Charges, ,,85,,323,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,258.4,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,212.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,228,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.13,,,86.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.13,,,86.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.13,,,86.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.13,,,86.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74246 - RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY,74246,HCPCS,,,53,Outpatient,,,605,151.25,121.77,3030,,,34.4,,208.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,288.07,,,288.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,396.88,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,423.5,Percent of Total Billed Charges, ,,85,,514.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,411.4,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,338.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,363,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.77,,,121.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.77,,,121.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.77,,,121.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.77,,,121.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74248 - RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY,74248,HCPCS,,,53,Outpatient,,,783,195.75,0.01,665.55,,,34.4,,269.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.09,,,50.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,364.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,513.65,Percent of Total Billed Charges, ,50.09,,,50.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,548.1,Percent of Total Billed Charges, ,,85,,665.55,Percent of Total Billed Charges, ,,50,,391.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,532.44,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,438.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,469.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.52,,,48.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
74270 - RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY,74270,HCPCS,,,52,Outpatient,,,688,172,145.53,584.8,,,34.4,,236.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,288.07,,,288.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,451.33,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,481.6,Percent of Total Billed Charges, ,,85,,584.8,Percent of Total Billed Charges, ,,50,,344,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,467.84,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,385.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,412.8,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,145.53,,,145.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,145.53,,,145.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,145.53,,,145.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,145.53,,,145.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74740 - HYSTEROSALPINGOGRAPHY RSANDI,74740,HCPCS,,,52,Outpatient,,,976,244,229.81,829.6,,,34.4,,335.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,640.26,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,683.2,Percent of Total Billed Charges, ,,85,,829.6,Percent of Total Billed Charges, ,,50,,488,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,663.68,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,546.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,585.6,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75820 - VENOGRAPHY EXTREMITY UNILATERAL RSANDI,75820,HCPCS,,,XU,Outpatient,,,2329,582.25,658.58,2294.21,,,34.4,,801.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,679.76,,,679.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2267.77,,,2267.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1527.82,Percent of Total Billed Charges, ,679.76,,,679.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1630.3,Percent of Total Billed Charges, ,,85,,1979.65,Percent of Total Billed Charges, ,,50,,1164.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1583.72,Percent of Total Billed Charges,0,1729.55,,,1729.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1304.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1397.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.58,,,658.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75820 - VENOGRAPHY EXTREMITY UNILATERAL RSANDI,75820,HCPCS,,,RT,Outpatient,,,2329,582.25,658.58,2294.21,,,34.4,,801.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,679.76,,,679.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2267.77,,,2267.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1527.82,Percent of Total Billed Charges, ,679.76,,,679.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1630.3,Percent of Total Billed Charges, ,,85,,1979.65,Percent of Total Billed Charges, ,,50,,1164.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1583.72,Percent of Total Billed Charges,0,1729.55,,,1729.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1304.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1397.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.58,,,658.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75820 - VENOGRAPHY EXTREMITY UNILATERAL RSANDI,75820,HCPCS,,,LT,Outpatient,,,2329,582.25,658.58,2294.21,,,34.4,,801.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,679.76,,,679.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2267.77,,,2267.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1527.82,Percent of Total Billed Charges, ,679.76,,,679.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1630.3,Percent of Total Billed Charges, ,,85,,1979.65,Percent of Total Billed Charges, ,,50,,1164.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1583.72,Percent of Total Billed Charges,0,1729.55,,,1729.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1304.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1397.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.58,,,658.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75822 - VENOGRAPHY EXTREMITY BILATERAL RSANDI,75822,HCPCS,,,XU,Outpatient,,,3653,913.25,1256.63,3105.05,,,34.4,,1256.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1758.55,,,1758.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2267.77,,,2267.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2396.37,Percent of Total Billed Charges, ,1758.55,,,1758.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2557.1,Percent of Total Billed Charges, ,,85,,3105.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2484.04,Percent of Total Billed Charges,0,1729.55,,,1729.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2045.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2191.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1703.74,,,1703.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75831 - VENOGRAPHY RENAL UNILATERAL SELECTIVE RSANDI,75831,HCPCS,,,LT,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75860 - VENOGRAPHY VENOUS SINUS-JUGULAR CATH RSANDI,75860,HCPCS,,,RT,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75870 - VENOGRAPHY SUPERIOR SAGITTAL SINUS RSANDI,75870,HCPCS,,,XU,Outpatient,,,5816,1454,1703.74,4943.6,,,34.4,,2000.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1758.55,,,1758.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3815.3,Percent of Total Billed Charges, ,1758.55,,,1758.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4071.2,Percent of Total Billed Charges, ,,85,,4943.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3954.88,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3256.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3489.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1703.74,,,1703.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75893 - VENOUS SAMPLING THRU CATH W-WO ANGIOGRAPHY RSAND,75893,HCPCS,,,XU,Outpatient,,,8401,2100.25,2889.94,7983.44,,,34.4,,2889.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7690.38,,,7690.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5511.06,Percent of Total Billed Charges, ,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5880.7,Percent of Total Billed Charges, ,,85,,7140.85,Percent of Total Billed Charges, ,,50,,4200.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5712.68,Percent of Total Billed Charges,0,5867.56,,,5867.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4704.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5040.6,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4800.8,,,4800.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75893 - VENOUS SAMPLING THRU CATH W-WO ANGIOGRAPHY RSAND,75893,HCPCS,,,50,Outpatient,,,8401,2100.25,2889.94,7983.44,,,34.4,,2889.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7690.38,,,7690.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5511.06,Percent of Total Billed Charges, ,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5880.7,Percent of Total Billed Charges, ,,85,,7140.85,Percent of Total Billed Charges, ,,50,,4200.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5712.68,Percent of Total Billed Charges,0,5867.56,,,5867.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4704.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5040.6,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4800.8,,,4800.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75984 - CHANGE PRQ TUBE-DRAINAGE CATH W CONTRAST RSANDI,75984,HCPCS,,,XU,Outpatient,,,740,185,0.01,629,,,34.4,,254.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.63,,,67.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,344.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,485.44,Percent of Total Billed Charges, ,67.63,,,67.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,518,Percent of Total Billed Charges, ,,85,,629,Percent of Total Billed Charges, ,,50,,370,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,503.2,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,414.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,444,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.52,,,65.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
75984 - CHANGE PRQ TUBE-DRAINAGE CATH W CONTRAST RSANDI,75984,HCPCS,,,RT,Outpatient,,,740,185,0.01,629,,,34.4,,254.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.63,,,67.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,344.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,485.44,Percent of Total Billed Charges, ,67.63,,,67.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,518,Percent of Total Billed Charges, ,,85,,629,Percent of Total Billed Charges, ,,50,,370,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,503.2,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,414.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,444,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.52,,,65.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
75984 - CHANGE PRQ TUBE-DRAINAGE CATH W CONTRAST RSANDI,75984,HCPCS,,,LT,Outpatient,,,740,185,0.01,629,,,34.4,,254.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.63,,,67.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,344.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,485.44,Percent of Total Billed Charges, ,67.63,,,67.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,518,Percent of Total Billed Charges, ,,85,,629,Percent of Total Billed Charges, ,,50,,370,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,503.2,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,414.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,444,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.52,,,65.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
75984 - CHANGE PRQ TUBE-DRAINAGE CATH W CONTRAST RSANDI,75984,HCPCS,,,50,Outpatient,,,2865,716.25,0.01,2435.25,,,34.4,,985.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.63,,,67.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,1332.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1879.44,Percent of Total Billed Charges, ,67.63,,,67.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2005.5,Percent of Total Billed Charges, ,,85,,2435.25,Percent of Total Billed Charges, ,,50,,1432.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1948.2,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1604.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1719,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.52,,,65.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,240.57,,,240.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76000 - FLUOROSCOPY UP TO 1 HOUR PHYSICIAN-QHP TIME,76000,HCPCS,,,XU,Outpatient,,,405,101.25,139.32,3030,,,34.4,,139.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.68,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,283.5,Percent of Total Billed Charges, ,,85,,344.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,275.4,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,226.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,243,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76000 - FLUOROSCOPY UP TO 1 HOUR PHYSICIAN-QHP TIME,76000,HCPCS,,,XP,Outpatient,,,405,101.25,139.32,3030,,,34.4,,139.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.68,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,283.5,Percent of Total Billed Charges, ,,85,,344.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,275.4,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,226.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,243,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76080 - RADEX ABSCESS-FISTULA-SINUS TRACT RSANDI,76080,HCPCS,,,XU,Outpatient,,,862,215.5,296.53,809.76,,,34.4,,296.53,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,519.21,,,519.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,779.23,,,779.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,809.76,,,809.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,565.47,Percent of Total Billed Charges, ,519.21,,,519.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,603.4,Percent of Total Billed Charges, ,,85,,732.7,Percent of Total Billed Charges, ,,50,,431,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,586.16,Percent of Total Billed Charges,0,593.95,,,593.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,482.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,517.2,Percent of Total Billed Charges, ,801.48,,,801.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,503.03,,,503.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.54,,,539.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,544.75,,,544.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.5,,,526.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.29,,,521.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.5,,,526.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,536.93,,,536.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.05,,,546.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
77001 - FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,77001,HCPCS,,,XU,Outpatient,,,509,127.25,0.01,432.65,,,34.4,,175.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.93,,,81.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,236.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,81.93,,,81.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,346.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.38,,,79.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,198.57,,,198.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.57,,,198.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.57,,,198.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.57,,,198.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77001 - FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,77001,HCPCS,,,RT,Outpatient,,,509,127.25,0.01,432.65,,,34.4,,175.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.93,,,81.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,236.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,81.93,,,81.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,346.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,79.38,,,79.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,198.57,,,198.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.57,,,198.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.57,,,198.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.57,,,198.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77002 - FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON,77002,HCPCS,,,XP,Outpatient,,,983,245.75,0.01,835.55,,,34.4,,338.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,84.95,,,84.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,457.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,644.85,Percent of Total Billed Charges, ,84.95,,,84.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,688.1,Percent of Total Billed Charges, ,,85,,835.55,Percent of Total Billed Charges, ,,50,,491.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,668.44,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,550.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,589.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.31,,,82.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77002 - FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON,77002,HCPCS,,,52,Outpatient,,,983,245.75,0.01,835.55,,,34.4,,338.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,84.95,,,84.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,457.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,644.85,Percent of Total Billed Charges, ,84.95,,,84.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,688.1,Percent of Total Billed Charges, ,,85,,835.55,Percent of Total Billed Charges, ,,50,,491.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,668.44,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,550.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,589.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.31,,,82.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77003 - FLUOR NEEDLE-CATH SPINE-PARASPINAL DX-THER ADDON,77003,HCPCS,,,XU,Outpatient,,,331,82.75,0.01,281.35,,,34.4,,113.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,75.16,,,75.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,153.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,217.14,Percent of Total Billed Charges, ,75.16,,,75.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,231.7,Percent of Total Billed Charges, ,,85,,281.35,Percent of Total Billed Charges, ,,50,,165.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,225.08,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,185.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,198.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.82,,,72.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,194.39,,,194.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77075 - RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPLETE,77075,HCPCS,,,FY,Outpatient,,,574,143.5,101.1,487.9,,,34.4,,197.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,376.54,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,401.8,Percent of Total Billed Charges, ,,85,,487.9,Percent of Total Billed Charges, ,,50,,287,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,390.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,321.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,344.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,214.11,,,214.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,214.11,,,214.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,214.11,,,214.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,214.11,,,214.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77080 - DXA BONE DENSITY STUDY 1-GREATER THAN SITES AXIAL SKEL,77080,HCPCS,,,GA,Outpatient,,,397,99.25,101.1,3030,,,34.4,,136.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,260.43,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,277.9,Percent of Total Billed Charges, ,,85,,337.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,269.96,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,222.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,238.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,460.59,,,460.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,460.59,,,460.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,460.59,,,460.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,460.59,,,460.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,0320,RC,,,,Outpatient,,,316.06,79.015,189.64,268.65,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,207.34,Percent of Total Billed Charges, ,,,,,,,,70,,221.24,Percent of Total Billed Charges, ,,85,,268.65,Percent of Total Billed Charges, ,,,,,,,,68,,214.92,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,189.64,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
73040 - RADEX SHOULDER ARTHROGRAPHY RSANDI,73040,HCPCS,,,RT,Outpatient,,,766,191.5,263.5,651.1,,,34.4,,263.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,502.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,536.2,Percent of Total Billed Charges, ,,85,,651.1,Percent of Total Billed Charges, ,,50,,383,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,520.88,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,428.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,459.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73040 - RADEX SHOULDER ARTHROGRAPHY RSANDI,73040,HCPCS,,,LT,Outpatient,,,766,191.5,263.5,651.1,,,34.4,,263.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,502.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,536.2,Percent of Total Billed Charges, ,,85,,651.1,Percent of Total Billed Charges, ,,50,,383,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,520.88,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,428.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,459.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73040 - RADEX SHOULDER ARTHROGRAPHY RSANDI,73040,HCPCS,,,50,Outpatient,,,1149,287.25,339.54,976.65,,,34.4,,395.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,753.74,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,804.3,Percent of Total Billed Charges, ,,85,,976.65,Percent of Total Billed Charges, ,,50,,574.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,781.32,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,643.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,689.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73085 - RADEX ELBOW ARTHROGRAPHY RSANDI,73085,HCPCS,,,RT,Outpatient,,,725,181.25,249.4,616.25,,,34.4,,249.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73085 - RADEX ELBOW ARTHROGRAPHY RSANDI,73085,HCPCS,,,LT,Outpatient,,,725,181.25,249.4,616.25,,,34.4,,249.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73115 - RADEX WRIST ARTHROGRAPHY RSANDI,73115,HCPCS,,,RT,Outpatient,,,725,181.25,249.4,616.25,,,34.4,,249.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73115 - RADEX WRIST ARTHROGRAPHY RSANDI,73115,HCPCS,,,LT,Outpatient,,,725,181.25,249.4,616.25,,,34.4,,249.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73115 - RADEX WRIST ARTHROGRAPHY RSANDI,73115,HCPCS,,,50,Outpatient,,,854,213.5,293.78,725.9,,,34.4,,293.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,560.22,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,597.8,Percent of Total Billed Charges, ,,85,,725.9,Percent of Total Billed Charges, ,,50,,427,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,580.72,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,478.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,512.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73525 - RADEX HIP ARTHROGRAPHY RSANDI,73525,HCPCS,,,RT,Outpatient,,,725,181.25,249.4,616.25,,,34.4,,249.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73525 - RADEX HIP ARTHROGRAPHY RSANDI,73525,HCPCS,,,LT,Outpatient,,,725,181.25,249.4,616.25,,,34.4,,249.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73525 - RADEX HIP ARTHROGRAPHY RSANDI,73525,HCPCS,,,50,Outpatient,,,1034,258.5,339.54,878.9,,,34.4,,355.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,678.3,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,723.8,Percent of Total Billed Charges, ,,85,,878.9,Percent of Total Billed Charges, ,,50,,517,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,703.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,579.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,620.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73580 - RADIOLOGIC EXAM KNEE ARTHROGRAPHY RSANDI,73580,HCPCS,,,RT,Outpatient,,,725,181.25,249.4,616.25,,,34.4,,249.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
73580 - RADIOLOGIC EXAM KNEE ARTHROGRAPHY RSANDI,73580,HCPCS,,,LT,Outpatient,,,725,181.25,249.4,616.25,,,34.4,,249.4,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.87,,,593.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0322 - RADIOLOGY - DIAGNOSTIC - ARTHROGRAPHY,0322,RC,,,,Outpatient,,,756.41,189.1025,453.85,642.95,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,496.2,Percent of Total Billed Charges, ,,,,,,,,70,,529.49,Percent of Total Billed Charges, ,,85,,642.95,Percent of Total Billed Charges, ,,,,,,,,68,,514.36,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,453.85,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
75625 - AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RSANDI,75625,HCPCS,,,XU,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75625 - AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RSANDI,75625,HCPCS,,,59,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75630 - AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RSANDI,75630,HCPCS,,,XU,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75630 - AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RSANDI,75630,HCPCS,,,59,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75705 - ANGIOGRAPHY SPINAL SELECTIVE RSANDI,75705,HCPCS,,,XU,Outpatient,,,9819,2454.75,3377.74,8346.15,,,34.4,,3377.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7690.38,,,7690.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6441.26,Percent of Total Billed Charges, ,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6873.3,Percent of Total Billed Charges, ,,85,,8346.15,Percent of Total Billed Charges, ,,50,,4909.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6676.92,Percent of Total Billed Charges,0,5867.56,,,5867.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5498.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5891.4,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4800.8,,,4800.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75710 - ANGIOGRAPHY EXTREMITY UNILATERAL RSANDI,75710,HCPCS,,,XU,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75710 - ANGIOGRAPHY EXTREMITY UNILATERAL RSANDI,75710,HCPCS,,,RT,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75710 - ANGIOGRAPHY EXTREMITY UNILATERAL RSANDI,75710,HCPCS,,,LT,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75710 - ANGIOGRAPHY EXTREMITY UNILATERAL RSANDI,75710,HCPCS,,,59,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75716 - ANGIOGRAPHY EXTREMITY BILATERAL RSANDI,75716,HCPCS,,,XU,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75716 - ANGIOGRAPHY EXTREMITY BILATERAL RSANDI,75716,HCPCS,,,LT,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75716 - ANGIOGRAPHY EXTREMITY BILATERAL RSANDI,75716,HCPCS,,,59,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75726 - ANGIOGRAPHY VISCERAL SLCTV-SUPRASLCTV RSANDI,75726,HCPCS,,,XU,Outpatient,,,9372,2343,3223.97,7983.44,,,34.4,,3223.97,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7690.38,,,7690.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6148.03,Percent of Total Billed Charges, ,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6560.4,Percent of Total Billed Charges, ,,85,,7966.2,Percent of Total Billed Charges, ,,50,,4686,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6372.96,Percent of Total Billed Charges,0,5867.56,,,5867.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5248.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5623.2,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4800.8,,,4800.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75736 - ANGIOGRAPHY PELVIC SLCTV-SUPRASLCTV RSANDI,75736,HCPCS,,,XU,Outpatient,,,8401,2100.25,2889.94,7983.44,,,34.4,,2889.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7690.38,,,7690.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5511.06,Percent of Total Billed Charges, ,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5880.7,Percent of Total Billed Charges, ,,85,,7140.85,Percent of Total Billed Charges, ,,50,,4200.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5712.68,Percent of Total Billed Charges,0,5867.56,,,5867.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4704.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5040.6,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4800.8,,,4800.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75736 - ANGIOGRAPHY PELVIC SLCTV-SUPRASLCTV RSANDI,75736,HCPCS,,,59,Outpatient,,,8401,2100.25,2889.94,7983.44,,,34.4,,2889.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7690.38,,,7690.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5511.06,Percent of Total Billed Charges, ,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5880.7,Percent of Total Billed Charges, ,,85,,7140.85,Percent of Total Billed Charges, ,,50,,4200.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5712.68,Percent of Total Billed Charges,0,5867.56,,,5867.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4704.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5040.6,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4800.8,,,4800.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75736 - ANGIOGRAPHY PELVIC SLCTV-SUPRASLCTV RSANDI,75736,HCPCS,,,50,Outpatient,,,8401,2100.25,2889.94,7983.44,,,34.4,,2889.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7690.38,,,7690.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5511.06,Percent of Total Billed Charges, ,4955.24,,,4955.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5880.7,Percent of Total Billed Charges, ,,85,,7140.85,Percent of Total Billed Charges, ,,50,,4200.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5712.68,Percent of Total Billed Charges,0,5867.56,,,5867.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4704.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5040.6,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4800.8,,,4800.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75741 - ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RSANDI,75741,HCPCS,,,XU,Outpatient,,,5043,1260.75,1734.79,4648.4,,,34.4,,1734.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4616.56,,,4616.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,2987.76,,,2987.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,,50,,2521.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,3519.84,,,3519.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2894.65,,,2894.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75774 - ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RSANDI,75774,HCPCS,,,XU,Outpatient,,,3105,776.25,0.01,2639.25,,,34.4,,1068.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.36,,,62.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,1443.83,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2036.88,Percent of Total Billed Charges, ,62.36,,,62.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2173.5,Percent of Total Billed Charges, ,,85,,2639.25,Percent of Total Billed Charges, ,,50,,1552.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2111.4,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1738.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1863,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.42,,,60.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
75774 - ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RSANDI,75774,HCPCS,,,LT,Outpatient,,,3105,776.25,0.01,2639.25,,,34.4,,1068.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.36,,,62.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,1443.83,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2036.88,Percent of Total Billed Charges, ,62.36,,,62.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2173.5,Percent of Total Billed Charges, ,,85,,2639.25,Percent of Total Billed Charges, ,,50,,1552.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2111.4,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1738.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1863,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.42,,,60.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY,0323,RC,,,,Outpatient,,,5524.68,1381.17,3314.81,4695.98,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,3624.19,Percent of Total Billed Charges, ,,,,,,,,70,,3867.28,Percent of Total Billed Charges, ,,85,,4695.98,Percent of Total Billed Charges, ,,,,,,,,68,,3756.78,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,3314.81,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
71045 - RADIOLOGIC EXAM CHEST SINGLE VIEW,71045,HCPCS,,,XU,Outpatient,,,171,42.75,35.22,3030,,,34.4,,58.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,119.7,Percent of Total Billed Charges, ,,85,,145.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,95.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,102.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71045 - RADIOLOGIC EXAM CHEST SINGLE VIEW,71045,HCPCS,,,XP,Outpatient,,,171,42.75,35.22,3030,,,34.4,,58.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,119.7,Percent of Total Billed Charges, ,,85,,145.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,95.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,102.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71045 - RADIOLOGIC EXAM CHEST SINGLE VIEW,71045,HCPCS,,,XE,Outpatient,,,171,42.75,35.22,3030,,,34.4,,58.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,119.7,Percent of Total Billed Charges, ,,85,,145.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,95.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,102.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71045 - RADIOLOGIC EXAM CHEST SINGLE VIEW,71045,HCPCS,,,FY,Outpatient,,,170.96,42.74,35.22,3030,,,34.4,,58.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.15,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,119.67,Percent of Total Billed Charges, ,,85,,145.32,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.25,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,95.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,102.58,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71045 - RADIOLOGIC EXAM CHEST SINGLE VIEW,71045,HCPCS,,,77,Outpatient,,,171,42.75,35.22,3030,,,34.4,,58.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,119.7,Percent of Total Billed Charges, ,,85,,145.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,95.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,102.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71045 - RADIOLOGIC EXAM CHEST SINGLE VIEW,71045,HCPCS,,,76,Outpatient,,,171,42.75,35.22,3030,,,34.4,,58.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.18,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,119.7,Percent of Total Billed Charges, ,,85,,145.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,95.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,102.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.22,,,35.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71046 - RADIOLOGIC EXAM CHEST 2 VIEWS,71046,HCPCS,,,XU,Outpatient,,,173,43.25,59.51,3030,,,34.4,,59.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,113.49,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,121.1,Percent of Total Billed Charges, ,,85,,147.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,117.64,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,96.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71046 - RADIOLOGIC EXAM CHEST 2 VIEWS,71046,HCPCS,,,PO,Outpatient,,,173,43.25,59.51,3030,,,34.4,,59.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,113.49,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,121.1,Percent of Total Billed Charges, ,,85,,147.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,117.64,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,96.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71046 - RADIOLOGIC EXAM CHEST 2 VIEWS,71046,HCPCS,,,FY,Outpatient,,,179.15,44.7875,61.63,3030,,,34.4,,61.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,117.52,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,125.41,Percent of Total Billed Charges, ,,85,,152.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,121.82,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,100.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,107.49,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.95,,,64.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71047 - RADIOLOGIC EXAM CHEST 3 VIEWS,71047,HCPCS,,,FY,Outpatient,,,153,38.25,52.63,130.45,,,34.4,,52.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,100.37,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.1,Percent of Total Billed Charges, ,,85,,130.05,Percent of Total Billed Charges, ,,50,,76.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,104.04,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,85.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,91.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.77,,,82.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.77,,,82.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.77,,,82.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,82.77,,,82.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71048 - RADIOLOGIC EXAM CHEST 4+ VIEWS,71048,HCPCS,,,FY,Outpatient,,,213,53.25,73.27,181.05,,,34.4,,73.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,139.73,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,149.1,Percent of Total Billed Charges, ,,85,,181.05,Percent of Total Billed Charges, ,,50,,106.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,144.84,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,119.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,127.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.15,,,85.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,85.15,,,85.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,85.15,,,85.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,85.15,,,85.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY,0324,RC,,,,Outpatient,,,172.94,43.235,103.76,147,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,113.45,Percent of Total Billed Charges, ,,,,,,,,70,,121.06,Percent of Total Billed Charges, ,,85,,147,Percent of Total Billed Charges, ,,,,,,,,68,,117.6,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,103.76,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
96401 - CHEMOTX ADMN SUBQ-IM NON-HORMONAL ANTI-NEO,96401,HCPCS,,,JB,Outpatient,,,468,117,67.66,397.8,,,34.4,,160.99,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,307.01,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,327.6,Percent of Total Billed Charges, ,,85,,397.8,Percent of Total Billed Charges, ,,50,,234,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,318.24,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,262.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,280.8,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96402 - CHEMOTX ADMN SUBQ-IM HORMONAL ANTI-NEO,96402,HCPCS,,,JB,Outpatient,,,209,52.25,67.66,177.65,,,34.4,,71.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,137.1,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,146.3,Percent of Total Billed Charges, ,,85,,177.65,Percent of Total Billed Charges, ,,50,,104.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,142.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,117.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,125.4,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0331 - RADIOLOGY - THERAPEUTIC AND-OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMIN - INJECTED,0331,RC,,,,Outpatient,,,454.56,113.64,272.74,960,,,,,,,,,,,,,,960,,,960,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,298.19,Percent of Total Billed Charges, ,,,,,,,,70,,318.19,Percent of Total Billed Charges, ,,85,,386.38,Percent of Total Billed Charges, ,,,,,,,,68,,309.1,Percent of Total Billed Charges,0,587,,,587,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,272.74,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
77280 - THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,77280,HCPCS,,,PO,Outpatient,,,881,220.25,126.23,3030,,,34.4,,303.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,577.94,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,616.7,Percent of Total Billed Charges, ,,85,,748.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,599.08,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,493.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,528.6,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,498.96,,,498.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,498.96,,,498.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,498.96,,,498.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,498.96,,,498.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77290 - THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,77290,HCPCS,,,PO,Outpatient,,,2344,586,348.04,3030,,,34.4,,806.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,540.63,,,540.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1537.66,Percent of Total Billed Charges, ,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1640.8,Percent of Total Billed Charges, ,,85,,1992.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1593.92,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,1312.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1406.4,Percent of Total Billed Charges, ,535.11,,,535.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,350.09,,,350.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,360.22,,,360.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.7,,,363.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,348.04,,,348.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.48,,,358.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,364.57,,,364.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891,,,891,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,891,,,891,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,891,,,891,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,891,,,891,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77293 - RESPIRATORY MOTION MANAGEMENT SIMULATION,77293,HCPCS,,,PO,Outpatient,,,1557,389.25,0.01,1323.45,,,34.4,,535.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,366.31,,,366.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1021.39,Percent of Total Billed Charges, ,366.31,,,366.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1089.9,Percent of Total Billed Charges, ,,85,,1323.45,Percent of Total Billed Charges, ,,50,,778.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1058.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,871.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,934.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.89,,,354.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1033.56,,,1033.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1033.56,,,1033.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1033.56,,,1033.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1033.56,,,1033.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77295 - 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS,77295,HCPCS,,,PO,Outpatient,,,8342,2085.5,1300.78,7090.7,,,34.4,,2869.65,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1342.63,,,1342.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2020.72,,,2020.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5472.35,Percent of Total Billed Charges, ,1342.63,,,1342.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5839.4,Percent of Total Billed Charges, ,,85,,7090.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5672.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,4671.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5005.2,Percent of Total Billed Charges, ,2000.07,,,2000.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1300.78,,,1300.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.39,,,1346.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1359.4,,,1359.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1313.87,,,1313.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1300.86,,,1300.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1313.87,,,1313.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.89,,,1339.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1362.65,,,1362.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1519.39,,,1519.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1519.39,,,1519.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1519.39,,,1519.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1519.39,,,1519.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77300 - BASIC RADIATION DOSIMETRY CALCULATION,77300,HCPCS,,,PO,Outpatient,,,867,216.75,126.23,3030,,,34.4,,298.25,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,568.75,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,606.9,Percent of Total Billed Charges, ,,85,,736.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,589.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,485.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,520.2,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,198.99,,,198.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.99,,,198.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.99,,,198.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.99,,,198.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77301 - NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,77301,HCPCS,,,PO,Outpatient,,,7332,1833,1300.78,6232.2,,,34.4,,2522.21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1342.63,,,1342.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2020.72,,,2020.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4809.79,Percent of Total Billed Charges, ,1342.63,,,1342.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5132.4,Percent of Total Billed Charges, ,,85,,6232.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4985.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,4105.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4399.2,Percent of Total Billed Charges, ,2000.07,,,2000.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1300.78,,,1300.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.39,,,1346.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1359.4,,,1359.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1313.87,,,1313.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1300.86,,,1300.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1313.87,,,1313.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.89,,,1339.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1362.65,,,1362.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2176.33,,,2176.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2176.33,,,2176.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2176.33,,,2176.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2176.33,,,2176.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77321 - SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,77321,HCPCS,,,PO,Outpatient,,,2046,511.5,348.04,3030,,,34.4,,703.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,540.63,,,540.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1342.18,Percent of Total Billed Charges, ,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1432.2,Percent of Total Billed Charges, ,,85,,1739.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1391.28,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,1145.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1227.6,Percent of Total Billed Charges, ,535.11,,,535.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,350.09,,,350.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,360.22,,,360.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.7,,,363.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,348.04,,,348.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.48,,,358.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,364.57,,,364.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,709.83,,,709.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,709.83,,,709.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,709.83,,,709.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,709.83,,,709.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77331 - SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,77331,HCPCS,,,PO,Outpatient,,,938,234.5,65.34,3030,,,34.4,,322.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,615.33,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,656.6,Percent of Total Billed Charges, ,,85,,797.3,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,637.84,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,525.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,562.8,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,65.34,,,65.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77332 - TX DEVICES DESIGN AND CONSTRUCTION SIMPLE,77332,HCPCS,,,XU,Outpatient,,,1502,375.5,126.23,3030,,,34.4,,516.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,985.31,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1051.4,Percent of Total Billed Charges, ,,85,,1276.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1021.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,841.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,901.2,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77332 - TX DEVICES DESIGN AND CONSTRUCTION SIMPLE,77332,HCPCS,,,PO,Outpatient,,,1502,375.5,126.23,3030,,,34.4,,516.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,985.31,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1051.4,Percent of Total Billed Charges, ,,85,,1276.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1021.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,841.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,901.2,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77333 - TX DEVICES DESIGN AND CONSTRUCTION INTERMEDIATE,77333,HCPCS,,,PO,Outpatient,,,1606,401.5,126.23,3030,,,34.4,,552.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1053.54,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1124.2,Percent of Total Billed Charges, ,,85,,1365.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1092.08,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,899.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,963.6,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.33,,,264.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,264.33,,,264.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,264.33,,,264.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,264.33,,,264.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77334 - TX DEVICES DESIGN AND CONSTRUCTION COMPLEX,77334,HCPCS,,,XU,Outpatient,,,1776,444,348.04,3030,,,34.4,,610.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,540.63,,,540.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1165.06,Percent of Total Billed Charges, ,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1243.2,Percent of Total Billed Charges, ,,85,,1509.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1207.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,994.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1065.6,Percent of Total Billed Charges, ,535.11,,,535.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,350.09,,,350.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,360.22,,,360.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.7,,,363.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,348.04,,,348.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.48,,,358.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,364.57,,,364.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77334 - TX DEVICES DESIGN AND CONSTRUCTION COMPLEX,77334,HCPCS,,,PO,Outpatient,,,1776,444,348.04,3030,,,34.4,,610.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,540.63,,,540.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1165.06,Percent of Total Billed Charges, ,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1243.2,Percent of Total Billed Charges, ,,85,,1509.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1207.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,994.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1065.6,Percent of Total Billed Charges, ,535.11,,,535.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,350.09,,,350.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,360.22,,,360.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.7,,,363.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,348.04,,,348.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.48,,,358.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,364.57,,,364.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77336 - CONTINUING MEDICAL PHYSICS CONSLTJ PR WK,77336,HCPCS,,,XU,Outpatient,,,915,228.75,126.23,3030,,,34.4,,314.76,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,600.24,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,640.5,Percent of Total Billed Charges, ,,85,,777.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,622.2,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,512.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,549,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,273.24,,,273.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,273.24,,,273.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,273.24,,,273.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,273.24,,,273.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77336 - CONTINUING MEDICAL PHYSICS CONSLTJ PR WK,77336,HCPCS,,,PO,Outpatient,,,915,228.75,126.23,3030,,,34.4,,314.76,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,600.24,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,640.5,Percent of Total Billed Charges, ,,85,,777.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,622.2,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,512.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,549,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,273.24,,,273.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,273.24,,,273.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,273.24,,,273.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,273.24,,,273.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77338 - MLC IMRT DESIGN AND CONSTRUCTION PER IMRT PLAN,77338,HCPCS,,,XU,Outpatient,,,7680,1920,348.04,6528,,,34.4,,2641.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,540.63,,,540.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5038.08,Percent of Total Billed Charges, ,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5376,Percent of Total Billed Charges, ,,85,,6528,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5222.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,4300.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4608,Percent of Total Billed Charges, ,535.11,,,535.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,350.09,,,350.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,360.22,,,360.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.7,,,363.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,348.04,,,348.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.48,,,358.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,364.57,,,364.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.78,,,664.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,664.78,,,664.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,664.78,,,664.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,664.78,,,664.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77338 - MLC IMRT DESIGN AND CONSTRUCTION PER IMRT PLAN,77338,HCPCS,,,PO,Outpatient,,,7680,1920,348.04,6528,,,34.4,,2641.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,540.63,,,540.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5038.08,Percent of Total Billed Charges, ,361.35,,,361.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5376,Percent of Total Billed Charges, ,,85,,6528,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5222.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,4300.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4608,Percent of Total Billed Charges, ,535.11,,,535.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,350.09,,,350.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,360.22,,,360.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.7,,,363.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,348.04,,,348.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,351.52,,,351.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.48,,,358.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,364.57,,,364.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.78,,,664.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,664.78,,,664.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,664.78,,,664.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,664.78,,,664.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77370 - SPEC MEDICAL RADJ PHYSICS CONSLTJ,77370,HCPCS,,,PO,Outpatient,,,928,232,126.23,3030,,,34.4,,319.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,608.77,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,649.6,Percent of Total Billed Charges, ,,85,,788.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,631.04,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,519.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,556.8,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,323.73,,,323.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,323.73,,,323.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,323.73,,,323.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,323.73,,,323.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77372 - RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR,77372,HCPCS,,,PO,Outpatient,,,17149,4287.25,2197.59,14576.65,,,34.4,,5899.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13502.93,,,13502.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,11289.81,,,11289.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11249.74,Percent of Total Billed Charges, ,13502.93,,,13502.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12004.3,Percent of Total Billed Charges, ,,85,,14576.65,Percent of Total Billed Charges, ,,50,,8574.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11661.32,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,9603.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10289.4,Percent of Total Billed Charges, ,11174.43,,,11174.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13082.09,,,13082.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7522.3,,,7522.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7594.98,,,7594.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7340.6,,,7340.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7267.92,,,7267.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7340.6,,,7340.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7485.96,,,7485.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7613.15,,,7613.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2197.59,,,2197.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2197.59,,,2197.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2197.59,,,2197.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2197.59,,,2197.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77373 - STEREOTACTIC BODY RADIATION TREATMENT DELIVERY,77373,HCPCS,,,PO,Outpatient,,,11922,2980.5,0.01,10133.7,,,34.4,,4101.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7156.55,,,7156.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2593.23,,,2593.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7820.83,Percent of Total Billed Charges, ,7156.55,,,7156.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8345.4,Percent of Total Billed Charges, ,,85,,10133.7,Percent of Total Billed Charges, ,,50,,5961,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8106.96,Percent of Total Billed Charges,0,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6676.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7153.2,Percent of Total Billed Charges, ,2566.72,,,2566.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6933.51,,,6933.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1727.84,,,1727.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1744.53,,,1744.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1686.1,,,1686.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1669.41,,,1669.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1686.1,,,1686.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1719.49,,,1719.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1748.71,,,1748.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4092.99,,,4092.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4092.99,,,4092.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4092.99,,,4092.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4092.99,,,4092.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77385 - INTENSITY MODULATED RADIATION TX DLVR SIMPLE,77385,HCPCS,,,PO,Outpatient,,,3204,801,0.01,3030,,,34.4,,1102.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,580.93,,,580.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,854.32,,,854.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2101.82,Percent of Total Billed Charges, ,580.93,,,580.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2242.8,Percent of Total Billed Charges, ,,85,,2723.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2178.72,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,1794.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1922.4,Percent of Total Billed Charges, ,845.58,,,845.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,562.82,,,562.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,569.22,,,569.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,574.72,,,574.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,555.47,,,555.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,549.97,,,549.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,555.47,,,555.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,566.47,,,566.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,576.09,,,576.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77386 - INTENSITY MODULATED RADIATION TX DLVR COMPLEX,77386,HCPCS,,,PO,Outpatient,,,3454,863.5,549.97,3030,,,34.4,,1188.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,580.93,,,580.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,854.32,,,854.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2265.82,Percent of Total Billed Charges, ,580.93,,,580.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2417.8,Percent of Total Billed Charges, ,,85,,2935.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2348.72,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,1934.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2072.4,Percent of Total Billed Charges, ,845.58,,,845.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,562.82,,,562.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,569.22,,,569.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,574.72,,,574.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,555.47,,,555.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,549.97,,,549.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,555.47,,,555.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,566.47,,,566.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,576.09,,,576.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1135.55,,,1135.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1135.55,,,1135.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1135.55,,,1135.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1135.55,,,1135.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77387 - GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR,77387,HCPCS,,,PO,Outpatient,,,768,192,0.01,652.8,,,34.4,,264.19,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,503.81,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,537.6,Percent of Total Billed Charges, ,,85,,652.8,Percent of Total Billed Charges, ,,50,,384,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,522.24,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,430.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,460.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,248.44,,,248.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,248.44,,,248.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,248.44,,,248.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,248.44,,,248.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77399 - UNLISTD PX MED RADJ PHYSIC DOSIMANDTX DEVANDSPEC SVC,77399,HCPCS,,,PO,Outpatient,,,474,118.5,0.01,3030,,,34.4,,163.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,196.08,,,196.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,310.94,Percent of Total Billed Charges, ,136.49,,,136.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,331.8,Percent of Total Billed Charges, ,,85,,402.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,322.32,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,265.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,284.4,Percent of Total Billed Charges, ,194.08,,,194.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.24,,,132.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.65,,,130.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.91,,,131.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.49,,,127.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.02,,,130.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.23,,,132.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77412 - RADIATION TREATMENT DELIVERY GREATER THAN =1 MEV COMPLEX,77412,HCPCS,,,PO,Outpatient,,,1258,314.5,225.72,3030,,,34.4,,432.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,254.82,,,254.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,388.39,,,388.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,825.25,Percent of Total Billed Charges, ,254.82,,,254.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,880.6,Percent of Total Billed Charges, ,,85,,1069.3,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,855.44,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,704.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,754.8,Percent of Total Billed Charges, ,384.42,,,384.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,246.88,,,246.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,258.78,,,258.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,261.28,,,261.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.53,,,252.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,250.03,,,250.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.53,,,252.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,257.53,,,257.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,261.91,,,261.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,225.72,,,225.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,225.72,,,225.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,225.72,,,225.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,225.72,,,225.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77417 - THERAPEUTIC RADIOLOGY PORT IMAGE(S),77417,HCPCS,,,PO,Outpatient,,,525,131.25,0.01,446.25,,,34.4,,180.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.9,,,11.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,344.4,Percent of Total Billed Charges, ,11.9,,,11.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,367.5,Percent of Total Billed Charges, ,,85,,446.25,Percent of Total Billed Charges, ,,50,,262.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,357,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,294,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,315,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.53,,,11.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,77.22,,,77.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77470 - SPECIAL TREATMENT PROCEDURE,77470,HCPCS,,,PO,Outpatient,,,3510,877.5,529.85,3030,,,34.4,,1207.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,580.93,,,580.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,854.32,,,854.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2302.56,Percent of Total Billed Charges, ,580.93,,,580.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2457,Percent of Total Billed Charges, ,,85,,2983.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2386.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,1965.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2106,Percent of Total Billed Charges, ,845.58,,,845.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,562.82,,,562.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,569.22,,,569.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,574.72,,,574.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,555.47,,,555.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,549.97,,,549.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,555.47,,,555.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,566.47,,,566.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,576.09,,,576.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,529.85,,,529.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,529.85,,,529.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,529.85,,,529.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,529.85,,,529.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0333 - RADIOLOGY - THERAPEUTIC AND-OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY,0333,RC,,,,Outpatient,,,2793.52,698.38,442,2374.49,,,,,,,,,,,,,,960,,,960,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,1832.55,Percent of Total Billed Charges, ,,,,,,,,70,,1955.46,Percent of Total Billed Charges, ,,85,,2374.49,Percent of Total Billed Charges, ,,,,,,,,68,,1899.59,Percent of Total Billed Charges,0,442,,,442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1676.11,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
38792 - INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE,38792,HCPCS,,,XU,Outpatient,,,1800,450,382.04,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,630.5,,,630.5,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,593.45,,,593.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,630.5,,,630.5,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,587.39,,,587.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,610.74,,,610.74,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,395.41,,,395.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,399.23,,,399.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.86,,,385.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,382.04,,,382.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.86,,,385.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,393.5,,,393.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,400.19,,,400.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78306 - BONE AND-JOINT IMAGING WHOLE BODY,78306,HCPCS,,,52,Outpatient,,,2496,624,175.23,3030,,,34.4,,858.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,396.88,,,396.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,593.45,,,593.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1637.38,Percent of Total Billed Charges, ,396.88,,,396.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1747.2,Percent of Total Billed Charges, ,,85,,2121.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1697.28,Percent of Total Billed Charges,0,,50,,1248,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1397.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1497.6,Percent of Total Billed Charges, ,587.39,,,587.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,384.51,,,384.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,395.41,,,395.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,399.23,,,399.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.86,,,385.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,382.04,,,382.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.86,,,385.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,393.5,,,393.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,400.19,,,400.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.23,,,175.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.23,,,175.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.23,,,175.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.23,,,175.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78452 - MYOCARDIAL SPECT MULTIPLE STUDIES,78452,HCPCS,,,GA,Outpatient,,,2996,749,792.13,2546.6,,,34.4,,1030.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1371.58,,,1371.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1928,,,1928,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1965.38,Percent of Total Billed Charges, ,1371.58,,,1371.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2097.2,Percent of Total Billed Charges, ,,85,,2546.6,Percent of Total Billed Charges, ,,50,,1498,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2037.28,Percent of Total Billed Charges,0,1606.31,,,1606.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1677.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1797.6,Percent of Total Billed Charges, ,1908.3,,,1908.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1328.83,,,1328.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1284.61,,,1284.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.02,,,1297.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1253.58,,,1253.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1241.17,,,1241.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1253.58,,,1253.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1278.41,,,1278.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1300.13,,,1300.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,792.13,,,792.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,792.13,,,792.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,792.13,,,792.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,792.13,,,792.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78452 - MYOCARDIAL SPECT MULTIPLE STUDIES,78452,HCPCS,,,52,Outpatient,,,2996,749,792.13,2546.6,,,34.4,,1030.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1371.58,,,1371.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1928,,,1928,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1965.38,Percent of Total Billed Charges, ,1371.58,,,1371.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2097.2,Percent of Total Billed Charges, ,,85,,2546.6,Percent of Total Billed Charges, ,,50,,1498,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2037.28,Percent of Total Billed Charges,0,1606.31,,,1606.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1677.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1797.6,Percent of Total Billed Charges, ,1908.3,,,1908.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1328.83,,,1328.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1284.61,,,1284.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.02,,,1297.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1253.58,,,1253.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1241.17,,,1241.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1253.58,,,1253.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1278.41,,,1278.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1300.13,,,1300.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,792.13,,,792.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,792.13,,,792.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,792.13,,,792.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,792.13,,,792.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78800 - RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING,78800,HCPCS,,,XU,Outpatient,,,905,226.25,89.1,3030,,,34.4,,311.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,396.88,,,396.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,593.45,,,593.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,593.68,Percent of Total Billed Charges, ,396.88,,,396.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,633.5,Percent of Total Billed Charges, ,,85,,769.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,615.4,Percent of Total Billed Charges,0,,50,,452.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,506.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,543,Percent of Total Billed Charges, ,587.39,,,587.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,384.51,,,384.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,395.41,,,395.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,399.23,,,399.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.86,,,385.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,382.04,,,382.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.86,,,385.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,393.5,,,393.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,400.19,,,400.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78800 - RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING,78800,HCPCS,,,53,Outpatient,,,905,226.25,89.1,3030,,,34.4,,311.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,396.88,,,396.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,593.45,,,593.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,593.68,Percent of Total Billed Charges, ,396.88,,,396.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,633.5,Percent of Total Billed Charges, ,,85,,769.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,615.4,Percent of Total Billed Charges,0,,50,,452.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,506.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,543,Percent of Total Billed Charges, ,587.39,,,587.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,384.51,,,384.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,395.41,,,395.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,399.23,,,399.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.86,,,385.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,382.04,,,382.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,385.86,,,385.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,393.5,,,393.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,400.19,,,400.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,89.1,,,89.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78803 - RP LOCLZJ TUM SPECT 1 AREA-ACQUISJ 1 DAY IMG,78803,HCPCS,,,XU,Outpatient,,,2002,500.5,106.92,3030,,,34.4,,688.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1371.58,,,1371.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1928,,,1928,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1313.31,Percent of Total Billed Charges, ,1371.58,,,1371.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1401.4,Percent of Total Billed Charges, ,,85,,1701.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1361.36,Percent of Total Billed Charges,0,,50,,1001,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1121.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1201.2,Percent of Total Billed Charges, ,1908.3,,,1908.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1328.83,,,1328.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1284.61,,,1284.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.02,,,1297.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1253.58,,,1253.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1241.17,,,1241.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1253.58,,,1253.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1278.41,,,1278.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1300.13,,,1300.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78803 - RP LOCLZJ TUM SPECT 1 AREA-ACQUISJ 1 DAY IMG,78803,HCPCS,,,53,Outpatient,,,2002,500.5,106.92,3030,,,34.4,,688.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1371.58,,,1371.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1928,,,1928,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1313.31,Percent of Total Billed Charges, ,1371.58,,,1371.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1401.4,Percent of Total Billed Charges, ,,85,,1701.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1361.36,Percent of Total Billed Charges,0,,50,,1001,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1121.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1201.2,Percent of Total Billed Charges, ,1908.3,,,1908.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1328.83,,,1328.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1284.61,,,1284.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.02,,,1297.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1253.58,,,1253.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1241.17,,,1241.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1253.58,,,1253.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1278.41,,,1278.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1300.13,,,1300.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,106.92,,,106.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0341 - NUCLEAR MEDICINE - DIAGNOSTIC,0341,RC,,,,Outpatient,,,1281.82,320.455,769.09,1089.55,,,,,,,,,,,,,,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,840.87,Percent of Total Billed Charges, ,,,,,,,,70,,897.27,Percent of Total Billed Charges, ,,85,,1089.55,Percent of Total Billed Charges, ,,,,,,,,68,,871.64,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,769.09,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
A9502 - TC99M TETROFOSMIN,A9502,HCPCS,,,GA,Outpatient,,,381,95.25,0.01,475.2,,,46,,175.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,106.93,,,106.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,108.73,,,108.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,249.94,Percent of Total Billed Charges, ,106.93,,,106.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,266.7,Percent of Total Billed Charges, ,,85,,323.85,Percent of Total Billed Charges, ,,50,,190.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,259.08,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,213.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,228.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.93,,,106.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,475.2,,,475.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,475.2,,,475.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,475.2,,,475.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,475.2,,,475.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
A9547 - IN111 OXYQUINOLINE,A9547,HCPCS,,,XU,Outpatient,,,3612,903,0.01,3070.2,,,46,,1661.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2639.65,,,2639.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2683.85,,,2683.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1141.08,,,1141.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2369.47,Percent of Total Billed Charges, ,2639.65,,,2639.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2528.4,Percent of Total Billed Charges, ,,85,,3070.2,Percent of Total Billed Charges, ,,50,,1806,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2456.16,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2022.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2167.2,Percent of Total Billed Charges, ,1129.42,,,1129.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2639.65,,,2639.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,760.29,,,760.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,767.64,,,767.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,741.93,,,741.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,734.58,,,734.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,741.93,,,741.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,756.62,,,756.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,769.47,,,769.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1215.56,,,1215.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1215.56,,,1215.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1215.56,,,1215.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1215.56,,,1215.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
A9552 - F18 FDG,A9552,HCPCS,,,PS,Outpatient,,,1044,261,0.01,887.4,,,46,,480.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,394.96,,,394.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,684.86,Percent of Total Billed Charges, ,394.96,,,394.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,730.8,Percent of Total Billed Charges, ,,85,,887.4,Percent of Total Billed Charges, ,,50,,522,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,709.92,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,584.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,626.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,394.96,,,394.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
A9552 - F18 FDG,A9552,HCPCS,,,PI,Outpatient,,,1044,261,0.01,887.4,,,46,,480.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,394.96,,,394.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,684.86,Percent of Total Billed Charges, ,394.96,,,394.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,730.8,Percent of Total Billed Charges, ,,85,,887.4,Percent of Total Billed Charges, ,,50,,522,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,709.92,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,584.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,626.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,394.96,,,394.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
A9552 - F18 FDG,A9552,HCPCS,,,KX,Outpatient,,,1044,261,0.01,887.4,,,46,,480.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,394.96,,,394.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,684.86,Percent of Total Billed Charges, ,394.96,,,394.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,730.8,Percent of Total Billed Charges, ,,85,,887.4,Percent of Total Billed Charges, ,,50,,522,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,709.92,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,584.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,626.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,394.96,,,394.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
A9592 - COPPER CU 64 DOTATATE DIAG,A9592,HCPCS,,,PS,Outpatient,,,9500,2375,0.01,8075,,,46,,4370,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1206.98,,,1206.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1227.19,,,1227.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,878.87,,,878.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6232,Percent of Total Billed Charges, ,1206.98,,,1206.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6650,Percent of Total Billed Charges, ,,85,,8075,Percent of Total Billed Charges, ,,50,,4750,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6460,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5320,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5700,Percent of Total Billed Charges, ,869.9,,,869.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1206.98,,,1206.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,585.59,,,585.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,591.25,,,591.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,571.45,,,571.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,565.79,,,565.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,571.45,,,571.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,582.76,,,582.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,592.67,,,592.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1066.38,,,1066.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1066.38,,,1066.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1066.38,,,1066.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1066.38,,,1066.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
A9592 - COPPER CU 64 DOTATATE DIAG,A9592,HCPCS,,,JZ,Outpatient,,,9500,2375,0.01,8075,,,46,,4370,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1206.98,,,1206.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1227.19,,,1227.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,878.87,,,878.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6232,Percent of Total Billed Charges, ,1206.98,,,1206.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6650,Percent of Total Billed Charges, ,,85,,8075,Percent of Total Billed Charges, ,,50,,4750,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6460,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5320,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5700,Percent of Total Billed Charges, ,869.9,,,869.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1206.98,,,1206.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,585.59,,,585.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,591.25,,,591.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,571.45,,,571.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,565.79,,,565.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,571.45,,,571.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,582.76,,,582.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,592.67,,,592.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1066.38,,,1066.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1066.38,,,1066.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1066.38,,,1066.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1066.38,,,1066.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
A9596 - GALLIUM ILLUCCIX 1 MILLICURE,A9596,HCPCS,,,PS,Outpatient,,,2350,587.5,611,2273.3,,,46,,1081,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,1081,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1254.6,,,1254.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1515.32,,,1515.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1541.6,Percent of Total Billed Charges, ,,46,,1081,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1645,Percent of Total Billed Charges, ,,85,,1997.5,Percent of Total Billed Charges, ,,50,,1175,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1598,Percent of Total Billed Charges,0,991.68,,,991.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1316,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1410,Percent of Total Billed Charges, ,1499.83,,,1499.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,611,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1009.64,,,1009.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.4,,,1019.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,985.26,,,985.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,975.5,,,975.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,985.26,,,985.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1004.77,,,1004.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1021.84,,,1021.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
A9596 - GALLIUM ILLUCCIX 1 MILLICURE,A9596,HCPCS,,,PI,Outpatient,,,2350,587.5,611,2273.3,,,46,,1081,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,1081,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1254.6,,,1254.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1515.32,,,1515.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1541.6,Percent of Total Billed Charges, ,,46,,1081,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1645,Percent of Total Billed Charges, ,,85,,1997.5,Percent of Total Billed Charges, ,,50,,1175,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1598,Percent of Total Billed Charges,0,991.68,,,991.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1316,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1410,Percent of Total Billed Charges, ,1499.83,,,1499.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,611,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1009.64,,,1009.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.4,,,1019.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,985.26,,,985.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,975.5,,,975.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,985.26,,,985.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1004.77,,,1004.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1021.84,,,1021.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
A9596 - GALLIUM ILLUCCIX 1 MILLICURE,A9596,HCPCS,,,JZ,Outpatient,,,2350,587.5,611,2273.3,,,46,,1081,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,1081,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1254.6,,,1254.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1515.32,,,1515.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1541.6,Percent of Total Billed Charges, ,,46,,1081,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1645,Percent of Total Billed Charges, ,,85,,1997.5,Percent of Total Billed Charges, ,,50,,1175,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1598,Percent of Total Billed Charges,0,991.68,,,991.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1316,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1410,Percent of Total Billed Charges, ,1499.83,,,1499.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,611,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1009.64,,,1009.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.4,,,1019.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,985.26,,,985.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,975.5,,,975.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,985.26,,,985.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1004.77,,,1004.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1021.84,,,1021.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2273.3,,,2273.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q9969 - NON-HEU TC-99M ADD-ON-DOSE,Q9969,HCPCS,,,53,Outpatient,,,25,6.25,0.01,21.25,,,46,,11.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11,,,11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,11.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.77,,,14.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16.4,Percent of Total Billed Charges, ,11,,,11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17.5,Percent of Total Billed Charges, ,,85,,21.25,Percent of Total Billed Charges, ,,50,,12.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17,Percent of Total Billed Charges,0,10,,,10,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15,Percent of Total Billed Charges, ,14.62,,,14.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11,,,11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.84,,,9.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.94,,,9.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.61,,,9.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.51,,,9.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.61,,,9.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.8,,,9.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.96,,,9.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS,0343,RC,,,,Outpatient,,,2704.84,676.21,1622.9,2299.11,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,1774.38,Percent of Total Billed Charges, ,,,,,,,,70,,1893.39,Percent of Total Billed Charges, ,,85,,2299.11,Percent of Total Billed Charges, ,,,,,,,,68,,1839.29,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,1622.9,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
75571 - CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,75571,HCPCS,,,PO,Outpatient,,,1471,367.75,83.36,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.96,,,162.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,162.96,,,162.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,162.96,,,162.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,162.96,,,162.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76380 - CT LIMITED-LOCALIZED FOLLOW UP STUDY,76380,HCPCS,,,XU,Outpatient,,,1471,367.75,83.36,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.13,,,86.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.13,,,86.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.13,,,86.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.13,,,86.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77012 - CT GUIDANCE NEEDLE PLACEMENT,77012,HCPCS,,,XU,Outpatient,,,1471,367.75,0.01,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.18,,,81.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,81.18,,,81.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.65,,,78.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
77012 - CT GUIDANCE NEEDLE PLACEMENT,77012,HCPCS,,,74,Outpatient,,,1471,367.75,0.01,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.18,,,81.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,81.18,,,81.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.65,,,78.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
77012 - CT GUIDANCE NEEDLE PLACEMENT,77012,HCPCS,,,73,Outpatient,,,1471,367.75,0.01,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,81.18,,,81.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,81.18,,,81.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.65,,,78.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0350 - CT SCAN - GENERAL CLASSIFICATION,0350,RC,,,,Outpatient,,,1471,367.75,400,1250.35,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,964.98,Percent of Total Billed Charges, ,,,,,,,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,882.6,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
70450 - CT HEAD-BRAIN W-O CONTRAST MATERIAL,70450,HCPCS,,,XU,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70450 - CT HEAD-BRAIN W-O CONTRAST MATERIAL,70450,HCPCS,,,XP,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70450 - CT HEAD-BRAIN W-O CONTRAST MATERIAL,70450,HCPCS,,,QJ,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70450 - CT HEAD-BRAIN W-O CONTRAST MATERIAL,70450,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70450 - CT HEAD-BRAIN W-O CONTRAST MATERIAL,70450,HCPCS,,,77,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70450 - CT HEAD-BRAIN W-O CONTRAST MATERIAL,70450,HCPCS,,,76,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,490.05,,,490.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70460 - CT HEAD-BRAIN W-CONTRAST MATERIAL,70460,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,617.76,,,617.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.76,,,617.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.76,,,617.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.76,,,617.76,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70470 - CT HEAD-BRAIN W-O AND W-CONTRAST MATERIAL,70470,HCPCS,,,XP,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,745.47,,,745.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,745.47,,,745.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,745.47,,,745.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,745.47,,,745.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70470 - CT HEAD-BRAIN W-O AND W-CONTRAST MATERIAL,70470,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,745.47,,,745.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,745.47,,,745.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,745.47,,,745.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,745.47,,,745.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70480 - CT ORBIT SELLA-POST FOSSA-EAR W-O CONTRAST MATRL,70480,HCPCS,,,XU,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70480 - CT ORBIT SELLA-POST FOSSA-EAR W-O CONTRAST MATRL,70480,HCPCS,,,XP,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70480 - CT ORBIT SELLA-POST FOSSA-EAR W-O CONTRAST MATRL,70480,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70481 - CT ORBIT SELLA-POST FOSSA-EAR W-CONTRAST MATRL,70481,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,656.37,,,656.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,656.37,,,656.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,656.37,,,656.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,656.37,,,656.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70482 - CT ORBIT SELLA-POST FOSSA-EAR W-O AND W-CONTR MATR,70482,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,763.29,,,763.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,763.29,,,763.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,763.29,,,763.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,763.29,,,763.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70486 - CT MAXILLOFACIAL W-O CONTRAST MATERIAL,70486,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,528.66,,,528.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,528.66,,,528.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,528.66,,,528.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,528.66,,,528.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70487 - CT MAXILLOFACIAL W-CONTRAST MATERIAL,70487,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,567.27,,,567.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,567.27,,,567.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,567.27,,,567.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,567.27,,,567.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70490 - CT SOFT TISSUE NECK W-O CONTRAST MATERIAL,70490,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,558.36,,,558.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,558.36,,,558.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,558.36,,,558.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,558.36,,,558.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70491 - CT SOFT TISSUE NECK W-CONTRAST MATERIAL,70491,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,677.16,,,677.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,677.16,,,677.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,677.16,,,677.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,677.16,,,677.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70492 - CT SOFT TISSUE NECK W-O AND W-CONTRAST MATERIAL,70492,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,421.74,,,421.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,421.74,,,421.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,421.74,,,421.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,421.74,,,421.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70496 - CT ANGIOGRAPHY HEAD W-CONTRAST-NONCONTRAST,70496,HCPCS,,,XU,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70496 - CT ANGIOGRAPHY HEAD W-CONTRAST-NONCONTRAST,70496,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70498 - CT ANGIOGRAPHY NECK W-CONTRAST-NONCONTRAST,70498,HCPCS,,,XU,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70498 - CT ANGIOGRAPHY NECK W-CONTRAST-NONCONTRAST,70498,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,834.27,,,834.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0351 - CT SCAN - HEAD SCAN,0351,RC,,,,Outpatient,,,1471,367.75,400,1250.35,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,964.98,Percent of Total Billed Charges, ,,,,,,,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,882.6,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
71250 - DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W-O CNTRST,71250,HCPCS,,,XU,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71250 - DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W-O CNTRST,71250,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71260 - DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W-CONTRAST,71260,HCPCS,,,XU,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.08,,,784.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,784.08,,,784.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,784.08,,,784.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,784.08,,,784.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71260 - DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W-CONTRAST,71260,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.08,,,784.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,784.08,,,784.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,784.08,,,784.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,784.08,,,784.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71270 - DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C--C+,71270,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,980.1,,,980.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,980.1,,,980.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,980.1,,,980.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,980.1,,,980.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71271 - COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-,71271,HCPCS,,,XP,Outpatient,,,1471,367.75,85.77,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,88.53,,,88.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,88.53,,,88.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.77,,,85.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71271 - COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-,71271,HCPCS,,,PO,Outpatient,,,1471,367.75,85.77,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,88.53,,,88.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,88.53,,,88.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.77,,,85.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71271 - COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-,71271,HCPCS,,,GA,Outpatient,,,1471,367.75,85.77,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,88.53,,,88.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,88.53,,,88.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.77,,,85.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,280.34,,,280.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71275 - CT ANGIOGRAPHY CHEST W-CONTRAST-NONCONTRAST,71275,HCPCS,,,XP,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1013.6,,,1013.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1013.6,,,1013.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1013.6,,,1013.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1013.6,,,1013.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71275 - CT ANGIOGRAPHY CHEST W-CONTRAST-NONCONTRAST,71275,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1013.6,,,1013.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1013.6,,,1013.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1013.6,,,1013.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1013.6,,,1013.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72125 - CT CERVICAL SPINE W-O CONTRAST MATERIAL,72125,HCPCS,,,QJ,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72125 - CT CERVICAL SPINE W-O CONTRAST MATERIAL,72125,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72125 - CT CERVICAL SPINE W-O CONTRAST MATERIAL,72125,HCPCS,,,77,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72125 - CT CERVICAL SPINE W-O CONTRAST MATERIAL,72125,HCPCS,,,76,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72128 - CT THORACIC SPINE W-O CONTRAST MATERIAL,72128,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72129 - CT THORACIC SPINE W-CONTRAST MATERIAL,72129,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72131 - CT LUMBAR SPINE W-O CONTRAST MATERIAL,72131,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,638.55,,,638.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72132 - CT LUMBAR SPINE W-CONTRAST MATERIAL,72132,HCPCS,,,PO,Outpatient,,,1471,367.75,339.54,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72192 - CT PELVIS W-O CONTRAST MATERIAL,72192,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,677.16,,,677.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,677.16,,,677.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,677.16,,,677.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,677.16,,,677.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72193 - CT PELVIS W-CONTRAST MATERIAL,72193,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,754.38,,,754.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,754.38,,,754.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,754.38,,,754.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,754.38,,,754.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72194 - CT PELVIS W-O AND W-CONTRAST MATERIAL,72194,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.7,,,920.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,920.7,,,920.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,920.7,,,920.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,920.7,,,920.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73200 - CT UPPER EXTREMITY W-O CONTRAST MATERIAL,73200,HCPCS,,,RT,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73200 - CT UPPER EXTREMITY W-O CONTRAST MATERIAL,73200,HCPCS,,,LT,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73200 - CT UPPER EXTREMITY W-O CONTRAST MATERIAL,73200,HCPCS,,,50,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,549.45,,,549.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73201 - CT UPPER EXTREMITY W-CONTRAST MATERIAL,73201,HCPCS,,,RT,Outpatient,,,1471,367.75,339.54,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73201 - CT UPPER EXTREMITY W-CONTRAST MATERIAL,73201,HCPCS,,,LT,Outpatient,,,1471,367.75,339.54,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73202 - CT UPPER EXTREMITY W-O AND W-CONTRAST MATERIAL,73202,HCPCS,,,RT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73202 - CT UPPER EXTREMITY W-O AND W-CONTRAST MATERIAL,73202,HCPCS,,,LT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73206 - CT ANGIOGRAPHY UPPER EXTREMITY,73206,HCPCS,,,RT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73206 - CT ANGIOGRAPHY UPPER EXTREMITY,73206,HCPCS,,,LT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73700 - CT LOWER EXTREMITY W-O CONTRAST MATERIAL,73700,HCPCS,,,RT,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73700 - CT LOWER EXTREMITY W-O CONTRAST MATERIAL,73700,HCPCS,,,LT,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73700 - CT LOWER EXTREMITY W-O CONTRAST MATERIAL,73700,HCPCS,,,77,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73700 - CT LOWER EXTREMITY W-O CONTRAST MATERIAL,73700,HCPCS,,,50,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.54,,,540.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73701 - CT LOWER EXTREMITY W-CONTRAST MATERIAL,73701,HCPCS,,,RT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73701 - CT LOWER EXTREMITY W-CONTRAST MATERIAL,73701,HCPCS,,,LT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.92,,,403.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73702 - CT LOWER EXTREMITY W-O AND W-CONTRAST MATRL,73702,HCPCS,,,RT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73702 - CT LOWER EXTREMITY W-O AND W-CONTRAST MATRL,73702,HCPCS,,,LT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.14,,,481.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73706 - CT ANGIOGRAPHY LOWER EXTREMITY,73706,HCPCS,,,RT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73706 - CT ANGIOGRAPHY LOWER EXTREMITY,73706,HCPCS,,,LT,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,856.55,,,856.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74150 - CT ABDOMEN W-O CONTRAST MATERIAL,74150,HCPCS,,,PO,Outpatient,,,1471,367.75,101.1,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,647.46,,,647.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,647.46,,,647.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,647.46,,,647.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,647.46,,,647.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74160 - CT ABDOMEN W-CONTRAST MATERIAL,74160,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,775.17,,,775.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74170 - CT ABDOMEN W-O CONTRAST FLWD BY CONTRAST MATRL,74170,HCPCS,,,XU,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,941.49,,,941.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,941.49,,,941.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,941.49,,,941.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,941.49,,,941.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74170 - CT ABDOMEN W-O CONTRAST FLWD BY CONTRAST MATRL,74170,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,941.49,,,941.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,941.49,,,941.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,941.49,,,941.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,941.49,,,941.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74174 - CTA ABDANDPLVS W-CNTRST AND IMG POSTPROCESSING,74174,HCPCS,,,XU,Outpatient,,,1471,367.75,339.54,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1274.61,,,1274.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1274.61,,,1274.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1274.61,,,1274.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1274.61,,,1274.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74174 - CTA ABDANDPLVS W-CNTRST AND IMG POSTPROCESSING,74174,HCPCS,,,PO,Outpatient,,,1471,367.75,339.54,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1274.61,,,1274.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1274.61,,,1274.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1274.61,,,1274.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1274.61,,,1274.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74175 - CTA ABDOMEN W-CONTRASTANDIMG POSTPROCESSING,74175,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,974.61,,,974.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,974.61,,,974.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,974.61,,,974.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,974.61,,,974.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74176 - CT ABDOMEN AND PELVIS W-O CONTRAST MATERIAL,74176,HCPCS,,,XU,Outpatient,,,1471,367.75,229.81,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74176 - CT ABDOMEN AND PELVIS W-O CONTRAST MATERIAL,74176,HCPCS,,,XP,Outpatient,,,1471,367.75,229.81,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74176 - CT ABDOMEN AND PELVIS W-O CONTRAST MATERIAL,74176,HCPCS,,,XE,Outpatient,,,1471,367.75,229.81,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74176 - CT ABDOMEN AND PELVIS W-O CONTRAST MATERIAL,74176,HCPCS,,,PO,Outpatient,,,1471,367.75,229.81,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74177 - CT ABDOMEN AND PELVIS W-CONTRAST MATERIAL,74177,HCPCS,,,XU,Outpatient,,,1471,367.75,339.54,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,612.62,,,612.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,612.62,,,612.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,612.62,,,612.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,612.62,,,612.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74177 - CT ABDOMEN AND PELVIS W-CONTRAST MATERIAL,74177,HCPCS,,,PO,Outpatient,,,1471,367.75,339.54,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,612.62,,,612.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,612.62,,,612.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,612.62,,,612.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,612.62,,,612.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74178 - CT ABDANDPLV W-O CNTRST 1-BTH FLWD CNTRST 1-BTH,74178,HCPCS,,,TC,Outpatient,,,1471,367.75,339.54,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,810.66,,,810.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,810.66,,,810.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,810.66,,,810.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,810.66,,,810.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74178 - CT ABDANDPLV W-O CNTRST 1-BTH FLWD CNTRST 1-BTH,74178,HCPCS,,,PO,Outpatient,,,1471,367.75,339.54,3030,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,810.66,,,810.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,810.66,,,810.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,810.66,,,810.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,810.66,,,810.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
75635 - CTA ABDL AORTAANDBI ILIOFEM W-CONTRASTANDPOSTP,75635,HCPCS,,,PO,Outpatient,,,1471,367.75,169.25,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,262.91,,,262.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,196.46,,,196.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,219.62,,,219.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,260.22,,,260.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.33,,,190.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.17,,,175.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.87,,,176.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.25,,,169.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.94,,,170.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.33,,,174.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.29,,,177.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,974.61,,,974.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,974.61,,,974.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,974.61,,,974.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,974.61,,,974.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0352 - CT SCAN - BODY SCAN,0352,RC,,,,Outpatient,,,1471,367.75,400,1250.35,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,964.98,Percent of Total Billed Charges, ,,,,,,,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,882.6,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
76377 - 3D RENDERING W-INTERPANDPOSTPROC DIFF WORK STATION,76377,HCPCS,,,XU,Outpatient,,,1471,367.75,0.01,1250.35,,,34.4,,506.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.75,,,33.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,964.98,Percent of Total Billed Charges, ,33.75,,,33.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1000.28,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,823.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,882.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.69,,,32.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0359 - CT SCAN - CT - OTHER,0359,RC,,,,Outpatient,,,1471,367.75,400,1250.35,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,964.98,Percent of Total Billed Charges, ,,,,,,,,70,,1029.7,Percent of Total Billed Charges, ,,85,,1250.35,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1000.28,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,882.6,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
0216T - NJX DX-THER PARAVER FCT JT W-US LUMB-SAC 1 LVL,0216T,HCPCS,,,50,Outpatient,,,1261,315.25,0.01,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,827.22,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,882.7,Percent of Total Billed Charges, ,,85,,1071.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,857.48,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,756.6,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0236T - TRLUML PERIPH ATHRC W-RSANDI ABDOM AORTA,0236T,HCPCS,,,LT,Outpatient,,,17696,4424,0.01,16748.39,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11608.58,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12387.2,Percent of Total Billed Charges, ,,85,,15041.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12033.28,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,10617.6,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0238T - TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA,0238T,HCPCS,,,XU,Outpatient,,,28765,7191.25,0.01,26519.48,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18869.84,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20135.5,Percent of Total Billed Charges, ,,85,,24450.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19560.2,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,17259,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0238T - TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA,0238T,HCPCS,,,RT,Outpatient,,,28765,7191.25,0.01,26519.48,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18869.84,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20135.5,Percent of Total Billed Charges, ,,85,,24450.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19560.2,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,17259,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0238T - TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA,0238T,HCPCS,,,LT,Outpatient,,,22678.26,5669.565,0.01,26519.48,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14876.94,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15874.78,Percent of Total Billed Charges, ,,85,,19276.52,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,15421.22,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,13606.96,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0707T - NJX BONE SUB MATRL INTO SUBCHONDRAL BONE DEFECT,0707T,HCPCS,,,RT,Outpatient,,,374.17,93.5425,0.01,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,245.46,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,261.92,Percent of Total Billed Charges, ,,85,,318.04,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,254.44,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,224.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0707T - NJX BONE SUB MATRL INTO SUBCHONDRAL BONE DEFECT,0707T,HCPCS,,,LT,Outpatient,,,253.35,63.3375,0.01,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,166.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,177.35,Percent of Total Billed Charges, ,,85,,215.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,172.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,152.01,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
10005 - FINE NEEDLE ASPIRATION BX W-US GDN 1ST LESION,10005,HCPCS,,,XU,Outpatient,,,1863.33,465.8325,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1222.34,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1304.33,Percent of Total Billed Charges, ,,85,,1583.83,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1267.06,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1043.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1118,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10005 - FINE NEEDLE ASPIRATION BX W-US GDN 1ST LESION,10005,HCPCS,,,XS,Outpatient,,,2106,526.5,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1381.54,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1474.2,Percent of Total Billed Charges, ,,85,,1790.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1432.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1179.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1263.6,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10005 - FINE NEEDLE ASPIRATION BX W-US GDN 1ST LESION,10005,HCPCS,,,RT,Outpatient,,,1872.13,468.0325,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1228.12,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1310.49,Percent of Total Billed Charges, ,,85,,1591.31,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1273.05,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1048.39,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1123.28,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10005 - FINE NEEDLE ASPIRATION BX W-US GDN 1ST LESION,10005,HCPCS,,,LT,Outpatient,,,1939.62,484.905,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1272.39,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1357.73,Percent of Total Billed Charges, ,,85,,1648.68,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1318.94,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1086.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1163.77,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10005 - FINE NEEDLE ASPIRATION BX W-US GDN 1ST LESION,10005,HCPCS,,,73,Outpatient,,,2056,514,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1348.74,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1439.2,Percent of Total Billed Charges, ,,85,,1747.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1398.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1151.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1233.6,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10005 - FINE NEEDLE ASPIRATION BX W-US GDN 1ST LESION,10005,HCPCS,,,52,Outpatient,,,2056,514,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1348.74,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1439.2,Percent of Total Billed Charges, ,,85,,1747.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1398.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1151.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1233.6,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10006 - FINE NEEDLE ASPIRATION BX W-US GDN EA ADDL,10006,HCPCS,,,XU,Outpatient,,,1169.79,292.4475,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,767.38,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,818.85,Percent of Total Billed Charges, ,,85,,994.32,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,795.46,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,655.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,701.87,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
10006 - FINE NEEDLE ASPIRATION BX W-US GDN EA ADDL,10006,HCPCS,,,XS,Outpatient,,,1370.66,342.665,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,899.15,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,959.46,Percent of Total Billed Charges, ,,85,,1165.06,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,932.05,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,767.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,822.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
10006 - FINE NEEDLE ASPIRATION BX W-US GDN EA ADDL,10006,HCPCS,,,RT,Outpatient,,,1417.39,354.3475,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,929.81,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,992.17,Percent of Total Billed Charges, ,,85,,1204.78,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,963.83,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,793.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,850.43,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
10006 - FINE NEEDLE ASPIRATION BX W-US GDN EA ADDL,10006,HCPCS,,,LT,Outpatient,,,1442.05,360.5125,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,945.98,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1009.44,Percent of Total Billed Charges, ,,85,,1225.74,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,980.59,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,807.55,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,865.23,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
10030 - IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ,10030,HCPCS,,,XU,Outpatient,,,6400.66,1600.165,668.93,5440.56,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4198.83,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4480.46,Percent of Total Billed Charges, ,,85,,5440.56,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4352.45,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3584.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3840.4,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10060 - INCISION AND DRAINAGE ABSCESS SIMPLE-SINGLE,10060,HCPCS,,,XU,Outpatient,,,8963.5,2240.875,188.91,7618.98,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5880.06,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6274.45,Percent of Total Billed Charges, ,,85,,7618.98,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6095.18,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5019.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5378.1,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10060 - INCISION AND DRAINAGE ABSCESS SIMPLE-SINGLE,10060,HCPCS,,,RT,Outpatient,,,9081,2270.25,188.91,7718.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5957.14,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6356.7,Percent of Total Billed Charges, ,,85,,7718.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6175.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5085.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5448.6,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10061 - INCISION AND DRAINAGE ABSCESS COMPLICATED-MULTIPLE,10061,HCPCS,,,RT,Outpatient,,,14207,3551.75,379.85,12075.95,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9319.79,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9944.9,Percent of Total Billed Charges, ,,85,,12075.95,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9660.76,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7955.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8524.2,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,RT,Outpatient,,,8136.34,2034.085,379.85,6915.89,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5337.44,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5695.44,Percent of Total Billed Charges, ,,85,,6915.89,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5532.71,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4556.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4881.8,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,LT,Outpatient,,,5383.4,1345.85,379.85,4575.89,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3531.51,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3768.38,Percent of Total Billed Charges, ,,85,,4575.89,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3660.71,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3014.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3230.04,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,F9,Outpatient,,,13742,3435.5,379.85,11680.7,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9014.75,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9619.4,Percent of Total Billed Charges, ,,85,,11680.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9344.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7695.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8245.2,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,F5,Outpatient,,,8432.5,2108.125,379.85,7167.63,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5531.72,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5902.75,Percent of Total Billed Charges, ,,85,,7167.63,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5734.1,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4722.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5059.5,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10121 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS COMP,10121,HCPCS,,,RT,Outpatient,,,5682.79,1420.6975,742.5,4830.37,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3727.91,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3977.95,Percent of Total Billed Charges, ,,85,,4830.37,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3864.3,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3182.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3409.67,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10121 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS COMP,10121,HCPCS,,,74,Outpatient,,,19012,4753,742.5,16160.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12471.87,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13308.4,Percent of Total Billed Charges, ,,85,,16160.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12928.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10646.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11407.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10140 - IANDD HEMATOMA SEROMA-FLUID COLLECTION,10140,HCPCS,,,LT,Outpatient,,,16488,4122,742.5,14014.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10816.13,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11541.6,Percent of Total Billed Charges, ,,85,,14014.8,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11211.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9233.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9892.8,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA-CYST,10160,HCPCS,,,LT,Outpatient,,,12192,3048,379.85,10363.2,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7997.95,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8534.4,Percent of Total Billed Charges, ,,85,,10363.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8290.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6827.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7315.2,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10180 - INCISION AND DRAINAGE COMPLEX PO WOUND INFECTION,10180,HCPCS,,,LT,Outpatient,,,16756,4189,742.5,14242.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10991.94,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11729.2,Percent of Total Billed Charges, ,,85,,14242.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11394.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9383.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10053.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11000 - DBRDMT EXTENSV ECZMT-INFCT SKIN UP 10PERCENT BDY SURF,11000,HCPCS,,,XU,Outpatient,,,4374,1093.5,581.98,3717.9,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2869.34,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3061.8,Percent of Total Billed Charges, ,,85,,3717.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2974.32,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2449.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2624.4,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11012 - DBRDMT FXAND-DISLC SUBQ T-M-F BONE,11012,HCPCS,,,XU,Outpatient,,,5741.5,1435.375,742.5,4880.28,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3766.42,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4019.05,Percent of Total Billed Charges, ,,85,,4880.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3904.22,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3215.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3444.9,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11012 - DBRDMT FXAND-DISLC SUBQ T-M-F BONE,11012,HCPCS,,,XS,Outpatient,,,5751.87,1437.9675,742.5,4889.09,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3773.23,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4026.31,Percent of Total Billed Charges, ,,85,,4889.09,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3911.27,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3221.05,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3451.12,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11012 - DBRDMT FXAND-DISLC SUBQ T-M-F BONE,11012,HCPCS,,,RT,Outpatient,,,11435,2858.75,742.5,9719.75,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7501.36,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8004.5,Percent of Total Billed Charges, ,,85,,9719.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7775.8,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6403.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6861,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11012 - DBRDMT FXAND-DISLC SUBQ T-M-F BONE,11012,HCPCS,,,LT,Outpatient,,,9841.3,2460.325,742.5,8365.11,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6455.89,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6888.91,Percent of Total Billed Charges, ,,85,,8365.11,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6692.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5511.13,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5904.78,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11012 - DBRDMT FXAND-DISLC SUBQ T-M-F BONE,11012,HCPCS,,,F7,Outpatient,,,6337.34,1584.335,742.5,5386.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4157.3,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4436.14,Percent of Total Billed Charges, ,,85,,5386.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4309.39,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3548.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3802.4,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11012 - DBRDMT FXAND-DISLC SUBQ T-M-F BONE,11012,HCPCS,,,F4,Outpatient,,,9273.5,2318.375,742.5,7882.48,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6083.42,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6491.45,Percent of Total Billed Charges, ,,85,,7882.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6305.98,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5193.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5564.1,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,XU,Outpatient,,,7388.67,1847.1675,379.85,6280.37,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4846.97,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5172.07,Percent of Total Billed Charges, ,,85,,6280.37,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5024.3,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4137.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4433.2,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,XS,Outpatient,,,7654.56,1913.64,379.85,6506.38,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5021.39,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5358.19,Percent of Total Billed Charges, ,,85,,6506.38,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5205.1,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4286.55,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4592.74,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,RT,Outpatient,,,11947,2986.75,379.85,10154.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7837.23,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8362.9,Percent of Total Billed Charges, ,,85,,10154.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8123.96,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6690.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7168.2,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,LT,Outpatient,,,11895.25,2973.8125,379.85,10110.96,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7803.28,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8326.68,Percent of Total Billed Charges, ,,85,,10110.96,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8088.77,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6661.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7137.15,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,73,Outpatient,,,4478,1119.5,379.85,3806.3,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2937.57,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3134.6,Percent of Total Billed Charges, ,,85,,3806.3,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3045.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2507.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2686.8,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11043 - DEBRIDEMENT MUSCLE AND-FASCIA 1ST 20 SQ CM-LESS THAN,11043,HCPCS,,,XU,Outpatient,,,6521.38,1630.345,581.98,5543.17,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4278.03,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4564.97,Percent of Total Billed Charges, ,,85,,5543.17,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4434.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3651.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3912.83,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11043 - DEBRIDEMENT MUSCLE AND-FASCIA 1ST 20 SQ CM-LESS THAN,11043,HCPCS,,,XS,Outpatient,,,9374.8,2343.7,581.98,7968.58,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6149.87,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6562.36,Percent of Total Billed Charges, ,,85,,7968.58,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6374.86,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5249.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5624.88,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11043 - DEBRIDEMENT MUSCLE AND-FASCIA 1ST 20 SQ CM-LESS THAN,11043,HCPCS,,,RT,Outpatient,,,7722.63,1930.6575,581.98,6564.24,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5066.05,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5405.84,Percent of Total Billed Charges, ,,85,,6564.24,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5251.39,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4324.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4633.58,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11043 - DEBRIDEMENT MUSCLE AND-FASCIA 1ST 20 SQ CM-LESS THAN,11043,HCPCS,,,78,Outpatient,,,18547,4636.75,581.98,15764.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12166.83,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12982.9,Percent of Total Billed Charges, ,,85,,15764.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12611.96,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10386.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11128.2,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11044 - DEBRIDEMENT BONE 1ST 20 SQ CM-LESS THAN,11044,HCPCS,,,XU,Outpatient,,,6393.93,1598.4825,742.5,5434.84,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4194.42,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4475.75,Percent of Total Billed Charges, ,,85,,5434.84,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4347.87,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3580.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3836.36,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11044 - DEBRIDEMENT BONE 1ST 20 SQ CM-LESS THAN,11044,HCPCS,,,RT,Outpatient,,,7175.68,1793.92,742.5,6099.33,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4707.25,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5022.98,Percent of Total Billed Charges, ,,85,,6099.33,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4879.46,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4018.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4305.41,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11044 - DEBRIDEMENT BONE 1ST 20 SQ CM-LESS THAN,11044,HCPCS,,,LT,Outpatient,,,13622,3405.5,742.5,11578.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8936.03,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9535.4,Percent of Total Billed Charges, ,,85,,11578.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9262.96,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7628.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8173.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11045 - DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM,11045,HCPCS,,,XU,Outpatient,,,4529,1132.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2971.02,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3170.3,Percent of Total Billed Charges, ,,85,,3849.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3079.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2536.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2717.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
11046 - DEBRIDEMENT MUSCLE AND-FASCIA EA ADDL 20 SQ CM,11046,HCPCS,,,XU,Outpatient,,,7029.49,1757.3725,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4611.35,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4920.64,Percent of Total Billed Charges, ,,85,,5975.07,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4780.05,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3936.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4217.69,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
11046 - DEBRIDEMENT MUSCLE AND-FASCIA EA ADDL 20 SQ CM,11046,HCPCS,,,XS,Outpatient,,,5459,1364.75,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3581.1,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3821.3,Percent of Total Billed Charges, ,,85,,4640.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3712.12,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3057.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3275.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
11047 - DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,11047,HCPCS,,,XU,Outpatient,,,4849.88,1212.47,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3181.52,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3394.92,Percent of Total Billed Charges, ,,85,,4122.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3297.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2715.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2909.93,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
11104 - PUNCH BIOPSY SKIN SINGLE LESION,11104,HCPCS,,,XS,Outpatient,,,3526.25,881.5625,379.85,9153,,,,,,,Service Paid at Rev Code level,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2313.22,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2468.38,Percent of Total Billed Charges, ,,85,,2997.31,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2397.85,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1974.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2115.75,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11106 - INCISIONAL BIOPSY SKIN SINGLE LESION,11106,HCPCS,,,LT,Outpatient,,,15209,3802.25,581.98,12927.65,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9977.1,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10646.3,Percent of Total Billed Charges, ,,85,,12927.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10342.12,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8517.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9125.4,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11200 - RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TOANDINC 15,11200,HCPCS,,,RT,Outpatient,,,12365.5,3091.375,0.01,10510.68,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8111.77,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8655.85,Percent of Total Billed Charges, ,,85,,10510.68,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8408.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6924.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7419.3,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11402 - EXC B9 LESION MRGN XCP SK TG T-A-L 1.1-2.0 CM,11402,HCPCS,,,XU,Outpatient,,,4540.53,1135.1325,668.93,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2978.59,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3178.37,Percent of Total Billed Charges, ,,85,,3859.45,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3087.56,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2542.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2724.32,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11402 - EXC B9 LESION MRGN XCP SK TG T-A-L 1.1-2.0 CM,11402,HCPCS,,,XS,Outpatient,,,4167.34,1041.835,668.93,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2733.78,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2917.14,Percent of Total Billed Charges, ,,85,,3542.24,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2833.79,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2333.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2500.4,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11403 - EXC B9 LESION MRGN XCP SK TG T-A-L 2.1-3.0 CM,11403,HCPCS,,,RT,Outpatient,,,10533.75,2633.4375,668.93,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6910.14,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7373.63,Percent of Total Billed Charges, ,,85,,8953.69,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7162.95,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5898.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6320.25,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11403 - EXC B9 LESION MRGN XCP SK TG T-A-L 2.1-3.0 CM,11403,HCPCS,,,LT,Outpatient,,,4471.68,1117.92,668.93,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2933.42,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3130.18,Percent of Total Billed Charges, ,,85,,3800.93,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3040.74,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2504.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2683.01,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11404 - EXC B9 LESION MRGN XCP SK TG T-A-L 3.1-4.0 CM,11404,HCPCS,,,RT,Outpatient,,,4839,1209.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3174.38,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3387.3,Percent of Total Billed Charges, ,,85,,4113.15,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3290.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2709.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2903.4,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11404 - EXC B9 LESION MRGN XCP SK TG T-A-L 3.1-4.0 CM,11404,HCPCS,,,LT,Outpatient,,,8498.5,2124.625,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5575.02,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5948.95,Percent of Total Billed Charges, ,,85,,7223.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5778.98,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4759.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5099.1,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11404 - EXC B9 LESION MRGN XCP SK TG T-A-L 3.1-4.0 CM,11404,HCPCS,,,74,Outpatient,,,5910,1477.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3876.96,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4137,Percent of Total Billed Charges, ,,85,,5023.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4018.8,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3309.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3546,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11406 - EXC B9 LESION MRGN XCP SK TG T-A-L GREATER THAN 4.0 CM,11406,HCPCS,,,RT,Outpatient,,,7750.69,1937.6725,742.5,6588.09,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5084.45,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5425.48,Percent of Total Billed Charges, ,,85,,6588.09,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5270.47,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4340.39,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4650.41,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11406 - EXC B9 LESION MRGN XCP SK TG T-A-L GREATER THAN 4.0 CM,11406,HCPCS,,,LT,Outpatient,,,8808.5,2202.125,742.5,7487.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5778.38,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6165.95,Percent of Total Billed Charges, ,,85,,7487.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5989.78,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4932.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5285.1,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11406 - EXC B9 LESION MRGN XCP SK TG T-A-L GREATER THAN 4.0 CM,11406,HCPCS,,,50,Outpatient,,,5924,1481,742.5,5035.4,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3886.14,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4146.8,Percent of Total Billed Charges, ,,85,,5035.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4028.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3317.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3554.4,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11420 - EXC B9 LESION MRGN XCP SK TG S-N-H-F-G 0.5 CM-LESS THAN,11420,HCPCS,,,XU,Outpatient,,,6836.67,1709.1675,742.5,5811.17,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4484.86,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4785.67,Percent of Total Billed Charges, ,,85,,5811.17,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4648.94,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3828.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4102,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11421 - EXC B9 LESION MRGN XCP SK TG S-N-H-F-G 0.6-1.0CM,11421,HCPCS,,,XU,Outpatient,,,6251,1562.75,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4100.66,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4375.7,Percent of Total Billed Charges, ,,85,,5313.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4250.68,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3500.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3750.6,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11422 - EXC B9 LESION MRGN XCP SK TG S-N-H-F-G 1.1-2.0CM,11422,HCPCS,,,LT,Outpatient,,,4425.68,1106.42,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2903.25,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3097.98,Percent of Total Billed Charges, ,,85,,3761.83,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3009.46,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2478.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2655.41,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11426 - EXC B9 LESION MRGN XCP SK TG S-N-H-F-G GREATER THAN 4.0CM,11426,HCPCS,,,FA,Outpatient,,,4404.25,1101.0625,742.5,4226.84,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2889.19,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3082.98,Percent of Total Billed Charges, ,,85,,3743.61,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2994.89,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2466.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2642.55,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11440 - EXC B9 LESION MRGN XCP SK TG F-E-E-N-L-M 0.5CM-LESS THAN,11440,HCPCS,,,XU,Outpatient,,,5290.5,1322.625,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3470.57,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3703.35,Percent of Total Billed Charges, ,,85,,4496.93,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3597.54,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2962.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3174.3,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11440 - EXC B9 LESION MRGN XCP SK TG F-E-E-N-L-M 0.5CM-LESS THAN,11440,HCPCS,,,RT,Outpatient,,,4839,1209.75,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3174.38,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3387.3,Percent of Total Billed Charges, ,,85,,4113.15,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3290.52,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2709.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2903.4,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11442 - EXC B9 LES MRGN XCP SK TG F-E-E-N-L-M 1.1-2.0CM,11442,HCPCS,,,XU,Outpatient,,,6017.5,1504.375,668.93,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3947.48,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4212.25,Percent of Total Billed Charges, ,,85,,5114.88,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4091.9,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3369.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3610.5,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11450 - EXCISION HIDRADENITIS AXILLARY SMPL-INTRM RPR,11450,HCPCS,,,XU,Outpatient,,,9041,2260.25,882.09,7684.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5930.9,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6328.7,Percent of Total Billed Charges, ,,85,,7684.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6147.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5062.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5424.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11451 - EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR,11451,HCPCS,,,XU,Outpatient,,,9465.38,2366.345,742.5,8045.57,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6209.29,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6625.77,Percent of Total Billed Charges, ,,85,,8045.57,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6436.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5300.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5679.23,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11451 - EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR,11451,HCPCS,,,RT,Outpatient,,,18547,4636.75,742.5,15764.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12166.83,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12982.9,Percent of Total Billed Charges, ,,85,,15764.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12611.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10386.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11128.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11451 - EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR,11451,HCPCS,,,50,Outpatient,,,44432,11108,742.5,37767.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29147.39,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31102.4,Percent of Total Billed Charges, ,,85,,37767.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30213.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24881.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26659.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR,11463,HCPCS,,,XU,Outpatient,,,8356.75,2089.1875,742.5,7103.24,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5482.03,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5849.73,Percent of Total Billed Charges, ,,85,,7103.24,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5682.59,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4679.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5014.05,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR,11463,HCPCS,,,RT,Outpatient,,,16222,4055.5,742.5,13788.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10641.63,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11355.4,Percent of Total Billed Charges, ,,85,,13788.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11030.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9084.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9733.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR,11463,HCPCS,,,LT,Outpatient,,,20872,5218,742.5,17741.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13692.03,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14610.4,Percent of Total Billed Charges, ,,85,,17741.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14192.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11688.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12523.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11602 - EXCISION MAL LESION TRUNK-ARM-LEG 1.1-2.0 CM,11602,HCPCS,,,RT,Outpatient,,,7577.34,1894.335,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4970.74,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5304.14,Percent of Total Billed Charges, ,,85,,6440.74,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5152.59,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4243.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4546.4,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11604 - EXCISION MAL LESION TRUNK-ARM-LEG 3.1-4.0 CM,11604,HCPCS,,,LT,Outpatient,,,4425.66,1106.415,668.93,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2903.23,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3097.96,Percent of Total Billed Charges, ,,85,,3761.81,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3009.45,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2478.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2655.4,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11606 - EXCISION MALIGNANT LESION TRUNK-ARM-LEG GREATER THAN 4.0 CM,11606,HCPCS,,,XU,Outpatient,,,3089.4,772.35,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2026.65,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2162.58,Percent of Total Billed Charges, ,,85,,2625.99,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2100.79,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1730.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1853.64,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11606 - EXCISION MALIGNANT LESION TRUNK-ARM-LEG GREATER THAN 4.0 CM,11606,HCPCS,,,RT,Outpatient,,,7937,1984.25,742.5,6746.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5206.67,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5555.9,Percent of Total Billed Charges, ,,85,,6746.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5397.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4444.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4762.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11626 - EXCISION MALIGNANT LESION S-N-H-F-G GREATER THAN 4.0 CM,11626,HCPCS,,,LT,Outpatient,,,4118.2,1029.55,742.5,4226.84,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2701.54,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2882.74,Percent of Total Billed Charges, ,,85,,3500.47,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2800.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2306.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2470.92,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11646 - EXCISION MALIGNANT LESION F-E-E-N-L GREATER THAN 4.0 CM,11646,HCPCS,,,XS,Outpatient,,,10212.34,2553.085,742.5,8680.49,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6699.3,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7148.64,Percent of Total Billed Charges, ,,85,,8680.49,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6944.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5718.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6127.4,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11646 - EXCISION MALIGNANT LESION F-E-E-N-L GREATER THAN 4.0 CM,11646,HCPCS,,,RT,Outpatient,,,11207,2801.75,742.5,9525.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7351.79,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7844.9,Percent of Total Billed Charges, ,,85,,9525.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7620.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6275.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6724.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11721 - DEBRIDEMENT NAIL ANY METHOD 6-GREATER THAN,11721,HCPCS,,,XU,Outpatient,,,5672.5,1418.125,56.47,4821.63,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3721.16,Percent of Total Billed Charges, ,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3970.75,Percent of Total Billed Charges, ,,85,,4821.63,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3857.3,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3176.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3403.5,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.32,,,90.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,XU,Outpatient,,,4844.5,1211.125,188.91,4117.83,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3177.99,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3391.15,Percent of Total Billed Charges, ,,85,,4117.83,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3294.26,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2712.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2906.7,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,TA,Outpatient,,,4806.92,1201.73,188.91,4085.88,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3153.34,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3364.84,Percent of Total Billed Charges, ,,85,,4085.88,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3268.71,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2691.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2884.15,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,T5,Outpatient,,,8442,2110.5,188.91,7175.7,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5537.95,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5909.4,Percent of Total Billed Charges, ,,85,,7175.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5740.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4727.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5065.2,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,F7,Outpatient,,,6030.25,1507.5625,188.91,5125.71,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3955.84,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4221.18,Percent of Total Billed Charges, ,,85,,5125.71,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4100.57,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3376.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3618.15,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,F5,Outpatient,,,8608.13,2152.0325,188.91,7316.91,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5646.93,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6025.69,Percent of Total Billed Charges, ,,85,,7316.91,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5853.53,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4820.55,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5164.88,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,F2,Outpatient,,,9551,2387.75,188.91,8118.35,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6265.46,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6685.7,Percent of Total Billed Charges, ,,85,,8118.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6494.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5348.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5730.6,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,50,Outpatient,,,5280.5,1320.125,188.91,4488.43,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3464.01,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3696.35,Percent of Total Billed Charges, ,,85,,4488.43,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3590.74,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2957.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3168.3,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11732 - AVULSION NAIL PLATE PARTIAL-COMP SIMPLE EA ADDL,11732,HCPCS,,,TA,Outpatient,,,8303,2075.75,0.01,7057.55,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5446.77,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5812.1,Percent of Total Billed Charges, ,,85,,7057.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5646.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4649.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4981.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11732 - AVULSION NAIL PLATE PARTIAL-COMP SIMPLE EA ADDL,11732,HCPCS,,,T4,Outpatient,,,3526.25,881.5625,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2313.22,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2468.38,Percent of Total Billed Charges, ,,85,,2997.31,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2397.85,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1974.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2115.75,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,HCPCS,,,XU,Outpatient,,,3675.35,918.8375,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2411.03,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2572.75,Percent of Total Billed Charges, ,,85,,3124.05,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2499.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2058.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2205.21,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,HCPCS,,,XS,Outpatient,,,3691.2,922.8,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2421.43,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2583.84,Percent of Total Billed Charges, ,,85,,3137.52,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2510.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2067.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2214.72,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,HCPCS,,,TA,Outpatient,,,4857.27,1214.3175,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3186.37,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3400.09,Percent of Total Billed Charges, ,,85,,4128.68,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3302.94,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2720.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2914.36,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,HCPCS,,,T5,Outpatient,,,5766.89,1441.7225,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3783.08,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4036.82,Percent of Total Billed Charges, ,,85,,4901.86,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3921.49,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3229.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3460.13,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,HCPCS,,,KX,Outpatient,,,5532.13,1383.0325,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3629.08,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3872.49,Percent of Total Billed Charges, ,,85,,4702.31,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3761.85,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3097.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3319.28,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,HCPCS,,,F6,Outpatient,,,9551,2387.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6265.46,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6685.7,Percent of Total Billed Charges, ,,85,,8118.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6494.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5348.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5730.6,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,HCPCS,,,F5,Outpatient,,,6293.5,1573.375,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4128.54,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4405.45,Percent of Total Billed Charges, ,,85,,5349.48,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4279.58,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3524.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3776.1,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,HCPCS,,,50,Outpatient,,,9624.5,2406.125,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6313.67,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6737.15,Percent of Total Billed Charges, ,,85,,8180.83,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6544.66,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5389.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5774.7,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE,11755,HCPCS,,,XU,Outpatient,,,5189.5,1297.375,668.93,4411.08,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3404.31,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3632.65,Percent of Total Billed Charges, ,,85,,4411.08,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3528.86,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2906.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3113.7,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,LT,Outpatient,,,6203.25,1550.8125,581.98,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4069.33,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4342.28,Percent of Total Billed Charges, ,,85,,5272.76,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4218.21,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3473.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3721.95,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,F9,Outpatient,,,4258.33,1064.5825,581.98,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2793.46,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2980.83,Percent of Total Billed Charges, ,,85,,3619.58,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2895.66,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2384.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2555,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,F8,Outpatient,,,6599.75,1649.9375,581.98,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4329.44,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4619.83,Percent of Total Billed Charges, ,,85,,5609.79,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4487.83,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3695.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3959.85,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,F7,Outpatient,,,6337.33,1584.3325,581.98,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4157.29,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4436.13,Percent of Total Billed Charges, ,,85,,5386.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4309.38,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3548.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3802.4,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,F5,Outpatient,,,6337.33,1584.3325,581.98,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4157.29,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4436.13,Percent of Total Billed Charges, ,,85,,5386.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4309.38,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3548.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3802.4,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,F3,Outpatient,,,6600.69,1650.1725,581.98,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4330.05,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4620.48,Percent of Total Billed Charges, ,,85,,5610.59,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4488.47,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3696.39,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3960.41,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,F2,Outpatient,,,6070.75,1517.6875,581.98,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3982.41,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4249.53,Percent of Total Billed Charges, ,,85,,5160.14,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4128.11,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3399.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3642.45,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,F1,Outpatient,,,5510.66,1377.665,581.98,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3614.99,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3857.46,Percent of Total Billed Charges, ,,85,,4684.06,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3747.25,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3085.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3306.4,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11765 - WEDGE EXCISION SKIN NAIL FOLD,11765,HCPCS,,,F2,Outpatient,,,16067,4016.75,379.85,13656.95,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10539.95,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11246.9,Percent of Total Billed Charges, ,,85,,13656.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10925.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8997.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9640.2,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11970 - REPLACEMENT TISSUE EXPANDER W-PERMANENT IMPLANT,11970,HCPCS,,,XU,Outpatient,,,10466.25,2616.5625,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6865.86,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7326.38,Percent of Total Billed Charges, ,,85,,8896.31,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7117.05,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5861.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6279.75,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11970 - REPLACEMENT TISSUE EXPANDER W-PERMANENT IMPLANT,11970,HCPCS,,,RT,Outpatient,,,11276,2819,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7397.06,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7893.2,Percent of Total Billed Charges, ,,85,,9584.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7667.68,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6314.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6765.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11970 - REPLACEMENT TISSUE EXPANDER W-PERMANENT IMPLANT,11970,HCPCS,,,LT,Outpatient,,,8350,2087.5,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5477.6,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5845,Percent of Total Billed Charges, ,,85,,7097.5,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5678,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4676,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5010,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11970 - REPLACEMENT TISSUE EXPANDER W-PERMANENT IMPLANT,11970,HCPCS,,,50,Outpatient,,,14917.87,3729.4675,950.4,12680.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9786.12,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10442.51,Percent of Total Billed Charges, ,,85,,12680.19,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10144.15,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8354.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8950.72,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11971 - REMOVAL TISSUE EXPANDER W-O INSERTION IMPLANT,11971,HCPCS,,,RT,Outpatient,,,10787.5,2696.875,742.5,9169.38,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7076.6,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7551.25,Percent of Total Billed Charges, ,,85,,9169.38,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7335.5,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6041,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6472.5,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11971 - REMOVAL TISSUE EXPANDER W-O INSERTION IMPLANT,11971,HCPCS,,,50,Outpatient,,,13328.67,3332.1675,742.5,11329.37,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8743.61,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9330.07,Percent of Total Billed Charges, ,,85,,11329.37,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9063.5,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7464.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7997.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11981 - INSERTION DRUG DELIVERY IMPLANT,11981,HCPCS,,,FP,Outpatient,,,5493,1373.25,122.55,4669.05,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3603.41,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3845.1,Percent of Total Billed Charges, ,,85,,4669.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3735.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3076.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3295.8,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.17,,,296.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,296.17,,,296.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,296.17,,,296.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,296.17,,,296.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,HCPCS,,,LT,Outpatient,,,10513.5,2628.375,379.38,8936.48,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,589.32,,,589.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6896.86,Percent of Total Billed Charges, ,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7359.45,Percent of Total Billed Charges, ,,85,,8936.48,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7149.18,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5887.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6308.1,Percent of Total Billed Charges, ,583.3,,,583.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.28,,,593.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.66,,,392.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.45,,,396.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.38,,,379.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,390.76,,,390.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.4,,,397.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,XU,Outpatient,,,6500.84,1625.21,188.91,5525.71,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4264.55,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4550.59,Percent of Total Billed Charges, ,,85,,5525.71,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4420.57,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3640.47,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3900.5,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,XS,Outpatient,,,9072.36,2268.09,188.91,7711.51,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5951.47,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6350.65,Percent of Total Billed Charges, ,,85,,7711.51,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6169.2,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5080.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5443.42,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,XS,Outpatient,,,10729,2682.25,188.91,9119.65,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7038.22,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7510.3,Percent of Total Billed Charges, ,,85,,9119.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7295.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6008.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6437.4,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12004 - SIMPLE RPR SCALP-NECK-AX-GENIT-TRUNK 7.6-12.5CM,12004,HCPCS,,,XU,Outpatient,,,7891.75,1972.9375,188.91,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5176.99,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5524.23,Percent of Total Billed Charges, ,,85,,6707.99,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5366.39,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4419.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4735.05,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12031 - REPAIR INTERMEDIATE S-A-T-E 2.5 CM-LESS THAN,12031,HCPCS,,,XU,Outpatient,,,6473.94,1618.485,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4246.9,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4531.76,Percent of Total Billed Charges, ,,85,,5502.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4402.28,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3625.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3884.36,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12032 - REPAIR INTERMEDIATE S-A-T-E 2.6-7.5 CM,12032,HCPCS,,,XU,Outpatient,,,6887.14,1721.785,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4517.96,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4821,Percent of Total Billed Charges, ,,85,,5854.07,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4683.26,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3856.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4132.28,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12032 - REPAIR INTERMEDIATE S-A-T-E 2.6-7.5 CM,12032,HCPCS,,,XS,Outpatient,,,5527.89,1381.9725,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3626.3,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3869.52,Percent of Total Billed Charges, ,,85,,4698.71,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3758.97,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3095.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3316.73,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12032 - REPAIR INTERMEDIATE S-A-T-E 2.6-7.5 CM,12032,HCPCS,,,LT,Outpatient,,,8498.5,2124.625,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5575.02,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5948.95,Percent of Total Billed Charges, ,,85,,7223.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5778.98,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4759.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5099.1,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12034 - REPAIR INTERMEDIATE S-A-T-E 7.6-12.5 CM,12034,HCPCS,,,XU,Outpatient,,,2965.4,741.35,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1945.3,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2075.78,Percent of Total Billed Charges, ,,85,,2520.59,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2016.47,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1660.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1779.24,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12034 - REPAIR INTERMEDIATE S-A-T-E 7.6-12.5 CM,12034,HCPCS,,,XS,Outpatient,,,5045.66,1261.415,379.85,4288.81,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3309.95,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3531.96,Percent of Total Billed Charges, ,,85,,4288.81,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3431.05,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2825.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3027.4,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12034 - REPAIR INTERMEDIATE S-A-T-E 7.6-12.5 CM,12034,HCPCS,,,LT,Outpatient,,,8033.5,2008.375,379.85,6828.48,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5269.98,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5623.45,Percent of Total Billed Charges, ,,85,,6828.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5462.78,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4498.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4820.1,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12036 - REPAIR INTERMEDIATE S-A-T-E 20.1-30.0 CM,12036,HCPCS,,,XU,Outpatient,,,4460.33,1115.0825,581.98,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2925.98,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3122.23,Percent of Total Billed Charges, ,,85,,3791.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3033.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2497.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2676.2,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,XU,Outpatient,,,7449.42,1862.355,379.85,6332.01,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4886.82,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5214.59,Percent of Total Billed Charges, ,,85,,6332.01,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5065.61,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4171.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4469.65,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12042 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.6-7.5 CM,12042,HCPCS,,,XU,Outpatient,,,8639.5,2159.875,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5667.51,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6047.65,Percent of Total Billed Charges, ,,85,,7343.58,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5874.86,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4838.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5183.7,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12042 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.6-7.5 CM,12042,HCPCS,,,XS,Outpatient,,,3532.13,883.0325,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2317.08,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2472.49,Percent of Total Billed Charges, ,,85,,3002.31,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2401.85,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1977.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2119.28,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12051 - REPAIR INTERMEDIATE F-E-E-N-LAND-MUC 2.5 CM-LESS THAN,12051,HCPCS,,,XS,Outpatient,,,5299.66,1324.915,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3476.58,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3709.76,Percent of Total Billed Charges, ,,85,,4504.71,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3603.77,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2967.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3179.8,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12052 - REPAIR INTERMEDIATE F-E-E-N-LAND-MUC 2.6-5.0 CM,12052,HCPCS,,,XU,Outpatient,,,4793.66,1198.415,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3144.64,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3355.56,Percent of Total Billed Charges, ,,85,,4074.61,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3259.69,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2684.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2876.2,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12053 - REPAIR INTERMEDIATE F-E-E-N-LAND-MUC 5.1-7.5 CM,12053,HCPCS,,,XS,Outpatient,,,4791.75,1197.9375,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3143.39,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3354.23,Percent of Total Billed Charges, ,,85,,4072.99,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3258.39,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2683.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2875.05,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM,13101,HCPCS,,,XU,Outpatient,,,6189.71,1547.4275,581.98,5261.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4060.45,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4332.8,Percent of Total Billed Charges, ,,85,,5261.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4209,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3466.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3713.83,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM,13101,HCPCS,,,XP,Outpatient,,,5944.05,1486.0125,581.98,5052.44,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3899.3,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4160.84,Percent of Total Billed Charges, ,,85,,5052.44,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4041.95,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3328.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3566.43,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM,13101,HCPCS,,,50,Outpatient,,,5924,1481,581.98,5035.4,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3886.14,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4146.8,Percent of Total Billed Charges, ,,85,,5035.4,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4028.32,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3317.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3554.4,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM-LESS THAN,13102,HCPCS,,,XU,Outpatient,,,6146.8,1536.7,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4032.3,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4302.76,Percent of Total Billed Charges, ,,85,,5224.78,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4179.82,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3442.21,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3688.08,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM-LESS THAN,13102,HCPCS,,,XP,Outpatient,,,5944.04,1486.01,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3899.29,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4160.83,Percent of Total Billed Charges, ,,85,,5052.43,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4041.95,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3328.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3566.42,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM-LESS THAN,13102,HCPCS,,,50,Outpatient,,,5924,1481,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3886.14,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4146.8,Percent of Total Billed Charges, ,,85,,5035.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4028.32,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3317.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3554.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
13121 - REPAIR COMPLEX SCALP-ARM-LEG 2.6-7.5 CM,13121,HCPCS,,,XU,Outpatient,,,5802.53,1450.6325,581.98,4932.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3806.46,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4061.77,Percent of Total Billed Charges, ,,85,,4932.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3945.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3249.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3481.52,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13121 - REPAIR COMPLEX SCALP-ARM-LEG 2.6-7.5 CM,13121,HCPCS,,,XS,Outpatient,,,6406,1601.5,581.98,5445.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4202.34,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4484.2,Percent of Total Billed Charges, ,,85,,5445.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4356.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3587.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3843.6,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13121 - REPAIR COMPLEX SCALP-ARM-LEG 2.6-7.5 CM,13121,HCPCS,,,LT,Outpatient,,,7491,1872.75,581.98,6367.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4914.1,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5243.7,Percent of Total Billed Charges, ,,85,,6367.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5093.88,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4194.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4494.6,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13122 - REPAIR COMPLEX SCALP-ARM-LEG EA ADDL 5 CM-LESS THAN,13122,HCPCS,,,XU,Outpatient,,,4322.38,1080.595,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2835.48,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3025.67,Percent of Total Billed Charges, ,,85,,3674.02,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2939.22,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2420.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2593.43,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
13122 - REPAIR COMPLEX SCALP-ARM-LEG EA ADDL 5 CM-LESS THAN,13122,HCPCS,,,LT,Outpatient,,,7491,1872.75,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4914.1,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5243.7,Percent of Total Billed Charges, ,,85,,6367.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5093.88,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4194.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4494.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
13132 - REPAIR COMPLEX F-C-C-M-N-AX-G-H-F 2.6-7.5 CM,13132,HCPCS,,,XU,Outpatient,,,5450,1362.5,581.98,4632.5,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3575.2,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3815,Percent of Total Billed Charges, ,,85,,4632.5,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3706,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3052,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3270,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13132 - REPAIR COMPLEX F-C-C-M-N-AX-G-H-F 2.6-7.5 CM,13132,HCPCS,,,XS,Outpatient,,,7411.01,1852.7525,581.98,6299.36,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4861.62,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5187.71,Percent of Total Billed Charges, ,,85,,6299.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5039.49,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4150.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4446.61,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13133 - REPAIR COMPLEX F-C-C-M-N-AX-G-H-F EA ADDL 5 CM-LESS THAN,13133,HCPCS,,,XU,Outpatient,,,4516.71,1129.1775,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2962.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3161.7,Percent of Total Billed Charges, ,,85,,3839.2,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3071.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2529.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2710.03,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
13151 - REPAIR COMPLEX EYELID-NOSE-EAR-LIP 1.1-2.5 CM,13151,HCPCS,,,XU,Outpatient,,,6633.68,1658.42,581.98,5638.63,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4351.69,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4643.58,Percent of Total Billed Charges, ,,85,,5638.63,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4510.9,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3714.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3980.21,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13152 - REPAIR COMPLEX EYELID-NOSE-EAR-LIP 2.6-7.5 CM,13152,HCPCS,,,XU,Outpatient,,,8578.95,2144.7375,581.98,7292.11,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5627.79,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6005.27,Percent of Total Billed Charges, ,,85,,7292.11,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5833.69,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4804.21,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5147.37,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13160 - SECONDARY CLOSURE SURG WOUND-DEHSN XTNSV-COMP,13160,HCPCS,,,RT,Outpatient,,,15291,3822.75,742.5,12997.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10030.9,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10703.7,Percent of Total Billed Charges, ,,85,,12997.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10397.88,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8562.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9174.6,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13160 - SECONDARY CLOSURE SURG WOUND-DEHSN XTNSV-COMP,13160,HCPCS,,,78,Outpatient,,,15912,3978,742.5,13525.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10438.27,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11138.4,Percent of Total Billed Charges, ,,85,,13525.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10820.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8910.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9547.2,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
14040 - ADJT TIS TRNS-REARGMT F-C-C-M-N-A-G-H-F 10SQCM-LESS THAN,14040,HCPCS,,,RT,Outpatient,,,9506.56,2376.64,742.5,8080.58,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6236.3,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6654.59,Percent of Total Billed Charges, ,,85,,8080.58,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6464.46,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5323.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5703.94,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
14040 - ADJT TIS TRNS-REARGMT F-C-C-M-N-A-G-H-F 10SQCM-LESS THAN,14040,HCPCS,,,F1,Outpatient,,,7164,1791,742.5,6089.4,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4699.58,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5014.8,Percent of Total Billed Charges, ,,85,,6089.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4871.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4011.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4298.4,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
14041 - ADJT-REARGMT F-C-C-M-N-AX-G-H-F 10.1-30.0 SQ CM,14041,HCPCS,,,RT,Outpatient,,,11261.5,2815.375,950.4,9572.28,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7387.54,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7883.05,Percent of Total Billed Charges, ,,85,,9572.28,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7657.82,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6306.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6756.9,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
14060 - ADJT TIS TRNSFR-REARRGMT E-N-E-L DFCT 10 SQ CM-LESS THAN,14060,HCPCS,,,XU,Outpatient,,,6410.64,1602.66,950.4,5449.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4205.38,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4487.45,Percent of Total Billed Charges, ,,85,,5449.04,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4359.24,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3589.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3846.38,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
14060 - ADJT TIS TRNSFR-REARRGMT E-N-E-L DFCT 10 SQ CM-LESS THAN,14060,HCPCS,,,LT,Outpatient,,,16481,4120.25,950.4,14008.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10811.54,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11536.7,Percent of Total Billed Charges, ,,85,,14008.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11207.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9229.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9888.6,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
14060 - ADJT TIS TRNSFR-REARRGMT E-N-E-L DFCT 10 SQ CM-LESS THAN,14060,HCPCS,,,E4,Outpatient,,,20846.5,5211.625,950.4,17719.53,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13675.3,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14592.55,Percent of Total Billed Charges, ,,85,,17719.53,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14175.62,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11674.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12507.9,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
14060 - ADJT TIS TRNSFR-REARRGMT E-N-E-L DFCT 10 SQ CM-LESS THAN,14060,HCPCS,,,E2,Outpatient,,,10241,2560.25,950.4,8704.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6718.1,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7168.7,Percent of Total Billed Charges, ,,85,,8704.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6963.88,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5734.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6144.6,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15004 - PREP SITE F-S-N-H-F-G-M-D GT 1ST 100 SQ CM-1PCT,15004,HCPCS,,,LT,Outpatient,,,11133.5,2783.375,581.98,9463.48,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7303.58,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7793.45,Percent of Total Billed Charges, ,,85,,9463.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7570.78,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6234.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6680.1,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15100 - SPLT AGRFT T-A-L 1ST 100 SQCM-LESS THAN -1PERCENT BDY INFT-CHLD,15100,HCPCS,,,XU,Outpatient,,,3089.4,772.35,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2026.65,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2162.58,Percent of Total Billed Charges, ,,85,,2625.99,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2100.79,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1730.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1853.64,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15100 - SPLT AGRFT T-A-L 1ST 100 SQCM-LESS THAN -1PERCENT BDY INFT-CHLD,15100,HCPCS,,,RT,Outpatient,,,12312,3078,742.5,10465.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8076.67,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8618.4,Percent of Total Billed Charges, ,,85,,10465.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8372.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6894.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7387.2,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15100 - SPLT AGRFT T-A-L 1ST 100 SQCM-LESS THAN -1PERCENT BDY INFT-CHLD,15100,HCPCS,,,LT,Outpatient,,,16377,4094.25,742.5,13920.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10743.31,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11463.9,Percent of Total Billed Charges, ,,85,,13920.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11136.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9171.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9826.2,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15100 - SPLT AGRFT T-A-L 1ST 100 SQCM-LESS THAN -1PERCENT BDY INFT-CHLD,15100,HCPCS,,,78,Outpatient,,,7461.68,1865.42,742.5,6342.43,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4894.86,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5223.18,Percent of Total Billed Charges, ,,85,,6342.43,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5073.94,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4178.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4477.01,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15101 - SPLT AGRFT T-A-L EA ADD 100 SQCM-EA 1PERCENT INFT-CHLD,15101,HCPCS,,,XU,Outpatient,,,3089.4,772.35,0.01,6015,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2026.65,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2162.58,Percent of Total Billed Charges, ,,85,,2625.99,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2100.79,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1730.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1853.64,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15120 - SPLT AGRFT F-S-N-H-F-G-M-DGT 1ST 100 SQCM-LESS THAN -1PERCENT,15120,HCPCS,,,LT,Outpatient,,,6415.5,1603.875,950.4,5453.18,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5406.73,,,5406.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4208.57,Percent of Total Billed Charges, ,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4490.85,Percent of Total Billed Charges, ,,85,,5453.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4362.54,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3592.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3849.3,Percent of Total Billed Charges, ,5351.47,,,5351.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5111.57,,,5111.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3602.45,,,3602.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3637.26,,,3637.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3480.63,,,3480.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.05,,,3585.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3645.96,,,3645.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15120 - SPLT AGRFT F-S-N-H-F-G-M-DGT 1ST 100 SQCM-LESS THAN -1PERCENT,15120,HCPCS,,,E1,Outpatient,,,5672.5,1418.125,950.4,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5406.73,,,5406.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3721.16,Percent of Total Billed Charges, ,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3970.75,Percent of Total Billed Charges, ,,85,,4821.63,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3857.3,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3176.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3403.5,Percent of Total Billed Charges, ,5351.47,,,5351.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5111.57,,,5111.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3602.45,,,3602.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3637.26,,,3637.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3480.63,,,3480.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.05,,,3585.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3645.96,,,3645.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15121 - SPLT AGRFT F-S-N-H-F-G-M-DGT EA 100 SQCM-EA 1PERCENT,15121,HCPCS,,,LT,Outpatient,,,6415.5,1603.875,0.01,6015,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4208.57,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4490.85,Percent of Total Billed Charges, ,,85,,5453.18,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4362.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3592.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3849.3,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15240 - FTH-GFT FR DIR CLSR F-C-C-M-N-AX-G-H-F 20SQCM-LESS THAN,15240,HCPCS,,,LT,Outpatient,,,4118.2,1029.55,950.4,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2701.54,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2882.74,Percent of Total Billed Charges, ,,85,,3500.47,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2800.38,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2306.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2470.92,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15260 - FTH-GFT FREE W-DIRECT CLOSURE N-E-E-L 20 SQ CM-LESS THAN,15260,HCPCS,,,RT,Outpatient,,,8147.97,2036.9925,950.4,6925.77,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5345.07,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5703.58,Percent of Total Billed Charges, ,,85,,6925.77,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5540.62,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4562.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4888.78,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15260 - FTH-GFT FREE W-DIRECT CLOSURE N-E-E-L 20 SQ CM-LESS THAN,15260,HCPCS,,,E4,Outpatient,,,5408.03,1352.0075,950.4,4596.83,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3547.67,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3785.62,Percent of Total Billed Charges, ,,85,,4596.83,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3677.46,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3028.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3244.82,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15260 - FTH-GFT FREE W-DIRECT CLOSURE N-E-E-L 20 SQ CM-LESS THAN,15260,HCPCS,,,E3,Outpatient,,,3183.68,795.92,950.4,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2088.49,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2228.58,Percent of Total Billed Charges, ,,85,,2706.13,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2164.9,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1782.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1910.21,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15260 - FTH-GFT FREE W-DIRECT CLOSURE N-E-E-L 20 SQ CM-LESS THAN,15260,HCPCS,,,E2,Outpatient,,,8209.83,2052.4575,950.4,6978.36,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5385.65,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5746.88,Percent of Total Billed Charges, ,,85,,6978.36,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5582.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4597.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4925.9,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15260 - FTH-GFT FREE W-DIRECT CLOSURE N-E-E-L 20 SQ CM-LESS THAN,15260,HCPCS,,,E1,Outpatient,,,5777,1444.25,950.4,4910.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3789.71,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4043.9,Percent of Total Billed Charges, ,,85,,4910.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3928.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3235.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3466.2,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15271 - APP SKN SUB GRFT T-A-L AREA-100SQ CM -LESS THAN 1ST 25,15271,HCPCS,,,RT,Outpatient,,,5764.08,1441.02,1078.11,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3781.24,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4034.86,Percent of Total Billed Charges, ,,85,,4899.47,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3919.57,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3227.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3458.45,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15271 - APP SKN SUB GRFT T-A-L AREA-100SQ CM -LESS THAN 1ST 25,15271,HCPCS,,,78,Outpatient,,,13852.75,3463.1875,1078.11,11774.84,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9087.4,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9696.93,Percent of Total Billed Charges, ,,85,,11774.84,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9419.87,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7757.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8311.65,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15271 - APP SKN SUB GRFT T-A-L AREA-100SQ CM -LESS THAN 1ST 25,15271,HCPCS,,,58,Outpatient,,,16636,4159,1078.11,14140.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10913.22,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11645.2,Percent of Total Billed Charges, ,,85,,14140.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11312.48,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9316.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9981.6,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15272 - APP SKN SUB GRFT T-A-L AREA-100SQ CM EA ADL 25SC,15272,HCPCS,,,RT,Outpatient,,,5510.66,1377.665,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3614.99,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3857.46,Percent of Total Billed Charges, ,,85,,4684.06,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3747.25,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3085.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3306.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15275 - SUB GRFT F-S-N-H-F-G-M-D LESS THAN 100SQ CM 1ST 25 SQ CM,15275,HCPCS,,,T6,Outpatient,,,4844.5,1211.125,1078.11,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3177.99,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3391.15,Percent of Total Billed Charges, ,,85,,4117.83,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3294.26,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2712.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2906.7,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15275 - SUB GRFT F-S-N-H-F-G-M-D LESS THAN 100SQ CM 1ST 25 SQ CM,15275,HCPCS,,,T2,Outpatient,,,4942.34,1235.585,1078.11,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3242.18,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3459.64,Percent of Total Billed Charges, ,,85,,4200.99,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3360.79,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2767.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2965.4,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15275 - SUB GRFT F-S-N-H-F-G-M-D LESS THAN 100SQ CM 1ST 25 SQ CM,15275,HCPCS,,,RT,Outpatient,,,10535,2633.75,1078.11,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6910.96,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7374.5,Percent of Total Billed Charges, ,,85,,8954.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7163.8,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5899.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6321,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15275 - SUB GRFT F-S-N-H-F-G-M-D LESS THAN 100SQ CM 1ST 25 SQ CM,15275,HCPCS,,,LT,Outpatient,,,15752.1,3938.025,1078.11,13389.29,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10333.38,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11026.47,Percent of Total Billed Charges, ,,85,,13389.29,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10711.43,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8821.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9451.26,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15275 - SUB GRFT F-S-N-H-F-G-M-D LESS THAN 100SQ CM 1ST 25 SQ CM,15275,HCPCS,,,F6,Outpatient,,,3322.19,830.5475,1078.11,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2179.36,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2325.53,Percent of Total Billed Charges, ,,85,,2823.86,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2259.09,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1860.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1993.31,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15275 - SUB GRFT F-S-N-H-F-G-M-D LESS THAN 100SQ CM 1ST 25 SQ CM,15275,HCPCS,,,F5,Outpatient,,,2608.37,652.0925,1078.11,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1711.09,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1825.86,Percent of Total Billed Charges, ,,85,,2217.11,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1773.69,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1460.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1565.02,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15630 - DELAY FLAP-SCTJ FLAP EYELIDS NOSE EARS-LIPS,15630,HCPCS,,,XU,Outpatient,,,8777.5,2194.375,1078.11,7460.88,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5758.04,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6144.25,Percent of Total Billed Charges, ,,85,,7460.88,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5968.7,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4915.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5266.5,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15736 - MUSC MYOCUTANEOUS-FASCIOCUTANEOUS FLAP UXTR,15736,HCPCS,,,LT,Outpatient,,,9437.34,2359.335,742.5,8021.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6190.9,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6606.14,Percent of Total Billed Charges, ,,85,,8021.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6417.39,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5284.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5662.4,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15738 - MUSC MYOCUTANEOUS-FASCIOCUTANEOUS FLAP LXTR,15738,HCPCS,,,78,Outpatient,,,7461.66,1865.415,1078.11,6342.41,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5406.73,,,5406.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4894.85,Percent of Total Billed Charges, ,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5223.16,Percent of Total Billed Charges, ,,85,,6342.41,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5073.93,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4178.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4477,Percent of Total Billed Charges, ,5351.47,,,5351.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5111.57,,,5111.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3602.45,,,3602.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3637.26,,,3637.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3480.63,,,3480.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.05,,,3585.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3645.96,,,3645.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15771 - GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS,15771,HCPCS,,,XU,Outpatient,,,8514.4,2128.6,3480.63,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5406.73,,,5406.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5585.45,Percent of Total Billed Charges, ,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5960.08,Percent of Total Billed Charges, ,,85,,7237.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5789.79,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4768.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5108.64,Percent of Total Billed Charges, ,5351.47,,,5351.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5111.57,,,5111.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3602.45,,,3602.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3637.26,,,3637.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3480.63,,,3480.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.05,,,3585.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3645.96,,,3645.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15771 - GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS,15771,HCPCS,,,RT,Outpatient,,,11621,2905.25,3480.63,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5406.73,,,5406.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7623.38,Percent of Total Billed Charges, ,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8134.7,Percent of Total Billed Charges, ,,85,,9877.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7902.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6507.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6972.6,Percent of Total Billed Charges, ,5351.47,,,5351.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5111.57,,,5111.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3602.45,,,3602.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3637.26,,,3637.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3480.63,,,3480.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.05,,,3585.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3645.96,,,3645.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15772 - GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC,15772,HCPCS,,,XU,Outpatient,,,5551.1,1387.775,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3641.52,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3885.77,Percent of Total Billed Charges, ,,85,,4718.44,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3774.75,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3108.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3330.66,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15777 - IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT,15777,HCPCS,,,XU,Outpatient,,,8032.64,2008.16,0.01,6827.74,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5269.41,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5622.85,Percent of Total Billed Charges, ,,85,,6827.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5462.2,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4498.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4819.58,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15777 - IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT,15777,HCPCS,,,RT,Outpatient,,,8043.54,2010.885,0.01,6837.01,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5276.56,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5630.48,Percent of Total Billed Charges, ,,85,,6837.01,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5469.61,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4504.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4826.12,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15777 - IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT,15777,HCPCS,,,LT,Outpatient,,,7926.21,1981.5525,0.01,6737.28,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5199.59,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5548.35,Percent of Total Billed Charges, ,,85,,6737.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5389.82,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4438.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4755.73,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15777 - IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT,15777,HCPCS,,,50,Outpatient,,,11039,2759.75,0.01,9383.15,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7241.58,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7727.3,Percent of Total Billed Charges, ,,85,,9383.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7506.52,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6181.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6623.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15820 - BLEPHAROPLASTY LOWER EYELID,15820,HCPCS,,,50,Outpatient,,,10900.81,2725.2025,1739.12,9265.69,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7150.93,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7630.57,Percent of Total Billed Charges, ,,85,,9265.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7412.55,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6104.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6540.49,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15821 - BLEPHAROPLASTY LOWER EYELID W-HERNIATED FAT PAD,15821,HCPCS,,,50,Outpatient,,,17241.75,4310.4375,1739.12,14655.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11310.59,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12069.23,Percent of Total Billed Charges, ,,85,,14655.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11724.39,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9655.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10345.05,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15822 - BLEPHAROPLASTY UPPER EYELID,15822,HCPCS,,,50,Outpatient,,,9574.29,2393.5725,1739.12,8138.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6280.73,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6702,Percent of Total Billed Charges, ,,85,,8138.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6510.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5361.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5744.57,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15823 - BLEPHAROPLASTY UPPER EYELID W-EXCESSIVE SKIN,15823,HCPCS,,,XU,Outpatient,,,5415.5,1353.875,1739.12,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3552.57,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3790.85,Percent of Total Billed Charges, ,,85,,4603.18,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3682.54,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3032.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3249.3,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15823 - BLEPHAROPLASTY UPPER EYELID W-EXCESSIVE SKIN,15823,HCPCS,,,RT,Outpatient,,,8541,2135.25,1739.12,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5602.9,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5978.7,Percent of Total Billed Charges, ,,85,,7259.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5807.88,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4782.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5124.6,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15823 - BLEPHAROPLASTY UPPER EYELID W-EXCESSIVE SKIN,15823,HCPCS,,,LT,Outpatient,,,8634.38,2158.595,1739.12,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5664.15,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6044.07,Percent of Total Billed Charges, ,,85,,7339.22,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5871.38,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4835.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5180.63,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15823 - BLEPHAROPLASTY UPPER EYELID W-EXCESSIVE SKIN,15823,HCPCS,,,E3,Outpatient,,,15137,3784.25,1739.12,12866.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9929.87,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10595.9,Percent of Total Billed Charges, ,,85,,12866.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10293.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8476.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9082.2,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15823 - BLEPHAROPLASTY UPPER EYELID W-EXCESSIVE SKIN,15823,HCPCS,,,E1,Outpatient,,,8853.75,2213.4375,1739.12,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5808.06,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6197.63,Percent of Total Billed Charges, ,,85,,7525.69,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6020.55,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4958.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5312.25,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15823 - BLEPHAROPLASTY UPPER EYELID W-EXCESSIVE SKIN,15823,HCPCS,,,50,Outpatient,,,9899.51,2474.8775,1739.12,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6494.08,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6929.66,Percent of Total Billed Charges, ,,85,,8414.58,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6731.67,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5543.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5939.71,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15830 - EXC EXCSV SKN ABD INFRAUMBILICAL PANNICULECTOMY,15830,HCPCS,,,XU,Outpatient,,,7018.15,1754.5375,882.09,9640.8,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4603.91,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4912.71,Percent of Total Billed Charges, ,,85,,5965.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4772.34,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3930.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4210.89,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15830 - EXC EXCSV SKN ABD INFRAUMBILICAL PANNICULECTOMY,15830,HCPCS,,,59,Outpatient,,,17391.68,4347.92,882.09,14782.93,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11408.94,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12174.18,Percent of Total Billed Charges, ,,85,,14782.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11826.34,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9739.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10435.01,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15832 - EXCISION EXCESSIVE SKIN AND SUBQ TISSUE THIGH,15832,HCPCS,,,50,Outpatient,,,16969.11,4242.2775,2721.07,14423.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11131.74,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11878.38,Percent of Total Billed Charges, ,,85,,14423.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11538.99,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9502.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10181.47,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15833 - EXCISION EXCESSIVE SKIN AND SUBQ TISSUE LEG,15833,HCPCS,,,50,Outpatient,,,11999.25,2999.8125,2721.07,10199.36,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7871.51,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8399.48,Percent of Total Billed Charges, ,,85,,10199.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8159.49,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6719.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7199.55,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15836 - EXCISION EXCESSIVE SKIN AND SUBQ TISSUE ARM,15836,HCPCS,,,LT,Outpatient,,,9971,2492.75,1895,8475.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6540.98,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6979.7,Percent of Total Billed Charges, ,,85,,8475.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6780.28,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5583.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5982.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15836 - EXCISION EXCESSIVE SKIN AND SUBQ TISSUE ARM,15836,HCPCS,,,50,Outpatient,,,18514.14,4628.535,1895,15737.02,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12145.28,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12959.9,Percent of Total Billed Charges, ,,85,,15737.02,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12589.62,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10367.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11108.48,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15847 - EXCISION EXCESSIVE SKIN AND SUBQ TISSUE ABDOMEN,15847,HCPCS,,,XU,Outpatient,,,8025.33,2006.3325,0.01,6821.53,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5264.62,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5617.73,Percent of Total Billed Charges, ,,85,,6821.53,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5457.22,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4494.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4815.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15851 - REMOVAL SUTURES-STAPLES REQUIRING ANESTHESIA,15851,HCPCS,,,RT,Outpatient,,,13122,3280.5,742.5,11153.7,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8608.03,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9185.4,Percent of Total Billed Charges, ,,85,,11153.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8922.96,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7348.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7873.2,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15860 - IV INJECTION TEST VASCULAR FLOW FLAP-GRAFT,15860,HCPCS,,,RT,Outpatient,,,5816.2,1454.05,0.01,4943.77,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,589.32,,,589.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3815.43,Percent of Total Billed Charges, ,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4071.34,Percent of Total Billed Charges, ,,85,,4943.77,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3955.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3257.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3489.72,Percent of Total Billed Charges, ,583.3,,,583.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.28,,,593.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.66,,,392.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.45,,,396.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.38,,,379.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,390.76,,,390.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.4,,,397.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15877 - SUCTION ASSISTED LIPECTOMY TRUNK,15877,HCPCS,,,XU,Outpatient,,,9700.24,2425.06,3215,8245.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5406.73,,,5406.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6363.36,Percent of Total Billed Charges, ,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6790.17,Percent of Total Billed Charges, ,,85,,8245.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6596.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5432.13,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5820.14,Percent of Total Billed Charges, ,5351.47,,,5351.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5111.57,,,5111.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3602.45,,,3602.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3637.26,,,3637.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3480.63,,,3480.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.05,,,3585.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3645.96,,,3645.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15878 - SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY,15878,HCPCS,,,50,Outpatient,,,10802.09,2700.5225,1739.12,9181.78,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7086.17,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7561.46,Percent of Total Billed Charges, ,,85,,9181.78,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7345.42,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6049.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6481.25,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
15879 - SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY,15879,HCPCS,,,50,Outpatient,,,13524.35,3381.0875,3215,11495.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5406.73,,,5406.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8871.97,Percent of Total Billed Charges, ,5276.99,,,5276.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9467.05,Percent of Total Billed Charges, ,,85,,11495.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9196.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7573.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8114.61,Percent of Total Billed Charges, ,5351.47,,,5351.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5111.57,,,5111.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3602.45,,,3602.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3637.26,,,3637.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3480.63,,,3480.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3515.44,,,3515.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.05,,,3585.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3645.96,,,3645.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
17250 - CHEMICAL CAUTERIZATION OF GRANULATION TISSUE,17250,HCPCS,,,XU,Outpatient,,,2860.33,715.0825,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1876.38,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2002.23,Percent of Total Billed Charges, ,,85,,2431.28,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1945.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1601.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1716.2,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19020 - MASTOTOMY W-EXPLORATION-DRAINAGE ABSCESS DEEP,19020,HCPCS,,,RT,Outpatient,,,12527.86,3131.965,742.5,10648.68,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8218.28,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8769.5,Percent of Total Billed Charges, ,,85,,10648.68,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8518.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7015.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7516.72,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19020 - MASTOTOMY W-EXPLORATION-DRAINAGE ABSCESS DEEP,19020,HCPCS,,,LT,Outpatient,,,12398.67,3099.6675,742.5,10538.87,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8133.53,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8679.07,Percent of Total Billed Charges, ,,85,,10538.87,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8431.1,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6943.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7439.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19101 - BIOPSY BREAST OPEN INCISIONAL,19101,HCPCS,,,RT,Outpatient,,,12502,3125.5,950.4,10626.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8201.31,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8751.4,Percent of Total Billed Charges, ,,85,,10626.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8501.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7001.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7501.2,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19120 - EXC CYST-ABERRANT BREAST TISSUE OPEN 1-GREATER THAN LESION,19120,HCPCS,,,RT,Outpatient,,,13065.68,3266.42,950.4,11105.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8571.09,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9145.98,Percent of Total Billed Charges, ,,85,,11105.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8884.66,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7316.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7839.41,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19120 - EXC CYST-ABERRANT BREAST TISSUE OPEN 1-GREATER THAN LESION,19120,HCPCS,,,LT,Outpatient,,,13139.56,3284.89,950.4,11168.63,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8619.55,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9197.69,Percent of Total Billed Charges, ,,85,,11168.63,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8934.9,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7358.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7883.74,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19120 - EXC CYST-ABERRANT BREAST TISSUE OPEN 1-GREATER THAN LESION,19120,HCPCS,,,50,Outpatient,,,11939.94,2984.985,950.4,10148.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7832.6,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8357.96,Percent of Total Billed Charges, ,,85,,10148.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8119.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6686.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7163.96,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19125 - EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,19125,HCPCS,,,XU,Outpatient,,,8787,2196.75,742.5,7468.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5764.27,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6150.9,Percent of Total Billed Charges, ,,85,,7468.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5975.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4920.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5272.2,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19125 - EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,19125,HCPCS,,,RT,Outpatient,,,14590.74,3647.685,742.5,12402.13,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9571.53,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10213.52,Percent of Total Billed Charges, ,,85,,12402.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9921.7,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8170.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8754.44,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19125 - EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,19125,HCPCS,,,LT,Outpatient,,,14505.67,3626.4175,742.5,12329.82,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9515.72,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10153.97,Percent of Total Billed Charges, ,,85,,12329.82,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9863.86,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8123.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8703.4,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19125 - EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,19125,HCPCS,,,50,Outpatient,,,15447,3861.75,742.5,13129.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10133.23,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10812.9,Percent of Total Billed Charges, ,,85,,13129.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10503.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8650.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9268.2,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19126 - EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL,19126,HCPCS,,,LT,Outpatient,,,10746,2686.5,0.01,9134.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7049.38,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7522.2,Percent of Total Billed Charges, ,,85,,9134.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7307.28,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6017.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6447.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
19300 - MASTECTOMY FOR GYNECOMASTIA,19300,HCPCS,,,50,Outpatient,,,24501.75,6125.4375,1078.11,20826.49,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16073.15,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17151.23,Percent of Total Billed Charges, ,,85,,20826.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16661.19,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13720.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14701.05,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19301 - MASTECTOMY PARTIAL,19301,HCPCS,,,XU,Outpatient,,,9281,2320.25,950.4,7888.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6088.34,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6496.7,Percent of Total Billed Charges, ,,85,,7888.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6311.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5197.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5568.6,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19301 - MASTECTOMY PARTIAL,19301,HCPCS,,,XP,Outpatient,,,14105,3526.25,950.4,11989.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9252.88,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9873.5,Percent of Total Billed Charges, ,,85,,11989.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9591.4,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7898.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8463,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19301 - MASTECTOMY PARTIAL,19301,HCPCS,,,RT,Outpatient,,,12766.72,3191.68,950.4,10851.71,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8374.97,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8936.7,Percent of Total Billed Charges, ,,85,,10851.71,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8681.37,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7149.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7660.03,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19301 - MASTECTOMY PARTIAL,19301,HCPCS,,,LT,Outpatient,,,12702.14,3175.535,950.4,10796.82,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8332.6,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8891.5,Percent of Total Billed Charges, ,,85,,10796.82,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8637.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7113.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7621.28,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19301 - MASTECTOMY PARTIAL,19301,HCPCS,,,50,Outpatient,,,21091,5272.75,950.4,17927.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13835.7,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14763.7,Percent of Total Billed Charges, ,,85,,17927.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14341.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11810.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12654.6,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19302 - MASTECTOMY PARTIAL W-AXILLARY LYMPHADENECTOMY,19302,HCPCS,,,RT,Outpatient,,,16906.03,4226.5075,1078.11,14370.13,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11090.36,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11834.22,Percent of Total Billed Charges, ,,85,,14370.13,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11496.1,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9467.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10143.62,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19302 - MASTECTOMY PARTIAL W-AXILLARY LYMPHADENECTOMY,19302,HCPCS,,,LT,Outpatient,,,19994,4998.5,1078.11,16994.9,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13116.06,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13995.8,Percent of Total Billed Charges, ,,85,,16994.9,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13595.92,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11196.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11996.4,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19303 - MASTECTOMY SIMPLE COMPLETE,19303,HCPCS,,,XU,Outpatient,,,10527.8,2631.95,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6906.24,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7369.46,Percent of Total Billed Charges, ,,85,,8948.63,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7158.9,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5895.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6316.68,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19303 - MASTECTOMY SIMPLE COMPLETE,19303,HCPCS,,,XS,Outpatient,,,9037.17,2259.2925,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5928.38,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6326.02,Percent of Total Billed Charges, ,,85,,7681.59,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6145.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5060.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5422.3,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19303 - MASTECTOMY SIMPLE COMPLETE,19303,HCPCS,,,RT,Outpatient,,,11034.29,2758.5725,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7238.49,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7724,Percent of Total Billed Charges, ,,85,,9379.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7503.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6179.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6620.57,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19303 - MASTECTOMY SIMPLE COMPLETE,19303,HCPCS,,,LT,Outpatient,,,10659.92,2664.98,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6992.91,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7461.94,Percent of Total Billed Charges, ,,85,,9060.93,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7248.75,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5969.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6395.95,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19303 - MASTECTOMY SIMPLE COMPLETE,19303,HCPCS,,,50,Outpatient,,,12654.03,3163.5075,950.4,10755.93,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8301.04,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8857.82,Percent of Total Billed Charges, ,,85,,10755.93,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8604.74,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7086.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7592.42,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19307 - MAST MODF RAD W-AX LYMPH NOD W-WO PECT-ALIS MIN,19307,HCPCS,,,XU,Outpatient,,,18195.5,4548.875,1078.11,15466.18,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11936.25,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12736.85,Percent of Total Billed Charges, ,,85,,15466.18,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12372.94,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10189.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10917.3,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19307 - MAST MODF RAD W-AX LYMPH NOD W-WO PECT-ALIS MIN,19307,HCPCS,,,RT,Outpatient,,,10667.28,2666.82,1078.11,9640.8,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6997.74,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7467.1,Percent of Total Billed Charges, ,,85,,9067.19,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7253.75,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5973.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6400.37,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19307 - MAST MODF RAD W-AX LYMPH NOD W-WO PECT-ALIS MIN,19307,HCPCS,,,LT,Outpatient,,,11120.79,2780.1975,1078.11,9640.8,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7295.24,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7784.55,Percent of Total Billed Charges, ,,85,,9452.67,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7562.14,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6227.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6672.47,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19307 - MAST MODF RAD W-AX LYMPH NOD W-WO PECT-ALIS MIN,19307,HCPCS,,,50,Outpatient,,,25001,6250.25,1078.11,21250.85,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16400.66,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17500.7,Percent of Total Billed Charges, ,,85,,21250.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,17000.68,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14000.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15000.6,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19316 - MASTOPEXY,19316,HCPCS,,,LT,Outpatient,,,10799.42,2699.855,5431,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7084.42,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7559.59,Percent of Total Billed Charges, ,,85,,9179.51,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7343.61,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6047.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6479.65,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
19316 - MASTOPEXY,19316,HCPCS,,,50,Outpatient,,,18731.73,4682.9325,5431,15921.97,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12288.01,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13112.21,Percent of Total Billed Charges, ,,85,,15921.97,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12737.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10489.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11239.04,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
19318 - BREAST REDUCTION,19318,HCPCS,,,RT,Outpatient,,,18735.33,4683.8325,950.4,15925.03,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12290.38,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13114.73,Percent of Total Billed Charges, ,,85,,15925.03,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12740.02,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10491.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11241.2,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19318 - BREAST REDUCTION,19318,HCPCS,,,LT,Outpatient,,,18082,4520.5,950.4,15369.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11861.79,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12657.4,Percent of Total Billed Charges, ,,85,,15369.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12295.76,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10125.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10849.2,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19318 - BREAST REDUCTION,19318,HCPCS,,,50,Outpatient,,,30319.1,7579.775,950.4,25771.24,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19889.33,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21223.37,Percent of Total Billed Charges, ,,85,,25771.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,20616.99,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16978.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18191.46,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19325 - BREAST AUGMENTATION WITH IMPLANT,19325,HCPCS,,,RT,Outpatient,,,16155.33,4038.8325,1078.11,14284.39,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14132.11,,,14132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10597.9,Percent of Total Billed Charges, ,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11308.73,Percent of Total Billed Charges, ,,85,,13732.03,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10985.62,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9046.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9693.2,Percent of Total Billed Charges, ,13987.68,,,13987.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13836.6,,,13836.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9416.1,,,9416.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9507.08,,,9507.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9097.68,,,9097.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9370.61,,,9370.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9529.82,,,9529.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19325 - BREAST AUGMENTATION WITH IMPLANT,19325,HCPCS,,,50,Outpatient,,,14849.1,3712.275,1078.11,14284.39,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14132.11,,,14132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9741.01,Percent of Total Billed Charges, ,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10394.37,Percent of Total Billed Charges, ,,85,,12621.74,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10097.39,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8315.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8909.46,Percent of Total Billed Charges, ,13987.68,,,13987.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13836.6,,,13836.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9416.1,,,9416.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9507.08,,,9507.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9097.68,,,9097.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9370.61,,,9370.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9529.82,,,9529.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19328 - REMOVAL INTACT BREAST IMPLANT,19328,HCPCS,,,RT,Outpatient,,,10694,2673.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7015.26,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7485.8,Percent of Total Billed Charges, ,,85,,9089.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7271.92,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5988.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6416.4,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19328 - REMOVAL INTACT BREAST IMPLANT,19328,HCPCS,,,50,Outpatient,,,11316.95,2829.2375,882.09,9619.41,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7423.92,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7921.87,Percent of Total Billed Charges, ,,85,,9619.41,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7695.53,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6337.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6790.17,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19330 - RMVL RUPTURED BREAST IMPLANT W-IMPLANT CONTENTS,19330,HCPCS,,,RT,Outpatient,,,6234,1558.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4089.5,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4363.8,Percent of Total Billed Charges, ,,85,,5298.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4239.12,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3491.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3740.4,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19330 - RMVL RUPTURED BREAST IMPLANT W-IMPLANT CONTENTS,19330,HCPCS,,,LT,Outpatient,,,9024,2256,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5919.74,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6316.8,Percent of Total Billed Charges, ,,85,,7670.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6136.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5053.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5414.4,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19330 - RMVL RUPTURED BREAST IMPLANT W-IMPLANT CONTENTS,19330,HCPCS,,,50,Outpatient,,,16814.5,4203.625,742.5,14292.33,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11030.31,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11770.15,Percent of Total Billed Charges, ,,85,,14292.33,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11433.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9416.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10088.7,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19340 - INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY,19340,HCPCS,,,LT,Outpatient,,,8606.27,2151.5675,950.4,9640.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5645.71,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6024.39,Percent of Total Billed Charges, ,,85,,7315.33,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5852.26,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4819.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5163.76,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19340 - INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY,19340,HCPCS,,,50,Outpatient,,,8933.15,2233.2875,950.4,9640.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5860.15,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6253.21,Percent of Total Billed Charges, ,,85,,7593.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6074.54,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5002.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5359.89,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19342 - INSJ-RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY,19342,HCPCS,,,RT,Outpatient,,,8845.49,2211.3725,742.5,14284.39,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14132.11,,,14132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5802.64,Percent of Total Billed Charges, ,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6191.84,Percent of Total Billed Charges, ,,85,,7518.67,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6014.93,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4953.47,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5307.29,Percent of Total Billed Charges, ,13987.68,,,13987.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13836.6,,,13836.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9416.1,,,9416.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9507.08,,,9507.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9097.68,,,9097.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9370.61,,,9370.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9529.82,,,9529.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19342 - INSJ-RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY,19342,HCPCS,,,LT,Outpatient,,,10615.61,2653.9025,742.5,14284.39,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14132.11,,,14132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6963.84,Percent of Total Billed Charges, ,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7430.93,Percent of Total Billed Charges, ,,85,,9023.27,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7218.61,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5944.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6369.37,Percent of Total Billed Charges, ,13987.68,,,13987.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13836.6,,,13836.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9416.1,,,9416.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9507.08,,,9507.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9097.68,,,9097.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9370.61,,,9370.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9529.82,,,9529.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19342 - INSJ-RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY,19342,HCPCS,,,50,Outpatient,,,13368.76,3342.19,742.5,14284.39,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14132.11,,,14132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8769.91,Percent of Total Billed Charges, ,14284.39,,,14284.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9358.13,Percent of Total Billed Charges, ,,85,,11363.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9090.76,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7486.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8021.26,Percent of Total Billed Charges, ,13987.68,,,13987.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13836.6,,,13836.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9416.1,,,9416.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9507.08,,,9507.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9097.68,,,9097.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9188.66,,,9188.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9370.61,,,9370.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9529.82,,,9529.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19350 - NIPPLE-AREOLA RECONSTRUCTION,19350,HCPCS,,,LT,Outpatient,,,12400.5,3100.125,742.5,10540.43,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8134.73,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8680.35,Percent of Total Billed Charges, ,,85,,10540.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8432.34,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6944.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7440.3,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19350 - NIPPLE-AREOLA RECONSTRUCTION,19350,HCPCS,,,50,Outpatient,,,10866.33,2716.5825,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7128.31,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7606.43,Percent of Total Billed Charges, ,,85,,9236.38,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7389.1,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6085.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6519.8,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19357 - TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION,19357,HCPCS,,,RT,Outpatient,,,12493.97,3123.4925,950.4,27063.88,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27063.88,,,27063.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25694.85,,,25694.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8196.04,Percent of Total Billed Charges, ,27063.88,,,27063.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8745.78,Percent of Total Billed Charges, ,,85,,10619.87,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8495.9,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6996.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7496.38,Percent of Total Billed Charges, ,25432.26,,,25432.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26215.48,,,26215.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17120.26,,,17120.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17285.67,,,17285.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16706.72,,,16706.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16541.31,,,16541.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16706.72,,,16706.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17037.55,,,17037.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17327.02,,,17327.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19357 - TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION,19357,HCPCS,,,LT,Outpatient,,,11816.28,2954.07,950.4,27063.88,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27063.88,,,27063.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25694.85,,,25694.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7751.48,Percent of Total Billed Charges, ,27063.88,,,27063.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8271.4,Percent of Total Billed Charges, ,,85,,10043.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8035.07,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6617.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7089.77,Percent of Total Billed Charges, ,25432.26,,,25432.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26215.48,,,26215.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17120.26,,,17120.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17285.67,,,17285.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16706.72,,,16706.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16541.31,,,16541.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16706.72,,,16706.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17037.55,,,17037.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17327.02,,,17327.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19357 - TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION,19357,HCPCS,,,50,Outpatient,,,14187.08,3546.77,950.4,27063.88,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27063.88,,,27063.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25694.85,,,25694.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9306.72,Percent of Total Billed Charges, ,27063.88,,,27063.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9930.96,Percent of Total Billed Charges, ,,85,,12059.02,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9647.21,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7944.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8512.25,Percent of Total Billed Charges, ,25432.26,,,25432.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26215.48,,,26215.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17120.26,,,17120.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17285.67,,,17285.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16706.72,,,16706.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16541.31,,,16541.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16706.72,,,16706.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17037.55,,,17037.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17327.02,,,17327.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19361 - BREAST RECONSTRUCTION W-LATISSIMUS DORSI FLAP,19361,HCPCS,,,LT,Outpatient,,,24437,6109.25,0.01,20771.45,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16030.67,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17105.9,Percent of Total Billed Charges, ,,85,,20771.45,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16617.16,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13684.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14662.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
19370 - REVISION PERI-IMPLANT CAPSULE BREAST,19370,HCPCS,,,XU,Outpatient,,,7412.85,1853.2125,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4862.83,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5189,Percent of Total Billed Charges, ,,85,,6300.92,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5040.74,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4151.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4447.71,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19370 - REVISION PERI-IMPLANT CAPSULE BREAST,19370,HCPCS,,,RT,Outpatient,,,20717,5179.25,882.09,17609.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13590.35,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14501.9,Percent of Total Billed Charges, ,,85,,17609.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14087.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11601.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12430.2,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19370 - REVISION PERI-IMPLANT CAPSULE BREAST,19370,HCPCS,,,LT,Outpatient,,,5510.66,1377.665,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3614.99,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3857.46,Percent of Total Billed Charges, ,,85,,4684.06,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3747.25,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3085.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3306.4,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19370 - REVISION PERI-IMPLANT CAPSULE BREAST,19370,HCPCS,,,50,Outpatient,,,8940.83,2235.2075,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5865.18,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6258.58,Percent of Total Billed Charges, ,,85,,7599.71,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6079.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5006.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5364.5,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19371 - PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE,19371,HCPCS,,,XU,Outpatient,,,12683.5,3170.875,882.09,10780.98,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8320.38,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8878.45,Percent of Total Billed Charges, ,,85,,10780.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8624.78,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7102.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7610.1,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19371 - PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE,19371,HCPCS,,,RT,Outpatient,,,12454.29,3113.5725,882.09,10586.15,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8170.01,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8718,Percent of Total Billed Charges, ,,85,,10586.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8468.92,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6974.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7472.57,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19371 - PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE,19371,HCPCS,,,LT,Outpatient,,,18874,4718.5,882.09,16042.9,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12381.34,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13211.8,Percent of Total Billed Charges, ,,85,,16042.9,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12834.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10569.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11324.4,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19371 - PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE,19371,HCPCS,,,50,Outpatient,,,15473.19,3868.2975,882.09,13152.21,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10150.41,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10831.23,Percent of Total Billed Charges, ,,85,,13152.21,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10521.77,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8664.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9283.91,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19380 - REVISION OF RECONSTRUCTED BREAST,19380,HCPCS,,,XU,Outpatient,,,7821.91,1955.4775,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5131.17,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5475.34,Percent of Total Billed Charges, ,,85,,6648.62,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5318.9,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4380.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4693.15,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19380 - REVISION OF RECONSTRUCTED BREAST,19380,HCPCS,,,RT,Outpatient,,,13814.6,3453.65,1078.11,11742.41,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9062.38,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9670.22,Percent of Total Billed Charges, ,,85,,11742.41,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9393.93,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7736.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8288.76,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19380 - REVISION OF RECONSTRUCTED BREAST,19380,HCPCS,,,LT,Outpatient,,,9749.72,2437.43,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6395.82,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6824.8,Percent of Total Billed Charges, ,,85,,8287.26,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6629.81,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5459.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5849.83,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19380 - REVISION OF RECONSTRUCTED BREAST,19380,HCPCS,,,50,Outpatient,,,10903.22,2725.805,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7152.51,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7632.25,Percent of Total Billed Charges, ,,85,,9267.74,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7414.19,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6105.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6541.93,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY,20103,HCPCS,,,XU,Outpatient,,,10358.5,2589.625,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6795.18,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7250.95,Percent of Total Billed Charges, ,,85,,8804.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7043.78,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5800.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6215.1,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY,20103,HCPCS,,,RT,Outpatient,,,19800.25,4950.0625,742.5,16830.21,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12988.96,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13860.18,Percent of Total Billed Charges, ,,85,,16830.21,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13464.17,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11088.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11880.15,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY,20103,HCPCS,,,LT,Outpatient,,,6403.34,1600.835,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4200.59,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4482.34,Percent of Total Billed Charges, ,,85,,5442.84,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4354.27,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3585.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3842,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20205 - BIOPSY MUSCLE DEEP,20205,HCPCS,,,RT,Outpatient,,,13897,3474.25,742.5,11812.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9116.43,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9727.9,Percent of Total Billed Charges, ,,85,,11812.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9449.96,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7782.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8338.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20220 - BIOPSY BONE TROCAR-NEEDLE SUPERFICIAL,20220,HCPCS,,,XS,Outpatient,,,9090.75,2272.6875,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5963.53,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6363.53,Percent of Total Billed Charges, ,,85,,7727.14,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6181.71,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5090.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5454.45,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20220 - BIOPSY BONE TROCAR-NEEDLE SUPERFICIAL,20220,HCPCS,,,RT,Outpatient,,,2420,605,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1587.52,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1694,Percent of Total Billed Charges, ,,85,,2057,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1645.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1355.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1452,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20220 - BIOPSY BONE TROCAR-NEEDLE SUPERFICIAL,20220,HCPCS,,,LT,Outpatient,,,2420,605,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1587.52,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1694,Percent of Total Billed Charges, ,,85,,2057,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1645.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1355.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1452,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20220 - BIOPSY BONE TROCAR-NEEDLE SUPERFICIAL,20220,HCPCS,,,74,Outpatient,,,2420,605,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1587.52,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1694,Percent of Total Billed Charges, ,,85,,2057,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1645.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1355.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1452,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20225 - BIOPSY BONE TROCAR-NEEDLE DEEP,20225,HCPCS,,,74,Outpatient,,,2320,580,950.4,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20240 - BIOPSY BONE OPEN SUPERFICIAL,20240,HCPCS,,,XU,Outpatient,,,4747.68,1186.92,882.09,4226.84,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3114.48,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3323.38,Percent of Total Billed Charges, ,,85,,4035.53,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3228.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2658.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2848.61,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20240 - BIOPSY BONE OPEN SUPERFICIAL,20240,HCPCS,,,FA,Outpatient,,,12311,3077.75,882.09,10464.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8076.02,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8617.7,Percent of Total Billed Charges, ,,85,,10464.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8371.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6894.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7386.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20245 - BIOPSY BONE OPEN DEEP,20245,HCPCS,,,RT,Outpatient,,,17462,4365.5,950.4,14842.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11455.07,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12223.4,Percent of Total Billed Charges, ,,85,,14842.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11874.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9778.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10477.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20525 - RMVL FOREIGN BODY MUSCLE-TENDON SHEATH DEEP-COMP,20525,HCPCS,,,RT,Outpatient,,,12812,3203,882.09,10890.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8404.67,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8968.4,Percent of Total Billed Charges, ,,85,,10890.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8712.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7174.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7687.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20526 - INJECTION THERAPEUTIC CARPAL TUNNEL,20526,HCPCS,,,XU,Outpatient,,,3876.88,969.22,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2543.23,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2713.82,Percent of Total Billed Charges, ,,85,,3295.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2636.28,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2171.05,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2326.13,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20526 - INJECTION THERAPEUTIC CARPAL TUNNEL,20526,HCPCS,,,XS,Outpatient,,,4756.97,1189.2425,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3120.57,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3329.88,Percent of Total Billed Charges, ,,85,,4043.42,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3234.74,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2663.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2854.18,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20526 - INJECTION THERAPEUTIC CARPAL TUNNEL,20526,HCPCS,,,RT,Outpatient,,,5099.89,1274.9725,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3345.53,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3569.92,Percent of Total Billed Charges, ,,85,,4334.91,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3467.93,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2855.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3059.93,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20550 - INJECTION 1 TENDON SHEATH-LIGAMENT APONEUROSIS,20550,HCPCS,,,XU,Outpatient,,,5373.1,1343.275,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3524.75,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3761.17,Percent of Total Billed Charges, ,,85,,4567.14,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3653.71,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3008.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3223.86,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20550 - INJECTION 1 TENDON SHEATH-LIGAMENT APONEUROSIS,20550,HCPCS,,,XS,Outpatient,,,3551.68,887.92,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2329.9,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2486.18,Percent of Total Billed Charges, ,,85,,3018.93,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2415.14,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1988.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2131.01,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20550 - INJECTION 1 TENDON SHEATH-LIGAMENT APONEUROSIS,20550,HCPCS,,,RT,Outpatient,,,8886,2221.5,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5829.22,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6220.2,Percent of Total Billed Charges, ,,85,,7553.1,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6042.48,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4976.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5331.6,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20550 - INJECTION 1 TENDON SHEATH-LIGAMENT APONEUROSIS,20550,HCPCS,,,LT,Outpatient,,,6389,1597.25,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4191.18,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4472.3,Percent of Total Billed Charges, ,,85,,5430.65,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4344.52,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3577.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3833.4,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20552 - INJECTION SINGLE-MLT TRIGGER POINT 1-2 MUSCLES,20552,HCPCS,,,LT,Outpatient,,,1800,450,280.65,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,XU,Outpatient,,,4092.27,1023.0675,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2684.53,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2864.59,Percent of Total Billed Charges, ,,85,,3478.43,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2782.74,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2291.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2455.36,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,XS,Outpatient,,,5975.68,1493.92,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3920.05,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4182.98,Percent of Total Billed Charges, ,,85,,5079.33,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4063.46,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3346.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3585.41,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,T4,Outpatient,,,5706.75,1426.6875,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3743.63,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3994.73,Percent of Total Billed Charges, ,,85,,4850.74,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3880.59,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3195.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3424.05,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,RT,Outpatient,,,5120.5,1280.125,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3359.05,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3584.35,Percent of Total Billed Charges, ,,85,,4352.43,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3481.94,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2867.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3072.3,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,FA,Outpatient,,,3183.68,795.92,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2088.49,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2228.58,Percent of Total Billed Charges, ,,85,,2706.13,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2164.9,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1782.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1910.21,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,F7,Outpatient,,,4249.25,1062.3125,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2787.51,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2974.48,Percent of Total Billed Charges, ,,85,,3611.86,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2889.49,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2379.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2549.55,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,F6,Outpatient,,,4475.47,1118.8675,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2935.91,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3132.83,Percent of Total Billed Charges, ,,85,,3804.15,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3043.32,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2506.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2685.28,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,F5,Outpatient,,,6297.75,1574.4375,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4131.32,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4408.43,Percent of Total Billed Charges, ,,85,,5353.09,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4282.47,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3526.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3778.65,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,F2,Outpatient,,,2767.25,691.8125,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1815.32,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1937.08,Percent of Total Billed Charges, ,,85,,2352.16,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1881.73,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1549.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1660.35,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20600 - ARTHROCENTESIS ASPIRAND-INJ SMALL JT-BURSA W-O US,20600,HCPCS,,,50,Outpatient,,,4810,1202.5,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3155.36,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3367,Percent of Total Billed Charges, ,,85,,4088.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3270.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2693.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2886,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20604 - ARTHROCNT ASPIRAND-INJ SMALL JT-BURSAW-US REC RPRT,20604,HCPCS,,,LT,Outpatient,,,5051.5,1262.875,280.65,4293.78,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3313.78,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3536.05,Percent of Total Billed Charges, ,,85,,4293.78,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3435.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2828.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3030.9,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20605 - ARTHROCENTESIS ASPIRAND-INJ INTERM JT-BURS W-O US,20605,HCPCS,,,XU,Outpatient,,,2858.66,714.665,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1875.28,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2001.06,Percent of Total Billed Charges, ,,85,,2429.86,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1943.89,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1600.85,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1715.2,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20605 - ARTHROCENTESIS ASPIRAND-INJ INTERM JT-BURS W-O US,20605,HCPCS,,,XS,Outpatient,,,20290.5,5072.625,280.65,17246.93,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13310.57,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14203.35,Percent of Total Billed Charges, ,,85,,17246.93,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13797.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11362.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12174.3,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20605 - ARTHROCENTESIS ASPIRAND-INJ INTERM JT-BURS W-O US,20605,HCPCS,,,RT,Outpatient,,,2965.4,741.35,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1945.3,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2075.78,Percent of Total Billed Charges, ,,85,,2520.59,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2016.47,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1660.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1779.24,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20605 - ARTHROCENTESIS ASPIRAND-INJ INTERM JT-BURS W-O US,20605,HCPCS,,,LT,Outpatient,,,4264.5,1066.125,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2797.51,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2985.15,Percent of Total Billed Charges, ,,85,,3624.83,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2899.86,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2388.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2558.7,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,XU,Outpatient,,,5723.26,1430.815,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3754.46,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4006.28,Percent of Total Billed Charges, ,,85,,4864.77,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3891.82,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3205.03,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3433.96,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,XS,Outpatient,,,7258.5,1814.625,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4761.58,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5080.95,Percent of Total Billed Charges, ,,85,,6169.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4935.78,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4064.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4355.1,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,RT,Outpatient,,,7968.13,1992.0325,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5227.09,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5577.69,Percent of Total Billed Charges, ,,85,,6772.91,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5418.33,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4462.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4780.88,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,LT,Outpatient,,,6308.86,1577.215,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4138.61,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4416.2,Percent of Total Billed Charges, ,,85,,5362.53,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4290.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3532.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3785.32,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE,20670,HCPCS,,,XU,Outpatient,,,5045.66,1261.415,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3309.95,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3531.96,Percent of Total Billed Charges, ,,85,,4288.81,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3431.05,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2825.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3027.4,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE,20670,HCPCS,,,RT,Outpatient,,,15912,3978,742.5,13525.2,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10438.27,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11138.4,Percent of Total Billed Charges, ,,85,,13525.2,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10820.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8910.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9547.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,XU,Outpatient,,,10788.52,2697.13,742.5,9170.24,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7077.27,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7551.96,Percent of Total Billed Charges, ,,85,,9170.24,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7336.19,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6041.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6473.11,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,XS,Outpatient,,,13894.14,3473.535,742.5,11810.02,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9114.56,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9725.9,Percent of Total Billed Charges, ,,85,,11810.02,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9448.02,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7780.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8336.48,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,TA,Outpatient,,,4977.68,1244.42,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3265.36,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3484.38,Percent of Total Billed Charges, ,,85,,4231.03,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3384.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2787.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2986.61,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,T5,Outpatient,,,4241.68,1060.42,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2782.54,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2969.18,Percent of Total Billed Charges, ,,85,,3605.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2884.34,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2375.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2545.01,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,T4,Outpatient,,,6561,1640.25,742.5,5576.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4304.02,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4592.7,Percent of Total Billed Charges, ,,85,,5576.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4461.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3674.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3936.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,RT,Outpatient,,,13090.21,3272.5525,742.5,11126.68,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8587.18,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9163.15,Percent of Total Billed Charges, ,,85,,11126.68,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8901.34,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7330.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7854.13,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,LT,Outpatient,,,11999.21,2999.8025,742.5,10199.33,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7871.48,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8399.45,Percent of Total Billed Charges, ,,85,,10199.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8159.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6719.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7199.53,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,F7,Outpatient,,,8938,2234.5,742.5,7597.3,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5863.33,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6256.6,Percent of Total Billed Charges, ,,85,,7597.3,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6077.84,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5005.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5362.8,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,F5,Outpatient,,,13829,3457.25,742.5,11754.65,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9071.82,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9680.3,Percent of Total Billed Charges, ,,85,,11754.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9403.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7744.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8297.4,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,78,Outpatient,,,10088.5,2522.125,742.5,8575.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6618.06,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7061.95,Percent of Total Billed Charges, ,,85,,8575.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6860.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5649.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6053.1,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,74,Outpatient,,,13292.84,3323.21,742.5,11298.91,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8720.1,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9304.99,Percent of Total Billed Charges, ,,85,,11298.91,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9039.13,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7443.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7975.7,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,58,Outpatient,,,16997,4249.25,742.5,14447.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11150.03,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11897.9,Percent of Total Billed Charges, ,,85,,14447.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11557.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9518.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10198.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,50,Outpatient,,,22422,5605.5,742.5,19058.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14708.83,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15695.4,Percent of Total Billed Charges, ,,85,,19058.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15246.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12556.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13453.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20680 - REMOVAL IMPLANT DEEP,20680,HCPCS,,,22,Outpatient,,,15767.88,3941.97,742.5,13402.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10343.73,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11037.52,Percent of Total Billed Charges, ,,85,,13402.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10722.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8830.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9460.73,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20692 - APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM,20692,HCPCS,,,RT,Outpatient,,,8154.88,2038.72,882.09,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5349.6,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5708.42,Percent of Total Billed Charges, ,,85,,6931.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5545.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4566.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4892.93,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20692 - APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM,20692,HCPCS,,,LT,Outpatient,,,9358.74,2339.685,882.09,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6139.33,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6551.12,Percent of Total Billed Charges, ,,85,,7954.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6363.94,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5240.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5615.24,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20693 - ADJUSTMENT-REVJ XTRNL FIXATION SYSTEM REQ ANES,20693,HCPCS,,,RT,Outpatient,,,7048,1762,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4623.49,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4933.6,Percent of Total Billed Charges, ,,85,,5990.8,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4792.64,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3946.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4228.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20694 - REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,20694,HCPCS,,,RT,Outpatient,,,13098.94,3274.735,742.5,11134.1,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8592.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9169.26,Percent of Total Billed Charges, ,,85,,11134.1,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8907.28,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7335.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7859.36,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20694 - REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,20694,HCPCS,,,LT,Outpatient,,,19083.85,4770.9625,742.5,16221.27,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12519.01,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13358.7,Percent of Total Billed Charges, ,,85,,16221.27,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12977.02,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10686.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11450.31,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20694 - REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,20694,HCPCS,,,58,Outpatient,,,12009.58,3002.395,742.5,10208.14,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7878.28,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8406.71,Percent of Total Billed Charges, ,,85,,10208.14,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8166.51,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6725.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7205.75,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20900 - BONE GRAFT ANY DONOR AREA MINOR-SMALL,20900,HCPCS,,,XU,Outpatient,,,7867.34,1966.835,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5160.98,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5507.14,Percent of Total Billed Charges, ,,85,,6687.24,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5349.79,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4405.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4720.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20900 - BONE GRAFT ANY DONOR AREA MINOR-SMALL,20900,HCPCS,,,RT,Outpatient,,,10160.68,2540.17,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6665.41,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7112.48,Percent of Total Billed Charges, ,,85,,8636.58,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6909.26,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5689.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6096.41,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20900 - BONE GRAFT ANY DONOR AREA MINOR-SMALL,20900,HCPCS,,,LT,Outpatient,,,8023.69,2005.9225,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5263.54,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5616.58,Percent of Total Billed Charges, ,,85,,6820.14,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5456.11,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4493.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4814.21,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20902 - BONE GRAFT ANY DONOR AREA MAJOR-LARGE,20902,HCPCS,,,XU,Outpatient,,,8171.75,2042.9375,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5360.67,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5720.23,Percent of Total Billed Charges, ,,85,,6945.99,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5556.79,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4576.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4903.05,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20902 - BONE GRAFT ANY DONOR AREA MAJOR-LARGE,20902,HCPCS,,,RT,Outpatient,,,7568.2,1892.05,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4964.74,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5297.74,Percent of Total Billed Charges, ,,85,,6432.97,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5146.38,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4238.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4540.92,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20902 - BONE GRAFT ANY DONOR AREA MAJOR-LARGE,20902,HCPCS,,,LT,Outpatient,,,6108.63,1527.1575,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4007.26,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4276.04,Percent of Total Billed Charges, ,,85,,5192.34,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4153.87,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3420.83,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3665.18,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20939 - BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY,20939,HCPCS,,,RT,Outpatient,,,4119.38,1029.845,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2702.31,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2883.57,Percent of Total Billed Charges, ,,85,,3501.47,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2801.18,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2306.85,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2471.63,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
20939 - BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY,20939,HCPCS,,,LT,Outpatient,,,4796.63,1199.1575,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3146.59,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3357.64,Percent of Total Billed Charges, ,,85,,4077.14,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3261.71,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2686.11,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2877.98,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
20985 - CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS,20985,HCPCS,,,RT,Outpatient,,,21651.5,5412.875,0.01,18403.78,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14203.38,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15156.05,Percent of Total Billed Charges, ,,85,,18403.78,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,14723.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12124.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12990.9,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
20985 - CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS,20985,HCPCS,,,LT,Outpatient,,,18480.88,4620.22,0.01,15708.75,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12123.46,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12936.62,Percent of Total Billed Charges, ,,85,,15708.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12567,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10349.29,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11088.53,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
20985 - CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS,20985,HCPCS,,,79,Outpatient,,,20728,5182,0.01,17618.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13597.57,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14509.6,Percent of Total Billed Charges, ,,85,,17618.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,14095.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11607.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12436.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
21012 - EXCISION TUMOR SOFT TISS FACE-SCALP SUBQ 2 CM-GREATER THAN,21012,HCPCS,,,E1,Outpatient,,,17081,4270.25,950.4,14518.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11205.14,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11956.7,Percent of Total Billed Charges, ,,85,,14518.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11615.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9565.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10248.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21014 - EXC TUMOR SOFT TISS FACEANDSCALP SUBFASCIAL 2 CM-GREATER THAN,21014,HCPCS,,,RT,Outpatient,,,18237,4559.25,950.4,15501.45,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11963.47,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12765.9,Percent of Total Billed Charges, ,,85,,15501.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12401.16,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10212.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10942.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21025 - EXCISION BONE MANDIBLE,21025,HCPCS,,,RT,Outpatient,,,17875.33,4468.8325,0.01,15194.03,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11726.22,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12512.73,Percent of Total Billed Charges, ,,85,,15194.03,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12155.22,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10010.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10725.2,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21026 - EXCISION FACIAL BONE,21026,HCPCS,,,50,Outpatient,,,20729,5182.25,882.09,17619.65,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13598.22,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14510.3,Percent of Total Billed Charges, ,,85,,17619.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14095.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11608.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12437.4,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21044 - EXCISION MALIGNANT TUMOR MANDIBLE,21044,HCPCS,,,LT,Outpatient,,,7629,1907.25,1078.11,9034,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5004.62,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5340.3,Percent of Total Billed Charges, ,,85,,6484.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5187.72,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4272.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4577.4,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21046 - EXC BENIGN TUMOR-CYST MNDBL INTRA-ORAL OSTEOT,21046,HCPCS,,,RT,Outpatient,,,19012,4753,950.4,16160.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12471.87,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13308.4,Percent of Total Billed Charges, ,,85,,16160.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12928.16,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10646.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11407.2,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21356 - OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE,21356,HCPCS,,,RT,Outpatient,,,14982,3745.5,882.09,12734.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9828.19,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10487.4,Percent of Total Billed Charges, ,,85,,12734.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10187.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8389.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8989.2,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21365 - OPEN TX COMP FX MALAR W-INTERNAL FXANDMULT SURG,21365,HCPCS,,,LT,Outpatient,,,28777,7194.25,1078.11,24460.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18877.71,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20143.9,Percent of Total Billed Charges, ,,85,,24460.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19568.36,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16115.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17266.2,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21390 - OPTX ORB FLOOR BLWT FX PRI-BITAL APPR W-ALLPLSTC,21390,HCPCS,,,RT,Outpatient,,,11541.25,2885.3125,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7571.06,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8078.88,Percent of Total Billed Charges, ,,85,,9810.06,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7848.05,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6463.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6924.75,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21465 - OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE,21465,HCPCS,,,RT,Outpatient,,,20872,5218,950.4,17741.2,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13692.03,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14610.4,Percent of Total Billed Charges, ,,85,,17741.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14192.96,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11688.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12523.2,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21470 - OPTX COMP MANDIBULAR FX MLT APPR W-INT FIXATION,21470,HCPCS,,,RT,Outpatient,,,32652,8163,742.5,27754.2,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21419.71,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22856.4,Percent of Total Billed Charges, ,,85,,27754.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22203.36,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18285.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19591.2,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21501 - IANDD DEEP ABSC-HMTMA SOFT TISSUE NECK-THORAX,21501,HCPCS,,,RT,Outpatient,,,13350.5,3337.625,742.5,11347.93,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8757.93,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9345.35,Percent of Total Billed Charges, ,,85,,11347.93,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9078.34,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7476.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8010.3,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21552 - EXC TUMOR SOFT TIS NECK-ANT THORAX SUBQ 3 CM-GREATER THAN,21552,HCPCS,,,RT,Outpatient,,,14362,3590.5,950.4,12207.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9421.47,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10053.4,Percent of Total Billed Charges, ,,85,,12207.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9766.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8042.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8617.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21554 - EXC TUMOR SOFT TISSUE NECK-THORAX SUBFASC 5 CM-GREATER THAN,21554,HCPCS,,,RT,Outpatient,,,4402,1100.5,950.4,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2887.71,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3081.4,Percent of Total Billed Charges, ,,85,,3741.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2993.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2465.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2641.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21555 - EXC TUMOR SOFT TISSUE NECK-ANT THORAX SUBQ LESS THAN 3CM,21555,HCPCS,,,XU,Outpatient,,,8731,2182.75,742.5,7421.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5727.54,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6111.7,Percent of Total Billed Charges, ,,85,,7421.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5937.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4889.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5238.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21930 - EXCISION TUMOR SOFT TISSUE BACK-FLANK SUBQ LESS THAN 3CM,21930,HCPCS,,,XU,Outpatient,,,8266,2066.5,742.5,7026.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5422.5,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5786.2,Percent of Total Billed Charges, ,,85,,7026.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5620.88,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4628.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4959.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21931 - EXCISION TUMOR SOFT TIS BACK-FLANK SUBQ 3 CM-GREATER THAN,21931,HCPCS,,,XU,Outpatient,,,7215.68,1803.92,950.4,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4733.49,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5050.98,Percent of Total Billed Charges, ,,85,,6133.33,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4906.66,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4040.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4329.41,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21931 - EXCISION TUMOR SOFT TIS BACK-FLANK SUBQ 3 CM-GREATER THAN,21931,HCPCS,,,XS,Outpatient,,,9893.5,2473.375,950.4,8409.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6490.14,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6925.45,Percent of Total Billed Charges, ,,85,,8409.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6727.58,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5540.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5936.1,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21931 - EXCISION TUMOR SOFT TIS BACK-FLANK SUBQ 3 CM-GREATER THAN,21931,HCPCS,,,RT,Outpatient,,,16222,4055.5,950.4,13788.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10641.63,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11355.4,Percent of Total Billed Charges, ,,85,,13788.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11030.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9084.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9733.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21931 - EXCISION TUMOR SOFT TIS BACK-FLANK SUBQ 3 CM-GREATER THAN,21931,HCPCS,,,LT,Outpatient,,,18857,4714.25,950.4,16028.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12370.19,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13199.9,Percent of Total Billed Charges, ,,85,,16028.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12822.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10559.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11314.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
22513 - PERQ VERT AGMNTJ CAVITY CRTJ UNI-BI CANNULATION,22513,HCPCS,,,74,Outpatient,,,11854,2963.5,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7776.22,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8297.8,Percent of Total Billed Charges, ,,85,,10075.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8060.72,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6638.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7112.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
22514 - PERQ VERT AGMNTJ CAVITY CRTJ UNI-BI CANNULJ LMBR,22514,HCPCS,,,50,Outpatient,,,17003,4250.75,1078.11,14452.55,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11153.97,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11902.1,Percent of Total Billed Charges, ,,85,,14452.55,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11562.04,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9521.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10201.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI-BI CANNULJ EACH,22515,HCPCS,,,XU,Outpatient,,,11557.65,2889.4125,0.01,9824,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7581.82,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8090.36,Percent of Total Billed Charges, ,,85,,9824,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7859.2,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6472.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6934.59,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22515 - PERQ VERT AGMNTJ CAVITY CRTJ UNI-BI CANNULJ EACH,22515,HCPCS,,,XS,Outpatient,,,14845.71,3711.4275,0.01,12618.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9738.79,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10392,Percent of Total Billed Charges, ,,85,,12618.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10095.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8313.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8907.43,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22551 - ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2,22551,HCPCS,,,XU,Outpatient,,,7189.83,1797.4575,1078.11,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4716.53,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5032.88,Percent of Total Billed Charges, ,,85,,6111.36,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4889.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4026.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4313.9,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
22552 - ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC,22552,HCPCS,,,XU,Outpatient,,,4699.59,1174.8975,0.01,6722,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3082.93,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3289.71,Percent of Total Billed Charges, ,,85,,3994.65,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3195.72,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2631.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2819.75,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22554 - ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2,22554,HCPCS,,,XU,Outpatient,,,5161.68,1290.42,1078.11,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3386.06,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3613.18,Percent of Total Billed Charges, ,,85,,4387.43,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3509.94,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2890.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3097.01,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
22558 - ARTHRD ANT INTERBODY MIN DSC LUMBAR,22558,HCPCS,,,XU,Outpatient,,,14087.34,3521.835,0.01,11974.24,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9241.3,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9861.14,Percent of Total Billed Charges, ,,85,,11974.24,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9579.39,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7888.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8452.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22600 - ARTHRD PST-PSTLAT TQ 1NTRSPC CRV BELW C2 SEGMENT,22600,HCPCS,,,73,Outpatient,,,7589,1897.25,0.01,11151,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4978.38,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5312.3,Percent of Total Billed Charges, ,,85,,6450.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5160.52,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4249.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4553.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22614 - ARTHRODESIS PST-PSTLAT TQ 1NTRSPC EA ADDL NTRSPC,22614,HCPCS,,,XU,Outpatient,,,6546.71,1636.6775,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4294.64,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4582.7,Percent of Total Billed Charges, ,,85,,5564.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4451.76,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3666.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3928.03,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
22630 - ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR,22630,HCPCS,,,74,Outpatient,,,4417,1104.25,2473.52,35521.64,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2897.55,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3091.9,Percent of Total Billed Charges, ,,85,,3754.45,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3003.56,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2473.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2650.2,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22634 - ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL,22634,HCPCS,,,XU,Outpatient,,,5041,1260.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3306.9,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3528.7,Percent of Total Billed Charges, ,,85,,4284.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3427.88,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2822.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3024.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22840 - POSTERIOR NON-SEGMENTAL INSTRUMENTATION,22840,HCPCS,,,XU,Outpatient,,,7191.84,1797.96,0.01,6113.06,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4717.85,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5034.29,Percent of Total Billed Charges, ,,85,,6113.06,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4890.45,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4027.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4315.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22845 - ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS,22845,HCPCS,,,XU,Outpatient,,,5319.72,1329.93,0.01,10452,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3489.74,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3723.8,Percent of Total Billed Charges, ,,85,,4521.76,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3617.41,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2979.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3191.83,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22846 - ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS,22846,HCPCS,,,XU,Outpatient,,,4868.34,1217.085,0.01,10452,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3193.63,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3407.84,Percent of Total Billed Charges, ,,85,,4138.09,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3310.47,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2726.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2921,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22852 - REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION,22852,HCPCS,,,XS,Outpatient,,,7119.4,1779.85,0.01,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4670.33,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4983.58,Percent of Total Billed Charges, ,,85,,6051.49,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4841.19,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3986.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4271.64,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22853 - INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W-ARTHRD,22853,HCPCS,,,XU,Outpatient,,,4330.4,1082.6,0.01,13976,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2840.74,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3031.28,Percent of Total Billed Charges, ,,85,,3680.84,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2944.67,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2425.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2598.24,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22853 - INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W-ARTHRD,22853,HCPCS,,,XS,Outpatient,,,5560.33,1390.0825,0.01,13976,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3647.58,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3892.23,Percent of Total Billed Charges, ,,85,,4726.28,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3781.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3113.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3336.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22853 - INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W-ARTHRD,22853,HCPCS,,,50,Outpatient,,,7659.25,1914.8125,0.01,13976,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5024.47,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5361.48,Percent of Total Billed Charges, ,,85,,6510.36,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5208.29,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4289.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4595.55,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
22902 - EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ LESS THAN 3CM,22902,HCPCS,,,XU,Outpatient,,,6630,1657.5,950.4,10028,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4349.28,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4641,Percent of Total Billed Charges, ,,85,,5635.5,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4508.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3712.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3978,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23030 - IANDD SHOULDER DEEP ABSCESS-HEMATOMA,23030,HCPCS,,,RT,Outpatient,,,7970.68,1992.67,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5228.77,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5579.48,Percent of Total Billed Charges, ,,85,,6775.08,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5420.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4463.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4782.41,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23035 - INCISION BONE CORTEX SHOULDER AREA,23035,HCPCS,,,LT,Outpatient,,,16997,4249.25,882.09,14447.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11150.03,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11897.9,Percent of Total Billed Charges, ,,85,,14447.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11557.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9518.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10198.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM-GREATER THAN,23071,HCPCS,,,RT,Outpatient,,,10609.46,2652.365,950.4,9018.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6959.81,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7426.62,Percent of Total Billed Charges, ,,85,,9018.04,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7214.43,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5941.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6365.68,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM-GREATER THAN,23071,HCPCS,,,LT,Outpatient,,,12284,3071,950.4,10441.4,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8058.3,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8598.8,Percent of Total Billed Charges, ,,85,,10441.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8353.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6879.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7370.4,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM-GREATER THAN,23071,HCPCS,,,50,Outpatient,,,12831,3207.75,950.4,10906.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8417.14,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8981.7,Percent of Total Billed Charges, ,,85,,10906.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8725.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7185.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7698.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23073 - EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM-GREATER THAN,23073,HCPCS,,,LT,Outpatient,,,11952.63,2988.1575,950.4,10159.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7840.93,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8366.84,Percent of Total Billed Charges, ,,85,,10159.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8127.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6693.47,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7171.58,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ LESS THAN 3CM,23075,HCPCS,,,LT,Outpatient,,,14517,3629.25,742.5,12339.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9523.15,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10161.9,Percent of Total Billed Charges, ,,85,,12339.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9871.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8129.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8710.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23076 - EXC TUMOR SOFT TISS SHOULDER SUBFASC LESS THAN 5CM,23076,HCPCS,,,RT,Outpatient,,,10480,2620,742.5,8908,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6874.88,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7336,Percent of Total Billed Charges, ,,85,,8908,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7126.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5868.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6288,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23076 - EXC TUMOR SOFT TISS SHOULDER SUBFASC LESS THAN 5CM,23076,HCPCS,,,LT,Outpatient,,,16727,4181.75,742.5,14217.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10972.91,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11708.9,Percent of Total Billed Charges, ,,85,,14217.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11374.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9367.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10036.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23120 - CLAVICULECTOMY PARTIAL,23120,HCPCS,,,RT,Outpatient,,,8257.65,2064.4125,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5417.02,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5780.36,Percent of Total Billed Charges, ,,85,,7019,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5615.2,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4624.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4954.59,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23120 - CLAVICULECTOMY PARTIAL,23120,HCPCS,,,LT,Outpatient,,,8821.18,2205.295,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5786.69,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6174.83,Percent of Total Billed Charges, ,,85,,7498,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5998.4,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4939.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5292.71,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23130 - ACROMIOPLASTY-ACROMIONECTOMY PRTL +-LIGAMENT RLS,23130,HCPCS,,,XU,Outpatient,,,7402.34,1850.585,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4855.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5181.64,Percent of Total Billed Charges, ,,85,,6291.99,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5033.59,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4145.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4441.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23130 - ACROMIOPLASTY-ACROMIONECTOMY PRTL +-LIGAMENT RLS,23130,HCPCS,,,XS,Outpatient,,,5897.66,1474.415,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3868.86,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4128.36,Percent of Total Billed Charges, ,,85,,5013.01,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4010.41,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3302.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3538.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23130 - ACROMIOPLASTY-ACROMIONECTOMY PRTL +-LIGAMENT RLS,23130,HCPCS,,,RT,Outpatient,,,7887.5,1971.875,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5174.2,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5521.25,Percent of Total Billed Charges, ,,85,,6704.38,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5363.5,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4417,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4732.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23170 - SEQUESTRECTOMY CLAVICLE,23170,HCPCS,,,LT,Outpatient,,,11753.5,2938.375,742.5,9990.48,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7710.3,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8227.45,Percent of Total Billed Charges, ,,85,,9990.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7992.38,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6581.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7052.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23410 - OPEN REPAIR OF ROTATOR CUFF ACUTE,23410,HCPCS,,,XS,Outpatient,,,10832.34,2708.085,882.09,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7106.02,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7582.64,Percent of Total Billed Charges, ,,85,,9207.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7365.99,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6066.11,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6499.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23410 - OPEN REPAIR OF ROTATOR CUFF ACUTE,23410,HCPCS,,,RT,Outpatient,,,10691.64,2672.91,882.09,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7013.72,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7484.15,Percent of Total Billed Charges, ,,85,,9087.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7270.32,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5987.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6414.98,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23410 - OPEN REPAIR OF ROTATOR CUFF ACUTE,23410,HCPCS,,,LT,Outpatient,,,10732.12,2683.03,882.09,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7040.27,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7512.48,Percent of Total Billed Charges, ,,85,,9122.3,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7297.84,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6009.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6439.27,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23410 - OPEN REPAIR OF ROTATOR CUFF ACUTE,23410,HCPCS,,,22,Outpatient,,,11491,2872.75,882.09,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7538.1,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8043.7,Percent of Total Billed Charges, ,,85,,9767.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7813.88,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6434.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6894.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23412 - OPEN REPAIR OF ROTATOR CUFF CHRONIC,23412,HCPCS,,,RT,Outpatient,,,13223,3305.75,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8674.29,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9256.1,Percent of Total Billed Charges, ,,85,,11239.55,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8991.64,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7404.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7933.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23412 - OPEN REPAIR OF ROTATOR CUFF CHRONIC,23412,HCPCS,,,LT,Outpatient,,,9735.04,2433.76,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6386.19,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6814.53,Percent of Total Billed Charges, ,,85,,8274.78,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6619.83,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5451.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5841.02,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23420 - RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,23420,HCPCS,,,RT,Outpatient,,,9078.13,2269.5325,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5955.25,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6354.69,Percent of Total Billed Charges, ,,85,,7716.41,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6173.13,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5083.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5446.88,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23420 - RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,23420,HCPCS,,,LT,Outpatient,,,11026,2756.5,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7233.06,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7718.2,Percent of Total Billed Charges, ,,85,,9372.1,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7497.68,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6174.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6615.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23420 - RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,23420,HCPCS,,,22,Outpatient,,,12421,3105.25,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8148.18,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8694.7,Percent of Total Billed Charges, ,,85,,10557.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8446.28,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6955.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7452.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23430 - TENODESIS LONG TENDON BICEPS,23430,HCPCS,,,XU,Outpatient,,,16129.43,4032.3575,742.5,13710.02,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10580.91,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11290.6,Percent of Total Billed Charges, ,,85,,13710.02,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10968.01,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9032.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9677.66,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23430 - TENODESIS LONG TENDON BICEPS,23430,HCPCS,,,XS,Outpatient,,,10713.13,2678.2825,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7027.81,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7499.19,Percent of Total Billed Charges, ,,85,,9106.16,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7284.93,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5999.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6427.88,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23430 - TENODESIS LONG TENDON BICEPS,23430,HCPCS,,,RT,Outpatient,,,6426.91,1606.7275,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4216.05,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4498.84,Percent of Total Billed Charges, ,,85,,5462.87,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4370.3,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3599.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3856.15,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23430 - TENODESIS LONG TENDON BICEPS,23430,HCPCS,,,LT,Outpatient,,,7046.34,1761.585,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4622.4,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4932.44,Percent of Total Billed Charges, ,,85,,5989.39,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4791.51,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3945.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4227.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23440 - RESECTION-TRANSPLANTATION LONG TENDON BICEPS,23440,HCPCS,,,RT,Outpatient,,,13026.9,3256.725,0.01,11072.87,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8545.65,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9118.83,Percent of Total Billed Charges, ,,85,,11072.87,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8858.29,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7295.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7816.14,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23440 - RESECTION-TRANSPLANTATION LONG TENDON BICEPS,23440,HCPCS,,,LT,Outpatient,,,10437.06,2609.265,0.01,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6846.71,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7305.94,Percent of Total Billed Charges, ,,85,,8871.5,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7097.2,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5844.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6262.24,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23460 - CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK,23460,HCPCS,,,LT,Outpatient,,,17536,4384,950.4,14905.6,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11503.62,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12275.2,Percent of Total Billed Charges, ,,85,,14905.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11924.48,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9820.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23462 - CAPSULORRHAPHY ANTERIOR W-CORACOID PROCESS TR,23462,HCPCS,,,RT,Outpatient,,,14990.5,3747.625,882.09,12741.93,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9833.77,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10493.35,Percent of Total Billed Charges, ,,85,,12741.93,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10193.54,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8394.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8994.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23466 - CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS,23466,HCPCS,,,LT,Outpatient,,,10871,2717.75,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7131.38,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7609.7,Percent of Total Billed Charges, ,,85,,9240.35,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7392.28,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6087.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6522.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23470 - ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY,23470,HCPCS,,,RT,Outpatient,,,22740.33,5685.0825,882.09,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14917.66,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15918.23,Percent of Total Billed Charges, ,,85,,19329.28,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15463.42,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12734.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13644.2,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23470 - ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY,23470,HCPCS,,,LT,Outpatient,,,14738.96,3684.74,882.09,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9668.76,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10317.27,Percent of Total Billed Charges, ,,85,,12528.12,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10022.49,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8253.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8843.38,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23472 - ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,23472,HCPCS,,,XU,Outpatient,,,11628.09,2907.0225,6015,27159.44,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7628.03,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8139.66,Percent of Total Billed Charges, ,,85,,9883.88,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7907.1,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6511.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6976.85,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
23472 - ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,23472,HCPCS,,,XS,Outpatient,,,13858,3464.5,6015,27159.44,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9090.85,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9700.6,Percent of Total Billed Charges, ,,85,,11779.3,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9423.44,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7760.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8314.8,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
23472 - ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,23472,HCPCS,,,RT,Outpatient,,,21607.61,5401.9025,6015,27159.44,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14174.59,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15125.33,Percent of Total Billed Charges, ,,85,,18366.47,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14693.17,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12100.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12964.57,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
23472 - ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,23472,HCPCS,,,LT,Outpatient,,,22865.7,5716.425,6015,27159.44,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14999.9,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16005.99,Percent of Total Billed Charges, ,,85,,19435.85,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15548.68,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12804.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13719.42,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
23472 - ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,23472,HCPCS,,,22,Outpatient,,,23175,5793.75,6015,27159.44,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15202.8,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16222.5,Percent of Total Billed Charges, ,,85,,19698.75,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15759,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12978,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13905,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
23473 - REVIS SHOULDER ARTHRPLSTY HUMERAL-GLENOID COMPNT,23473,HCPCS,,,RT,Outpatient,,,7815.68,1953.92,1078.11,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5127.09,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5470.98,Percent of Total Billed Charges, ,,85,,6643.33,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5314.66,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4376.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4689.41,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23473 - REVIS SHOULDER ARTHRPLSTY HUMERAL-GLENOID COMPNT,23473,HCPCS,,,LT,Outpatient,,,22159.5,5539.875,1078.11,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14536.63,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15511.65,Percent of Total Billed Charges, ,,85,,18835.58,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15068.46,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12409.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13295.7,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23480 - OSTEOTOMY CLAVICLE W-WO INTERNAL FIXATION,23480,HCPCS,,,RT,Outpatient,,,25522,6380.5,0.01,21693.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16742.43,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17865.4,Percent of Total Billed Charges, ,,85,,21693.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17354.96,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14292.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15313.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23485 - OSTEOTOMY CLAV W-WO INT FIXJ W-BONE GRF NON-MAL,23485,HCPCS,,,LT,Outpatient,,,16877.75,4219.4375,950.4,21166.19,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11071.8,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11814.43,Percent of Total Billed Charges, ,,85,,14346.09,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11476.87,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9451.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10126.65,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23515 - OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,23515,HCPCS,,,RT,Outpatient,,,21493.9,5373.475,1078.11,18269.82,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14100,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15045.73,Percent of Total Billed Charges, ,,85,,18269.82,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14615.85,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12036.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12896.34,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23515 - OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,23515,HCPCS,,,LT,Outpatient,,,18300.86,4575.215,1078.11,15555.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12005.36,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12810.6,Percent of Total Billed Charges, ,,85,,15555.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12444.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10248.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10980.52,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23550 - OPEN TX ACROMIOCLAVICULAR DISLC ACUTE-CHRONIC,23550,HCPCS,,,RT,Outpatient,,,13240.29,3310.0725,950.4,11254.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8685.63,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9268.2,Percent of Total Billed Charges, ,,85,,11254.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9003.4,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7414.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7944.17,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23550 - OPEN TX ACROMIOCLAVICULAR DISLC ACUTE-CHRONIC,23550,HCPCS,,,LT,Outpatient,,,10243.52,2560.88,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6719.75,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7170.46,Percent of Total Billed Charges, ,,85,,8706.99,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6965.59,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5736.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6146.11,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23552 - OPTX ACROMCLAV DISLC ACUTE-CHRONIC W-FASCIAL GRF,23552,HCPCS,,,LT,Outpatient,,,22577,5644.25,882.09,19190.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14810.51,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15803.9,Percent of Total Billed Charges, ,,85,,19190.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15352.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12643.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13546.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23585 - OPEN TX SCAPULAR FX W-INT FIXATION WHEN PFRMD,23585,HCPCS,,,LT,Outpatient,,,24977.75,6244.4375,0.01,21231.09,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16385.4,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17484.43,Percent of Total Billed Charges, ,,85,,21231.09,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16984.87,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13987.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14986.65,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23615 - OPTX PROX HUMERAL FX W-INT FIXJ RPR TUBEROSITY,23615,HCPCS,,,RT,Outpatient,,,13639.09,3409.7725,882.09,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8947.24,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9547.36,Percent of Total Billed Charges, ,,85,,11593.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9274.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7637.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8183.45,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23615 - OPTX PROX HUMERAL FX W-INT FIXJ RPR TUBEROSITY,23615,HCPCS,,,LT,Outpatient,,,17198.79,4299.6975,882.09,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11282.41,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12039.15,Percent of Total Billed Charges, ,,85,,14618.97,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11695.18,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9631.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10319.27,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23630 - OPTX GREATER HUMERAL TUBEROSITY FX W-INT FIXJ,23630,HCPCS,,,RT,Outpatient,,,10832.33,2708.0825,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7106.01,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7582.63,Percent of Total Billed Charges, ,,85,,9207.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7365.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6066.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6499.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23655 - CLSD TX SHOULDER DISLC W-MANIPULATION REQ ANES,23655,HCPCS,,,RT,Outpatient,,,7113.92,1778.48,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4666.73,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4979.74,Percent of Total Billed Charges, ,,85,,6046.83,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4837.47,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3983.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4268.35,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23665 - CLTX SHOULDER DISLC W-FX HUMERAL TUBRST W-MNPJ,23665,HCPCS,,,RT,Outpatient,,,4539,1134.75,882.09,3858.15,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2977.58,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3177.3,Percent of Total Billed Charges, ,,85,,3858.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3086.52,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2541.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2723.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23670 - OPTX SHO DISLC W-FX GR HUMERAL TUBRST INT FIXJ,23670,HCPCS,,,RT,Outpatient,,,14901,3725.25,1078.11,12665.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9775.06,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10430.7,Percent of Total Billed Charges, ,,85,,12665.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10132.68,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8344.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8940.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23670 - OPTX SHO DISLC W-FX GR HUMERAL TUBRST INT FIXJ,23670,HCPCS,,,LT,Outpatient,,,11897.33,2974.3325,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7804.65,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8328.13,Percent of Total Billed Charges, ,,85,,10112.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8090.18,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6662.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7138.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23680 - OPTX SHO DISLC W-SURG-ANTMCL NECK FX INT FIXJ,23680,HCPCS,,,LT,Outpatient,,,22651,5662.75,1078.11,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14859.06,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15855.7,Percent of Total Billed Charges, ,,85,,19253.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15402.68,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12684.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13590.6,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23700 - MNPJ W-ANES SHOULDER JT APPL FIXATION APPARATUS,23700,HCPCS,,,XU,Outpatient,,,6214,1553.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4076.38,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4349.8,Percent of Total Billed Charges, ,,85,,5281.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4225.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3479.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3728.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23700 - MNPJ W-ANES SHOULDER JT APPL FIXATION APPARATUS,23700,HCPCS,,,RT,Outpatient,,,6949,1737.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4558.54,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4864.3,Percent of Total Billed Charges, ,,85,,5906.65,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4725.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3891.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4169.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23700 - MNPJ W-ANES SHOULDER JT APPL FIXATION APPARATUS,23700,HCPCS,,,LT,Outpatient,,,6238.44,1559.61,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4092.42,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4366.91,Percent of Total Billed Charges, ,,85,,5302.67,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4242.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3493.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3743.06,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23700 - MNPJ W-ANES SHOULDER JT APPL FIXATION APPARATUS,23700,HCPCS,,,58,Outpatient,,,4417,1104.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2897.55,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3091.9,Percent of Total Billed Charges, ,,85,,3754.45,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3003.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2473.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2650.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24006 - ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX,24006,HCPCS,,,LT,Outpatient,,,16319,4079.75,742.5,13871.15,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10705.26,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11423.3,Percent of Total Billed Charges, ,,85,,13871.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11096.92,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9138.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9791.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24071 - EXC TUMOR SOFT TISSUE UPPER ARM-ELBOW SUBQ 3CM-GREATER THAN,24071,HCPCS,,,XU,Outpatient,,,2934.4,733.6,950.4,9153,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1924.97,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2054.08,Percent of Total Billed Charges, ,,85,,2494.24,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1995.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1643.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1760.64,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24071 - EXC TUMOR SOFT TISSUE UPPER ARM-ELBOW SUBQ 3CM-GREATER THAN,24071,HCPCS,,,RT,Outpatient,,,15311,3827.75,950.4,13014.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10044.02,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10717.7,Percent of Total Billed Charges, ,,85,,13014.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10411.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8574.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9186.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24071 - EXC TUMOR SOFT TISSUE UPPER ARM-ELBOW SUBQ 3CM-GREATER THAN,24071,HCPCS,,,LT,Outpatient,,,11792.25,2948.0625,950.4,10023.41,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7735.72,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8254.58,Percent of Total Billed Charges, ,,85,,10023.41,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8018.73,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6603.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7075.35,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24071 - EXC TUMOR SOFT TISSUE UPPER ARM-ELBOW SUBQ 3CM-GREATER THAN,24071,HCPCS,,,50,Outpatient,,,12744,3186,950.4,10832.4,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8360.06,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8920.8,Percent of Total Billed Charges, ,,85,,10832.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8665.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7136.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7646.4,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24073 - EXC TUMOR SOFT TISS UPPER ARM-ELBW SUBFASC 5CM-GREATER THAN,24073,HCPCS,,,RT,Outpatient,,,19632,4908,950.4,16687.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12878.59,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13742.4,Percent of Total Billed Charges, ,,85,,16687.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13349.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10993.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11779.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24073 - EXC TUMOR SOFT TISS UPPER ARM-ELBW SUBFASC 5CM-GREATER THAN,24073,HCPCS,,,LT,Outpatient,,,9971,2492.75,950.4,8475.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6540.98,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6979.7,Percent of Total Billed Charges, ,,85,,8475.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6780.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5583.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5982.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24075 - EXC TUMOR SOFT TISS UPPER ARM-ELBOW SUBQ LESS THAN 3CM,24075,HCPCS,,,RT,Outpatient,,,13826,3456.5,882.09,11752.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9069.86,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9678.2,Percent of Total Billed Charges, ,,85,,11752.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9401.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7742.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8295.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24075 - EXC TUMOR SOFT TISS UPPER ARM-ELBOW SUBQ LESS THAN 3CM,24075,HCPCS,,,LT,Outpatient,,,12812,3203,882.09,10890.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8404.67,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8968.4,Percent of Total Billed Charges, ,,85,,10890.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8712.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7174.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7687.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24101 - ARTHRT ELBOW W-JT EXPL W-WOBX W-O RMVL LOOSE-FB,24101,HCPCS,,,RT,Outpatient,,,18245,4561.25,742.5,15508.25,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11968.72,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12771.5,Percent of Total Billed Charges, ,,85,,15508.25,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12406.6,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10217.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10947,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24101 - ARTHRT ELBOW W-JT EXPL W-WOBX W-O RMVL LOOSE-FB,24101,HCPCS,,,LT,Outpatient,,,16784.5,4196.125,742.5,14266.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11010.63,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11749.15,Percent of Total Billed Charges, ,,85,,14266.83,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11413.46,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9399.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10070.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24102 - ARTHROTOMY ELBOW W-SYNOVECTOMY,24102,HCPCS,,,XU,Outpatient,,,6790.5,1697.625,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4454.57,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4753.35,Percent of Total Billed Charges, ,,85,,5771.93,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4617.54,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3802.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4074.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24102 - ARTHROTOMY ELBOW W-SYNOVECTOMY,24102,HCPCS,,,LT,Outpatient,,,10668.5,2667.125,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6998.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7467.95,Percent of Total Billed Charges, ,,85,,9068.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7254.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5974.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6401.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24105 - EXCISION OLECRANON BURSA,24105,HCPCS,,,XU,Outpatient,,,7055.21,1763.8025,742.5,5996.93,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4628.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4938.65,Percent of Total Billed Charges, ,,85,,5996.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4797.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3950.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4233.13,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24105 - EXCISION OLECRANON BURSA,24105,HCPCS,,,RT,Outpatient,,,12683.5,3170.875,742.5,10780.98,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8320.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8878.45,Percent of Total Billed Charges, ,,85,,10780.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8624.78,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7102.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7610.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24105 - EXCISION OLECRANON BURSA,24105,HCPCS,,,LT,Outpatient,,,14738.5,3684.625,742.5,12527.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9668.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10316.95,Percent of Total Billed Charges, ,,85,,12527.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10022.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8253.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8843.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24120 - EXC-CURTG BONE CYST-BENIGN TUMOR H-N RDS-OLECRN,24120,HCPCS,,,RT,Outpatient,,,7926,1981.5,950.4,6737.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5199.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5548.2,Percent of Total Billed Charges, ,,85,,6737.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5389.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4438.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4755.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24130 - EXCISION RADIAL HEAD,24130,HCPCS,,,RT,Outpatient,,,13581.68,3395.42,950.4,11544.43,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8909.58,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9507.18,Percent of Total Billed Charges, ,,85,,11544.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9235.54,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7605.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8149.01,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24140 - PARTIAL EXCISION BONE HUMERUS,24140,HCPCS,,,XU,Outpatient,,,4738,1184.5,882.09,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3108.13,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3316.6,Percent of Total Billed Charges, ,,85,,4027.3,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3221.84,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2653.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2842.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24147 - PARTIAL EXCISION BONE OLECRANON PROCESS,24147,HCPCS,,,RT,Outpatient,,,6764.94,1691.235,882.09,5750.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4437.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4735.46,Percent of Total Billed Charges, ,,85,,5750.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4600.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3788.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4058.96,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24149 - RAD RESCJ CAPSL TISSANDHTRTPC B1 ELBW CONTRCT RLS,24149,HCPCS,,,LT,Outpatient,,,10640.5,2660.125,0.01,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6980.17,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7448.35,Percent of Total Billed Charges, ,,85,,9044.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7235.54,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5958.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6384.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24164 - PROSTHESIS REMOVAL RADIAL HEAD,24164,HCPCS,,,LT,Outpatient,,,6946.75,1736.6875,882.09,5904.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4557.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4862.73,Percent of Total Billed Charges, ,,85,,5904.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4723.79,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3890.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4168.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24200 - RMVL FOREIGN BODY UPPER ARM-ELBOW SUBCUTANEOUS,24200,HCPCS,,,RT,Outpatient,,,21027,5256.75,742.5,17872.95,,,,,,,Service Paid at Rev Code level,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13793.71,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14718.9,Percent of Total Billed Charges, ,,85,,17872.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,14298.36,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11775.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12616.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24200 - RMVL FOREIGN BODY UPPER ARM-ELBOW SUBCUTANEOUS,24200,HCPCS,,,LT,Outpatient,,,8581,2145.25,742.5,7293.85,,,,,,,Service Paid at Rev Code level,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5835.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24201 - REMOVAL FOREIGN BODY UPPER ARM-ELBOW DEEP,24201,HCPCS,,,LT,Outpatient,,,12725,3181.25,742.5,10816.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8347.6,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8907.5,Percent of Total Billed Charges, ,,85,,10816.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8653,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7126,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7635,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24220 - INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY,24220,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24220 - INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY,24220,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24300 - MANIPULATION ELBOW UNDER ANESTHESIA,24300,HCPCS,,,RT,Outpatient,,,5910,1477.5,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3876.96,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4137,Percent of Total Billed Charges, ,,85,,5023.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4018.8,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3309.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3546,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24305 - TENDON LENGTHENING UPPER ARM-ELBOW EA TENDON,24305,HCPCS,,,RT,Outpatient,,,9757.67,2439.4175,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6401.03,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6830.37,Percent of Total Billed Charges, ,,85,,8294.02,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6635.22,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5464.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5854.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24340 - TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE,24340,HCPCS,,,XU,Outpatient,,,13797,3449.25,1078.11,11727.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9050.83,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9657.9,Percent of Total Billed Charges, ,,85,,11727.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9381.96,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7726.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8278.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24340 - TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE,24340,HCPCS,,,LT,Outpatient,,,16867.5,4216.875,1078.11,14337.38,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11065.08,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11807.25,Percent of Total Billed Charges, ,,85,,14337.38,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11469.9,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9445.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10120.5,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24341 - REPAIR TENDON-MUSCLE UPPER ARM-ELBOW EA TDN-MUSC,24341,HCPCS,,,RT,Outpatient,,,11196.8,2799.2,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7345.1,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7837.76,Percent of Total Billed Charges, ,,85,,9517.28,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7613.82,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6270.21,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6718.08,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24341 - REPAIR TENDON-MUSCLE UPPER ARM-ELBOW EA TDN-MUSC,24341,HCPCS,,,LT,Outpatient,,,24414,6103.5,742.5,20751.9,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16015.58,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17089.8,Percent of Total Billed Charges, ,,85,,20751.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16601.52,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13671.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14648.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24342 - RINSJ RPTD BICEPS-TRICEPS TDN DSTL W-WO TDN GRF,24342,HCPCS,,,RT,Outpatient,,,14981.7,3745.425,1078.11,12734.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9828,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10487.19,Percent of Total Billed Charges, ,,85,,12734.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10187.56,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8389.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8989.02,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24342 - RINSJ RPTD BICEPS-TRICEPS TDN DSTL W-WO TDN GRF,24342,HCPCS,,,LT,Outpatient,,,18788.14,4697.035,1078.11,15969.92,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12325.02,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13151.7,Percent of Total Billed Charges, ,,85,,15969.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12775.94,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10521.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11272.88,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24343 - REPAIR LATERAL COLLATERAL LIGAMENT ELBOW,24343,HCPCS,,,XU,Outpatient,,,6869.25,1717.3125,950.4,9034,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4506.23,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4808.48,Percent of Total Billed Charges, ,,85,,5838.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4671.09,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3846.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4121.55,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24343 - REPAIR LATERAL COLLATERAL LIGAMENT ELBOW,24343,HCPCS,,,LT,Outpatient,,,10042.26,2510.565,950.4,9034,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6587.72,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7029.58,Percent of Total Billed Charges, ,,85,,8535.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6828.74,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5623.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6025.36,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24346 - RCNSTJ MEDIAL COLTRL LIGM ELBW W-TDN GRF,24346,HCPCS,,,RT,Outpatient,,,27227,6806.75,950.4,23142.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17860.91,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19058.9,Percent of Total Billed Charges, ,,85,,23142.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18514.36,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15247.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16336.2,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24346 - RCNSTJ MEDIAL COLTRL LIGM ELBW W-TDN GRF,24346,HCPCS,,,LT,Outpatient,,,21971,5492.75,950.4,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14412.98,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15379.7,Percent of Total Billed Charges, ,,85,,18675.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14940.28,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12303.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13182.6,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24358 - TNOT ELBOW LATERAL-MEDIAL DEBRIDE OPEN,24358,HCPCS,,,XU,Outpatient,,,7567.63,1891.9075,950.4,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4964.37,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5297.34,Percent of Total Billed Charges, ,,85,,6432.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5145.99,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4237.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4540.58,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24358 - TNOT ELBOW LATERAL-MEDIAL DEBRIDE OPEN,24358,HCPCS,,,RT,Outpatient,,,13196,3299,950.4,11216.6,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8656.58,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9237.2,Percent of Total Billed Charges, ,,85,,11216.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8973.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7389.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7917.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24358 - TNOT ELBOW LATERAL-MEDIAL DEBRIDE OPEN,24358,HCPCS,,,LT,Outpatient,,,5686.13,1421.5325,950.4,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3730.1,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3980.29,Percent of Total Billed Charges, ,,85,,4833.21,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3866.57,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3184.23,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3411.68,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24359 - TNOT ELBOW LATERAL-MEDIAL DEBRIDE OPEN TDN RPR,24359,HCPCS,,,XU,Outpatient,,,5164.25,1291.0625,1078.11,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3387.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3614.98,Percent of Total Billed Charges, ,,85,,4389.61,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3511.69,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2891.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3098.55,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24359 - TNOT ELBOW LATERAL-MEDIAL DEBRIDE OPEN TDN RPR,24359,HCPCS,,,RT,Outpatient,,,10516.74,2629.185,1078.11,8939.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6898.98,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7361.72,Percent of Total Billed Charges, ,,85,,8939.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7151.38,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5889.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6310.04,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24359 - TNOT ELBOW LATERAL-MEDIAL DEBRIDE OPEN TDN RPR,24359,HCPCS,,,LT,Outpatient,,,11814.17,2953.5425,1078.11,10042.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7750.1,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8269.92,Percent of Total Billed Charges, ,,85,,10042.04,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8033.64,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6615.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7088.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24363 - ARTHRP ELBOW W-DISTAL HUMANDPROX UR PROSTC RPLCM,24363,HCPCS,,,RT,Outpatient,,,13581.66,3395.415,0.01,35521.64,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8909.57,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9507.16,Percent of Total Billed Charges, ,,85,,11544.41,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9235.53,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7605.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8149,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24365 - ARTHROPLASTY RADIAL HEAD,24365,HCPCS,,,LT,Outpatient,,,15706,3926.5,742.5,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10303.14,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10994.2,Percent of Total Billed Charges, ,,85,,13350.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10680.08,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8795.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9423.6,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24366 - ARTHROPLASTY RADIAL HEAD W-IMPLANT,24366,HCPCS,,,RT,Outpatient,,,33298.5,8324.625,882.09,28303.73,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21843.82,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23308.95,Percent of Total Billed Charges, ,,85,,28303.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22642.98,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18647.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19979.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24366 - ARTHROPLASTY RADIAL HEAD W-IMPLANT,24366,HCPCS,,,LT,Outpatient,,,12510.56,3127.64,882.09,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8206.93,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8757.39,Percent of Total Billed Charges, ,,85,,10633.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8507.18,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7005.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7506.34,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24430 - REPAIR NON-MALUNION HUMERUS W-O GRAFT,24430,HCPCS,,,LT,Outpatient,,,15539,3884.75,950.4,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10193.58,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10877.3,Percent of Total Billed Charges, ,,85,,13208.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10566.52,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8701.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9323.4,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24435 - REPAIR NON-MALUNION HUMERUS W-ILIAC-OTH AGRFT,24435,HCPCS,,,RT,Outpatient,,,11678.5,2919.625,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7661.1,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8174.95,Percent of Total Billed Charges, ,,85,,9926.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7941.38,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6539.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7007.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24515 - OPTX HUMERAL SHFT FX W-PLATE-SCREWS W-WOCERCLAGE,24515,HCPCS,,,RT,Outpatient,,,25418.85,6354.7125,1078.11,21606.02,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16674.77,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17793.2,Percent of Total Billed Charges, ,,85,,21606.02,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17284.82,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14234.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15251.31,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24515 - OPTX HUMERAL SHFT FX W-PLATE-SCREWS W-WOCERCLAGE,24515,HCPCS,,,LT,Outpatient,,,21784.25,5446.0625,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14290.47,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15248.98,Percent of Total Billed Charges, ,,85,,18516.61,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14813.29,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12199.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13070.55,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24515 - OPTX HUMERAL SHFT FX W-PLATE-SCREWS W-WOCERCLAGE,24515,HCPCS,,,58,Outpatient,,,17923.5,4480.875,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11757.82,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12546.45,Percent of Total Billed Charges, ,,85,,15234.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12187.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10037.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10754.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24516 - TX HUMRAL SHAFT FX W-INSJ IMED IMPLT W-W CERCLGE,24516,HCPCS,,,RT,Outpatient,,,13735,3433.75,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9010.16,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9614.5,Percent of Total Billed Charges, ,,85,,11674.75,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9339.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7691.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8241,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24516 - TX HUMRAL SHAFT FX W-INSJ IMED IMPLT W-W CERCLGE,24516,HCPCS,,,LT,Outpatient,,,17246.17,4311.5425,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11313.49,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12072.32,Percent of Total Billed Charges, ,,85,,14659.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11727.4,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9657.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10347.7,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24545 - OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W-O XTN,24545,HCPCS,,,RT,Outpatient,,,21975.2,5493.8,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14415.73,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15382.64,Percent of Total Billed Charges, ,,85,,18678.92,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14943.14,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12306.11,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13185.12,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24545 - OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W-O XTN,24545,HCPCS,,,LT,Outpatient,,,31041,7760.25,1078.11,26384.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20362.9,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21728.7,Percent of Total Billed Charges, ,,85,,26384.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21107.88,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17382.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18624.6,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24546 - OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W-XTN,24546,HCPCS,,,RT,Outpatient,,,19544.58,4886.145,1078.11,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12821.24,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13681.21,Percent of Total Billed Charges, ,,85,,16612.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13290.31,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10944.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11726.75,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24546 - OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W-XTN,24546,HCPCS,,,LT,Outpatient,,,24572.38,6143.095,1078.11,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16119.48,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17200.67,Percent of Total Billed Charges, ,,85,,20886.52,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16709.22,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13760.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14743.43,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24546 - OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W-XTN,24546,HCPCS,,,80,Outpatient,,,18573.5,4643.375,1078.11,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12184.22,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13001.45,Percent of Total Billed Charges, ,,85,,15787.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12629.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10401.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11144.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24575 - OPEN TX HUMERAL EPICONDYLAR FRACTURE,24575,HCPCS,,,RT,Outpatient,,,16058.25,4014.5625,882.09,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10534.21,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11240.78,Percent of Total Billed Charges, ,,85,,13649.51,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10919.61,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8992.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9634.95,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24579 - OPEN TREATMENT HUMERAL CONDYLAR FRACTURE,24579,HCPCS,,,LT,Outpatient,,,11157.25,2789.3125,1078.11,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7319.16,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7810.08,Percent of Total Billed Charges, ,,85,,9483.66,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7586.93,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6248.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6694.35,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24586 - OPTX PERIARTICULAR FRACTURE AND-DISLOCATION ELBO,24586,HCPCS,,,RT,Outpatient,,,15288.5,3822.125,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10029.26,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10701.95,Percent of Total Billed Charges, ,,85,,12995.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10396.18,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8561.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9173.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24586 - OPTX PERIARTICULAR FRACTURE AND-DISLOCATION ELBO,24586,HCPCS,,,LT,Outpatient,,,12851.5,3212.875,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8430.58,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8996.05,Percent of Total Billed Charges, ,,85,,10923.78,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8739.02,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7196.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7710.9,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24615 - OPEN TX ACUTE-CHRONIC ELBOW DISLOCATION,24615,HCPCS,,,LT,Outpatient,,,6869.25,1717.3125,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4506.23,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4808.48,Percent of Total Billed Charges, ,,85,,5838.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4671.09,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3846.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4121.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24665 - OPEN TX RADIAL HEAD-NECK FRACTURE,24665,HCPCS,,,RT,Outpatient,,,12033.5,3008.375,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7893.98,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8423.45,Percent of Total Billed Charges, ,,85,,10228.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8182.78,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6738.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7220.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24665 - OPEN TX RADIAL HEAD-NECK FRACTURE,24665,HCPCS,,,LT,Outpatient,,,11300.85,2825.2125,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7413.36,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7910.6,Percent of Total Billed Charges, ,,85,,9605.72,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7684.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6328.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6780.51,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24666 - OPEN TX RADIAL HEAD-NECK FRACTURE PROSTHETIC,24666,HCPCS,,,RT,Outpatient,,,14048.5,3512.125,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9215.82,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9833.95,Percent of Total Billed Charges, ,,85,,11941.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9552.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7867.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8429.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24666 - OPEN TX RADIAL HEAD-NECK FRACTURE PROSTHETIC,24666,HCPCS,,,LT,Outpatient,,,7909.25,1977.3125,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5188.47,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5536.48,Percent of Total Billed Charges, ,,85,,6722.86,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5378.29,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4429.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4745.55,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24685 - OPEN TREATMENT ULNAR FRACTURE PROXIMAL END,24685,HCPCS,,,RT,Outpatient,,,18118.56,4529.64,1078.11,15400.78,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11885.78,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12682.99,Percent of Total Billed Charges, ,,85,,15400.78,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12320.62,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10146.39,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10871.14,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24685 - OPEN TREATMENT ULNAR FRACTURE PROXIMAL END,24685,HCPCS,,,LT,Outpatient,,,17600.87,4400.2175,1078.11,14960.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11546.17,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12320.61,Percent of Total Billed Charges, ,,85,,14960.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11968.59,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9856.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10560.52,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24685 - OPEN TREATMENT ULNAR FRACTURE PROXIMAL END,24685,HCPCS,,,58,Outpatient,,,16636,4159,1078.11,14140.6,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10913.22,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11645.2,Percent of Total Billed Charges, ,,85,,14140.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11312.48,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9316.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9981.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24999 - UNLISTED PROCEDURE HUMERUS-ELBOW,24999,HCPCS,,,LT,Outpatient,,,4596.4,1149.1,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3015.24,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3217.48,Percent of Total Billed Charges, ,,85,,3906.94,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3125.55,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2573.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2757.84,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25000 - INCISION EXTENSOR TENDON SHEATH WRIST,25000,HCPCS,,,XU,Outpatient,,,5654.29,1413.5725,742.5,4806.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3709.21,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3958,Percent of Total Billed Charges, ,,85,,4806.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3844.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3166.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3392.57,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25000 - INCISION EXTENSOR TENDON SHEATH WRIST,25000,HCPCS,,,RT,Outpatient,,,8116.07,2029.0175,742.5,6898.66,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5324.14,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5681.25,Percent of Total Billed Charges, ,,85,,6898.66,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5518.93,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4545,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4869.64,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25000 - INCISION EXTENSOR TENDON SHEATH WRIST,25000,HCPCS,,,LT,Outpatient,,,7516.69,1879.1725,742.5,6389.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4930.95,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5261.68,Percent of Total Billed Charges, ,,85,,6389.19,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5111.35,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4209.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4510.01,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25000 - INCISION EXTENSOR TENDON SHEATH WRIST,25000,HCPCS,,,50,Outpatient,,,14105,3526.25,742.5,11989.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9252.88,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9873.5,Percent of Total Billed Charges, ,,85,,11989.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9591.4,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7898.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8463,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25028 - IANDD FOREARMAND-WRIST DEEP ABSCESS-HEMATOMA,25028,HCPCS,,,LT,Outpatient,,,11345,2836.25,742.5,9643.25,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7442.32,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7941.5,Percent of Total Billed Charges, ,,85,,9643.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7714.6,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6353.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6807,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25071 - EXC TUMOR SOFT TISS FOREARM AND-WRIST SUBQ 3CM-GREATER THAN,25071,HCPCS,,,RT,Outpatient,,,9196,2299,950.4,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6032.58,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6437.2,Percent of Total Billed Charges, ,,85,,7816.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6253.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5149.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5517.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25071 - EXC TUMOR SOFT TISS FOREARM AND-WRIST SUBQ 3CM-GREATER THAN,25071,HCPCS,,,LT,Outpatient,,,10419.55,2604.8875,950.4,8856.62,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6835.22,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7293.69,Percent of Total Billed Charges, ,,85,,8856.62,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7085.29,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5834.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6251.73,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25075 - EXC TUMOR SOFT TISSUE FOREARM AND-WRIST SUBQ LESS THAN 3CM,25075,HCPCS,,,RT,Outpatient,,,9861.2,2465.3,742.5,8382.02,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6468.95,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6902.84,Percent of Total Billed Charges, ,,85,,8382.02,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6705.62,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5522.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5916.72,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25075 - EXC TUMOR SOFT TISSUE FOREARM AND-WRIST SUBQ LESS THAN 3CM,25075,HCPCS,,,LT,Outpatient,,,7058.58,1764.645,742.5,5999.79,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4630.43,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4941.01,Percent of Total Billed Charges, ,,85,,5999.79,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4799.83,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3952.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4235.15,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25076 - EXC TUMOR SOFT TISS FOREARMAND-WRIST SUBFASC LESS THAN 3CM,25076,HCPCS,,,XU,Outpatient,,,6018.5,1504.625,742.5,5115.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3948.14,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4212.95,Percent of Total Billed Charges, ,,85,,5115.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4092.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3370.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3611.1,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25076 - EXC TUMOR SOFT TISS FOREARMAND-WRIST SUBFASC LESS THAN 3CM,25076,HCPCS,,,RT,Outpatient,,,6017.5,1504.375,742.5,5114.88,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3947.48,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4212.25,Percent of Total Billed Charges, ,,85,,5114.88,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4091.9,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3369.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3610.5,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25076 - EXC TUMOR SOFT TISS FOREARMAND-WRIST SUBFASC LESS THAN 3CM,25076,HCPCS,,,LT,Outpatient,,,7855.61,1963.9025,742.5,6677.27,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5153.28,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5498.93,Percent of Total Billed Charges, ,,85,,6677.27,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5341.81,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4399.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4713.37,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25085 - CAPSULOTOMY WRIST,25085,HCPCS,,,LT,Outpatient,,,3655.25,913.8125,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2397.84,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2558.68,Percent of Total Billed Charges, ,,85,,3106.96,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2485.57,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2046.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2193.15,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25101 - ARTHRT WRST W-JT EXPL W-WO BX W-WO RMVL LOOSE-FB,25101,HCPCS,,,RT,Outpatient,,,8963.5,2240.875,950.4,7618.98,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5880.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6274.45,Percent of Total Billed Charges, ,,85,,7618.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6095.18,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5019.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5378.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25107 - ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE,25107,HCPCS,,,LT,Outpatient,,,4701.4,1175.35,950.4,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3084.12,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3290.98,Percent of Total Billed Charges, ,,85,,3996.19,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3196.95,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2632.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2820.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25111 - EXCISION GANGLION WRIST DORSAL-VOLAR PRIMARY,25111,HCPCS,,,XU,Outpatient,,,7060.48,1765.12,742.5,6001.41,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4631.67,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4942.34,Percent of Total Billed Charges, ,,85,,6001.41,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4801.13,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3953.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4236.29,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25111 - EXCISION GANGLION WRIST DORSAL-VOLAR PRIMARY,25111,HCPCS,,,XS,Outpatient,,,6858.25,1714.5625,742.5,5829.51,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4499.01,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4800.78,Percent of Total Billed Charges, ,,85,,5829.51,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4663.61,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3840.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4114.95,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25111 - EXCISION GANGLION WRIST DORSAL-VOLAR PRIMARY,25111,HCPCS,,,RT,Outpatient,,,11887.42,2971.855,742.5,10104.31,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7798.15,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8321.19,Percent of Total Billed Charges, ,,85,,10104.31,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8083.45,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6656.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7132.45,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25111 - EXCISION GANGLION WRIST DORSAL-VOLAR PRIMARY,25111,HCPCS,,,LT,Outpatient,,,11485.13,2871.2825,742.5,9762.36,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7534.25,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8039.59,Percent of Total Billed Charges, ,,85,,9762.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7809.89,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6431.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6891.08,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25111 - EXCISION GANGLION WRIST DORSAL-VOLAR PRIMARY,25111,HCPCS,,,F5,Outpatient,,,19942,4985.5,742.5,16950.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13081.95,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13959.4,Percent of Total Billed Charges, ,,85,,16950.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13560.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11167.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11965.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25111 - EXCISION GANGLION WRIST DORSAL-VOLAR PRIMARY,25111,HCPCS,,,50,Outpatient,,,16377,4094.25,742.5,13920.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10743.31,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11463.9,Percent of Total Billed Charges, ,,85,,13920.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11136.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9171.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9826.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25112 - EXCISION GANGLION WRIST DORSAL-VOLAR RECURRENT,25112,HCPCS,,,XU,Outpatient,,,8432.5,2108.125,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5531.72,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5902.75,Percent of Total Billed Charges, ,,85,,7167.63,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5734.1,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4722.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5059.5,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25112 - EXCISION GANGLION WRIST DORSAL-VOLAR RECURRENT,25112,HCPCS,,,RT,Outpatient,,,8581,2145.25,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25112 - EXCISION GANGLION WRIST DORSAL-VOLAR RECURRENT,25112,HCPCS,,,LT,Outpatient,,,6845.5,1711.375,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4490.65,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4791.85,Percent of Total Billed Charges, ,,85,,5818.68,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4654.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3833.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4107.3,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25115 - RAD EXC BURSA SYNVA WRST-F-ARM TDN SHTHS FLXRS,25115,HCPCS,,,RT,Outpatient,,,8953.56,2238.39,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5873.54,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6267.49,Percent of Total Billed Charges, ,,85,,7610.53,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6088.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5013.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5372.14,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25115 - RAD EXC BURSA SYNVA WRST-F-ARM TDN SHTHS FLXRS,25115,HCPCS,,,LT,Outpatient,,,9957.42,2489.355,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6532.07,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6970.19,Percent of Total Billed Charges, ,,85,,8463.81,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6771.05,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5576.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5974.45,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25116 - RAD EXC BURSA SYNVA WRST-F-ARM TDN SHTHS XTNSRS,25116,HCPCS,,,XU,Outpatient,,,5345.68,1336.42,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3506.77,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3741.98,Percent of Total Billed Charges, ,,85,,4543.83,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3635.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2993.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3207.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25116 - RAD EXC BURSA SYNVA WRST-F-ARM TDN SHTHS XTNSRS,25116,HCPCS,,,RT,Outpatient,,,7760,1940,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5090.56,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5432,Percent of Total Billed Charges, ,,85,,6596,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5276.8,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4345.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4656,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25116 - RAD EXC BURSA SYNVA WRST-F-ARM TDN SHTHS XTNSRS,25116,HCPCS,,,LT,Outpatient,,,7280.63,1820.1575,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4776.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5096.44,Percent of Total Billed Charges, ,,85,,6188.54,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4950.83,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4077.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4368.38,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25118 - SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT,25118,HCPCS,,,XU,Outpatient,,,2600.2,650.05,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1705.73,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1820.14,Percent of Total Billed Charges, ,,85,,2210.17,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1768.14,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1456.11,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1560.12,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25118 - SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT,25118,HCPCS,,,RT,Outpatient,,,7153.58,1788.395,742.5,6080.54,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4692.75,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5007.51,Percent of Total Billed Charges, ,,85,,6080.54,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4864.43,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4006,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4292.15,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25118 - SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT,25118,HCPCS,,,LT,Outpatient,,,7385.2,1846.3,742.5,6277.42,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4844.69,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5169.64,Percent of Total Billed Charges, ,,85,,6277.42,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5021.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4135.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4431.12,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25119 - SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA,25119,HCPCS,,,RT,Outpatient,,,10451.68,2612.92,882.09,8883.93,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6856.3,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7316.18,Percent of Total Billed Charges, ,,85,,8883.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7107.14,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5852.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6271.01,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25210 - CARPECTOMY 1 BONE,25210,HCPCS,,,XU,Outpatient,,,6164.07,1541.0175,882.09,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4043.63,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4314.85,Percent of Total Billed Charges, ,,85,,5239.46,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4191.57,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3451.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3698.44,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25210 - CARPECTOMY 1 BONE,25210,HCPCS,,,XS,Outpatient,,,6440.68,1610.17,882.09,5474.58,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4225.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4508.48,Percent of Total Billed Charges, ,,85,,5474.58,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4379.66,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3606.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3864.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25210 - CARPECTOMY 1 BONE,25210,HCPCS,,,RT,Outpatient,,,8375.7,2093.925,882.09,7119.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5494.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5862.99,Percent of Total Billed Charges, ,,85,,7119.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5695.48,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4690.39,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5025.42,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25210 - CARPECTOMY 1 BONE,25210,HCPCS,,,LT,Outpatient,,,13629.5,3407.375,882.09,11585.08,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8940.95,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9540.65,Percent of Total Billed Charges, ,,85,,11585.08,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9268.06,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7632.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8177.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25215 - CARPECTOMY ALL BONES PROXIMAL ROW,25215,HCPCS,,,RT,Outpatient,,,11598.5,2899.625,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7608.62,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8118.95,Percent of Total Billed Charges, ,,85,,9858.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7886.98,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6495.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6959.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25215 - CARPECTOMY ALL BONES PROXIMAL ROW,25215,HCPCS,,,LT,Outpatient,,,10929,2732.25,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7169.42,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7650.3,Percent of Total Billed Charges, ,,85,,9289.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7431.72,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6120.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6557.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25230 - RADICAL STYLOIDECTOMY SEPARATE PROCEDURE,25230,HCPCS,,,RT,Outpatient,,,8804.42,2201.105,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5775.7,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6163.09,Percent of Total Billed Charges, ,,85,,7483.76,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5987.01,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4930.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5282.65,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25240 - EXCISION DISTAL ULNA PARTIAL-COMPLETE,25240,HCPCS,,,RT,Outpatient,,,7600.17,1900.0425,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4985.71,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5320.12,Percent of Total Billed Charges, ,,85,,6460.14,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5168.12,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4256.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4560.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25240 - EXCISION DISTAL ULNA PARTIAL-COMPLETE,25240,HCPCS,,,LT,Outpatient,,,7551.04,1887.76,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4953.48,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5285.73,Percent of Total Billed Charges, ,,85,,6418.38,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5134.71,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4228.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4530.62,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25246 - INJECTION WRIST ARTHROGRAPHY,25246,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25246 - INJECTION WRIST ARTHROGRAPHY,25246,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25246 - INJECTION WRIST ARTHROGRAPHY,25246,HCPCS,,,74,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25246 - INJECTION WRIST ARTHROGRAPHY,25246,HCPCS,,,50,Outpatient,,,1450,362.5,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,951.2,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1015,Percent of Total Billed Charges, ,,85,,1232.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,986,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,812,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,870,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25248 - EXPL W-REMOVAL DEEP FOREIGN BODY FOREARM-WRIST,25248,HCPCS,,,RT,Outpatient,,,12777.83,3194.4575,882.09,10861.16,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8382.26,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8944.48,Percent of Total Billed Charges, ,,85,,10861.16,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8688.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7155.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7666.7,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25248 - EXPL W-REMOVAL DEEP FOREIGN BODY FOREARM-WRIST,25248,HCPCS,,,LT,Outpatient,,,20407,5101.75,882.09,17345.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13386.99,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14284.9,Percent of Total Billed Charges, ,,85,,17345.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13876.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11427.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12244.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25260 - RPR TDN-MUSC FLXR F-ARMAND-WRST PRIM 1 EA TDN-MU,25260,HCPCS,,,RT,Outpatient,,,7560.72,1890.18,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4959.83,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5292.5,Percent of Total Billed Charges, ,,85,,6426.61,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5141.29,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4234,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4536.43,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25260 - RPR TDN-MUSC FLXR F-ARMAND-WRST PRIM 1 EA TDN-MU,25260,HCPCS,,,LT,Outpatient,,,11735.38,2933.845,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7698.41,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8214.77,Percent of Total Billed Charges, ,,85,,9975.07,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7980.06,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6571.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7041.23,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25270 - RPR TDN-MUSC XTNSR F-ARMAND-WRIST PRIM 1 EA TDN,25270,HCPCS,,,XU,Outpatient,,,4701.66,1175.415,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3084.29,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3291.16,Percent of Total Billed Charges, ,,85,,3996.41,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3197.13,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2632.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2821,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25270 - RPR TDN-MUSC XTNSR F-ARMAND-WRIST PRIM 1 EA TDN,25270,HCPCS,,,RT,Outpatient,,,7003.63,1750.9075,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4594.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4902.54,Percent of Total Billed Charges, ,,85,,5953.09,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4762.47,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3922.03,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4202.18,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25270 - RPR TDN-MUSC XTNSR F-ARMAND-WRIST PRIM 1 EA TDN,25270,HCPCS,,,LT,Outpatient,,,16997,4249.25,742.5,14447.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11150.03,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11897.9,Percent of Total Billed Charges, ,,85,,14447.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11557.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9518.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10198.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25272 - RPR TDN-MUSC XTNSR F-ARMAND-WRIST SEC 1 EA TDN-MU,25272,HCPCS,,,RT,Outpatient,,,5345.66,1336.415,742.5,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3506.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3741.96,Percent of Total Billed Charges, ,,85,,4543.81,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3635.05,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2993.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3207.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25272 - RPR TDN-MUSC XTNSR F-ARMAND-WRIST SEC 1 EA TDN-MU,25272,HCPCS,,,LT,Outpatient,,,4701.4,1175.35,742.5,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3084.12,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3290.98,Percent of Total Billed Charges, ,,85,,3996.19,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3196.95,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2632.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2820.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25275 - RPR TENDON SHEATH EXTENSOR F-ARMAND-WRIST W-GRAFT,25275,HCPCS,,,RT,Outpatient,,,7768.71,1942.1775,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5096.27,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5438.1,Percent of Total Billed Charges, ,,85,,6603.4,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5282.72,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4350.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4661.23,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25275 - RPR TENDON SHEATH EXTENSOR F-ARMAND-WRIST W-GRAFT,25275,HCPCS,,,LT,Outpatient,,,11432.34,2858.085,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7499.62,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8002.64,Percent of Total Billed Charges, ,,85,,9717.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7773.99,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6402.11,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6859.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25290 - TNOT FLXR-XTNSR TENDON FOREARMAND-WRIST 1 EA,25290,HCPCS,,,RT,Outpatient,,,8784.02,2196.005,742.5,7466.42,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5762.32,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6148.81,Percent of Total Billed Charges, ,,85,,7466.42,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5973.13,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4919.05,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5270.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25290 - TNOT FLXR-XTNSR TENDON FOREARMAND-WRIST 1 EA,25290,HCPCS,,,LT,Outpatient,,,7014.84,1753.71,742.5,5962.61,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4601.74,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4910.39,Percent of Total Billed Charges, ,,85,,5962.61,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4770.09,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3928.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4208.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25295 - TNOLS FLXR-XTNSR TENDON FOREARMAND-WRIST 1 EA,25295,HCPCS,,,XU,Outpatient,,,6686.2,1671.55,950.4,5683.27,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4386.15,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4680.34,Percent of Total Billed Charges, ,,85,,5683.27,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4546.62,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3744.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4011.72,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25295 - TNOLS FLXR-XTNSR TENDON FOREARMAND-WRIST 1 EA,25295,HCPCS,,,XS,Outpatient,,,17549,4387.25,950.4,14916.65,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11512.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12284.3,Percent of Total Billed Charges, ,,85,,14916.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11933.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9827.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10529.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25295 - TNOLS FLXR-XTNSR TENDON FOREARMAND-WRIST 1 EA,25295,HCPCS,,,RT,Outpatient,,,9738.5,2434.625,950.4,8277.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6388.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6816.95,Percent of Total Billed Charges, ,,85,,8277.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6622.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5453.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5843.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25295 - TNOLS FLXR-XTNSR TENDON FOREARMAND-WRIST 1 EA,25295,HCPCS,,,LT,Outpatient,,,13065.33,3266.3325,950.4,11105.53,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8570.86,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9145.73,Percent of Total Billed Charges, ,,85,,11105.53,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8884.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7316.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7839.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25310 - TDN TRNSPLJ-TR FLXR-XTNSR F-ARMAND-WRST 1 EA TDN,25310,HCPCS,,,XU,Outpatient,,,5122,1280.5,1078.11,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3360.03,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3585.4,Percent of Total Billed Charges, ,,85,,4353.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3482.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2868.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3073.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25310 - TDN TRNSPLJ-TR FLXR-XTNSR F-ARMAND-WRST 1 EA TDN,25310,HCPCS,,,RT,Outpatient,,,8780.6,2195.15,1078.11,7463.51,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5760.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6146.42,Percent of Total Billed Charges, ,,85,,7463.51,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5970.81,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4917.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5268.36,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25310 - TDN TRNSPLJ-TR FLXR-XTNSR F-ARMAND-WRST 1 EA TDN,25310,HCPCS,,,LT,Outpatient,,,5744.28,1436.07,1078.11,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3768.25,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4021,Percent of Total Billed Charges, ,,85,,4882.64,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3906.11,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3216.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3446.57,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25310 - TDN TRNSPLJ-TR FLXR-XTNSR F-ARMAND-WRST 1 EA TDN,25310,HCPCS,,,FA,Outpatient,,,8708.5,2177.125,1078.11,7402.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5712.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6095.95,Percent of Total Billed Charges, ,,85,,7402.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5921.78,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4876.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5225.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25312 - TDN TRNSPLJ-TR FLXR-XTNSR F-ARMAND-WRST 1-TDN GR,25312,HCPCS,,,RT,Outpatient,,,6130.66,1532.665,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4021.71,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4291.46,Percent of Total Billed Charges, ,,85,,5211.06,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4168.85,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3433.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3678.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25312 - TDN TRNSPLJ-TR FLXR-XTNSR F-ARMAND-WRST 1-TDN GR,25312,HCPCS,,,LT,Outpatient,,,6234,1558.5,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4089.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4363.8,Percent of Total Billed Charges, ,,85,,5298.9,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4239.12,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3491.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3740.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25320 - CAPSL-RHPHY-RCNSTJ WRST OPN CARPL INS,25320,HCPCS,,,RT,Outpatient,,,13293.44,3323.36,1078.11,11299.42,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8720.5,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9305.41,Percent of Total Billed Charges, ,,85,,11299.42,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9039.54,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7444.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7976.06,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25320 - CAPSL-RHPHY-RCNSTJ WRST OPN CARPL INS,25320,HCPCS,,,LT,Outpatient,,,6964.9,1741.225,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4568.97,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4875.43,Percent of Total Billed Charges, ,,85,,5920.17,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4736.13,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3900.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4178.94,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25337 - RCNSTJ STABLJ DSTL U-DSTL JT 2 SOFT TISS STABLJ,25337,HCPCS,,,RT,Outpatient,,,12409.08,3102.27,950.4,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8140.36,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8686.36,Percent of Total Billed Charges, ,,85,,10547.72,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8438.17,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6949.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7445.45,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25337 - RCNSTJ STABLJ DSTL U-DSTL JT 2 SOFT TISS STABLJ,25337,HCPCS,,,LT,Outpatient,,,8702.75,2175.6875,950.4,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5709,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6091.93,Percent of Total Billed Charges, ,,85,,7397.34,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5917.87,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4873.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5221.65,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25350 - OSTEOTOMY RADIUS DISTAL THIRD,25350,HCPCS,,,XU,Outpatient,,,7088.84,1772.21,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4650.28,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4962.19,Percent of Total Billed Charges, ,,85,,6025.51,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4820.41,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3969.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4253.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25350 - OSTEOTOMY RADIUS DISTAL THIRD,25350,HCPCS,,,RT,Outpatient,,,11338.83,2834.7075,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7438.27,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7937.18,Percent of Total Billed Charges, ,,85,,9638.01,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7710.4,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6349.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6803.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25390 - OSTEOPLASTY RADIUS-ULNA SHORTENING,25390,HCPCS,,,RT,Outpatient,,,10534.74,2633.685,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6910.79,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7374.32,Percent of Total Billed Charges, ,,85,,8954.53,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7163.62,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5899.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6320.84,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25390 - OSTEOPLASTY RADIUS-ULNA SHORTENING,25390,HCPCS,,,LT,Outpatient,,,8915.45,2228.8625,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5848.54,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6240.82,Percent of Total Billed Charges, ,,85,,7578.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6062.51,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4992.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5349.27,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25391 - OSTEOPLASTY RADIUS-ULNA LENGTHENING W-AUTOGRAFT,25391,HCPCS,,,RT,Outpatient,,,11568.5,2892.125,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7588.94,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8097.95,Percent of Total Billed Charges, ,,85,,9833.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7866.58,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6478.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6941.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25394 - OSTEOPLASTY CARPAL BONE SHORTENING,25394,HCPCS,,,LT,Outpatient,,,6766.4,1691.6,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4438.76,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4736.48,Percent of Total Billed Charges, ,,85,,5751.44,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4601.15,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3789.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4059.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25400 - RPR NONUNION-MALUNION RADIUS-ULNA W-O AUTOGRAFT,25400,HCPCS,,,RT,Outpatient,,,11086.13,2771.5325,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7272.5,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7760.29,Percent of Total Billed Charges, ,,85,,9423.21,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7538.57,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6208.23,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6651.68,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25400 - RPR NONUNION-MALUNION RADIUS-ULNA W-O AUTOGRAFT,25400,HCPCS,,,LT,Outpatient,,,16617.17,4154.2925,950.4,14124.59,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10900.86,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11632.02,Percent of Total Billed Charges, ,,85,,14124.59,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11299.68,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9305.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9970.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25405 - RPR NONUNION-MALUNION RADIUS-ULNA W-AUTOGRAFT,25405,HCPCS,,,RT,Outpatient,,,9058.95,2264.7375,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5942.67,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6341.27,Percent of Total Billed Charges, ,,85,,7700.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6160.09,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5073.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5435.37,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25405 - RPR NONUNION-MALUNION RADIUS-ULNA W-AUTOGRAFT,25405,HCPCS,,,LT,Outpatient,,,17805.83,4451.4575,1078.11,15134.96,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11680.62,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12464.08,Percent of Total Billed Charges, ,,85,,15134.96,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12107.96,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9971.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10683.5,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25420 - RPR NONUNION-MALUNION RADIUSANDULNA W-AUTOGRAFT,25420,HCPCS,,,LT,Outpatient,,,16683.5,4170.875,0.01,14180.98,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10944.38,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11678.45,Percent of Total Billed Charges, ,,85,,14180.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11344.78,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9342.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10010.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25430 - INSERTION VASCULAR PEDICLE CARPAL BONE,25430,HCPCS,,,LT,Outpatient,,,6766.4,1691.6,882.09,6722,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4438.76,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4736.48,Percent of Total Billed Charges, ,,85,,5751.44,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4601.15,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3789.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4059.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25442 - ARTHROPLASTY W-PROSTHETIC RPLCMT DISTAL ULNA,25442,HCPCS,,,RT,Outpatient,,,18128,4532,0.01,35521.64,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11891.97,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12689.6,Percent of Total Billed Charges, ,,85,,15408.8,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12327.04,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10151.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10876.8,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25446 - ARTHRP W-PROSTC RPLCMT DSTL RDSANDPRTL-ENTIR CARPS,25446,HCPCS,,,LT,Outpatient,,,21876,5469,950.4,35521.64,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14350.66,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15313.2,Percent of Total Billed Charges, ,,85,,18594.6,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14875.68,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12250.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13125.6,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25447 - ARTHRP INTERCARPAL-CARP-MTCRPL JT INTERPOSITION,25447,HCPCS,,,RT,Outpatient,,,7692.25,1923.0625,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5046.12,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5384.58,Percent of Total Billed Charges, ,,85,,6538.41,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5230.73,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4307.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4615.35,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25447 - ARTHRP INTERCARPAL-CARP-MTCRPL JT INTERPOSITION,25447,HCPCS,,,LT,Outpatient,,,7979.98,1994.995,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5234.87,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5585.99,Percent of Total Billed Charges, ,,85,,6782.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5426.39,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4468.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4787.99,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25447 - ARTHRP INTERCARPAL-CARP-MTCRPL JT INTERPOSITION,25447,HCPCS,,,FA,Outpatient,,,8724.38,2181.095,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5723.19,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6107.07,Percent of Total Billed Charges, ,,85,,7415.72,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5932.58,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4885.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5234.63,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25447 - ARTHRP INTERCARPAL-CARP-MTCRPL JT INTERPOSITION,25447,HCPCS,,,F7,Outpatient,,,7009,1752.25,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4597.9,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4906.3,Percent of Total Billed Charges, ,,85,,5957.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4766.12,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3925.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4205.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25447 - ARTHRP INTERCARPAL-CARP-MTCRPL JT INTERPOSITION,25447,HCPCS,,,F5,Outpatient,,,7988.38,1997.095,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5240.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5591.87,Percent of Total Billed Charges, ,,85,,6790.12,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5432.1,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4473.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4793.03,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25515 - OPEN TREATMENT RADIAL SHAFT FRACTURE W-INT FIXJ,25515,HCPCS,,,RT,Outpatient,,,16584.1,4146.025,742.5,14096.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10879.17,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11608.87,Percent of Total Billed Charges, ,,85,,14096.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11277.19,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9287.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9950.46,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25515 - OPEN TREATMENT RADIAL SHAFT FRACTURE W-INT FIXJ,25515,HCPCS,,,LT,Outpatient,,,12540.56,3135.14,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8226.61,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8778.39,Percent of Total Billed Charges, ,,85,,10659.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8527.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7022.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7524.34,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25535 - CLOSED TX ULNAR SHAFT FRACTURE W-MANIPULATION,25535,HCPCS,,,RT,Outpatient,,,9196,2299,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6032.58,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6437.2,Percent of Total Billed Charges, ,,85,,7816.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6253.28,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5149.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5517.6,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25545 - OPEN TREATMENT ULNAR SHAFT FRACTURE W-INT FIXJ,25545,HCPCS,,,RT,Outpatient,,,12066.83,3016.7075,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7915.84,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8446.78,Percent of Total Billed Charges, ,,85,,10256.81,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8205.44,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6757.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7240.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25545 - OPEN TREATMENT ULNAR SHAFT FRACTURE W-INT FIXJ,25545,HCPCS,,,LT,Outpatient,,,17083.44,4270.86,882.09,14520.92,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11206.74,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11958.41,Percent of Total Billed Charges, ,,85,,14520.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11616.74,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9566.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10250.06,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25565 - CLOSED TX RADIALANDULNAR SHAFT FRACTURES W-MNPJ,25565,HCPCS,,,RT,Outpatient,,,9206,2301.5,674,7825.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6039.14,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6444.2,Percent of Total Billed Charges, ,,85,,7825.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6260.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5155.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5523.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25574 - OPTX RADIALANDULNAR SHFT FX W-INT FIXJ RADIUS-ULNA,25574,HCPCS,,,LT,Outpatient,,,21027,5256.75,1078.11,17872.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13793.71,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14718.9,Percent of Total Billed Charges, ,,85,,17872.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14298.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11775.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12616.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25575 - OPTX RADIALANDULNAR SHFT FX W-INT FIXJ RADIUSANDULNA,25575,HCPCS,,,RT,Outpatient,,,21920.79,5480.1975,1078.11,18632.67,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14380.04,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15344.55,Percent of Total Billed Charges, ,,85,,18632.67,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14906.14,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12275.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13152.47,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25575 - OPTX RADIALANDULNAR SHFT FX W-INT FIXJ RADIUSANDULNA,25575,HCPCS,,,LT,Outpatient,,,17996.68,4499.17,1078.11,15297.18,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11805.82,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12597.68,Percent of Total Billed Charges, ,,85,,15297.18,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12237.74,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10078.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10798.01,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25605 - CLTX DSTL RDL FX-EPIPHYSL SEP W-MNPJ,25605,HCPCS,,,RT,Outpatient,,,9321.5,2330.375,742.5,7923.28,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6114.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6525.05,Percent of Total Billed Charges, ,,85,,7923.28,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6338.62,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5220.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5592.9,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25605 - CLTX DSTL RDL FX-EPIPHYSL SEP W-MNPJ,25605,HCPCS,,,LT,Outpatient,,,7933.19,1983.2975,742.5,6743.21,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5204.17,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5553.23,Percent of Total Billed Charges, ,,85,,6743.21,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5394.57,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4442.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4759.91,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25606 - PERQ SKEL FIXJ DISTAL RADIAL FX-EPIPHYSL SEP,25606,HCPCS,,,RT,Outpatient,,,14207,3551.75,742.5,12075.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9319.79,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9944.9,Percent of Total Billed Charges, ,,85,,12075.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9660.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7955.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8524.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25606 - PERQ SKEL FIXJ DISTAL RADIAL FX-EPIPHYSL SEP,25606,HCPCS,,,LT,Outpatient,,,12772.63,3193.1575,742.5,10856.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8378.85,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8940.84,Percent of Total Billed Charges, ,,85,,10856.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8685.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7152.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7663.58,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25607 - OPTX DSTL RDL X-ARTIC FX-EPIPHYSL SEPARATION,25607,HCPCS,,,RT,Outpatient,,,12681.83,3170.4575,882.09,10779.56,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8319.28,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8877.28,Percent of Total Billed Charges, ,,85,,10779.56,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8623.64,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7101.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7609.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25607 - OPTX DSTL RDL X-ARTIC FX-EPIPHYSL SEPARATION,25607,HCPCS,,,LT,Outpatient,,,14958.18,3739.545,882.09,12714.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9812.57,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10470.73,Percent of Total Billed Charges, ,,85,,12714.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10171.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8376.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8974.91,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25608 - OPTX DSTL RADL I-ARTIC FX-EPIPHYSL SEP 2 FRAG,25608,HCPCS,,,RT,Outpatient,,,14570.43,3642.6075,882.09,12384.87,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9558.2,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10199.3,Percent of Total Billed Charges, ,,85,,12384.87,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9907.89,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8159.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8742.26,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25608 - OPTX DSTL RADL I-ARTIC FX-EPIPHYSL SEP 2 FRAG,25608,HCPCS,,,LT,Outpatient,,,13957.93,3489.4825,882.09,11864.24,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9156.4,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9770.55,Percent of Total Billed Charges, ,,85,,11864.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9491.39,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7816.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8374.76,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25609 - OPTX DSTL RADL I-ARTIC FX-EPIPHYSL SEP 3+ FRAG,25609,HCPCS,,,XU,Outpatient,,,7009,1752.25,882.09,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4597.9,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4906.3,Percent of Total Billed Charges, ,,85,,5957.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4766.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3925.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4205.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25609 - OPTX DSTL RADL I-ARTIC FX-EPIPHYSL SEP 3+ FRAG,25609,HCPCS,,,RT,Outpatient,,,13908.34,3477.085,882.09,11822.09,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9123.87,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9735.84,Percent of Total Billed Charges, ,,85,,11822.09,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9457.67,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7788.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8345,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25609 - OPTX DSTL RADL I-ARTIC FX-EPIPHYSL SEP 3+ FRAG,25609,HCPCS,,,LT,Outpatient,,,13334.58,3333.645,882.09,11334.39,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8747.48,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9334.21,Percent of Total Billed Charges, ,,85,,11334.39,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9067.51,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7467.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8000.75,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25609 - OPTX DSTL RADL I-ARTIC FX-EPIPHYSL SEP 3+ FRAG,25609,HCPCS,,,50,Outpatient,,,36633,9158.25,882.09,31138.05,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24031.25,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25643.1,Percent of Total Billed Charges, ,,85,,31138.05,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24910.44,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20514.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21979.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25628 - OPEN TX CARPAL SCAPHOID NAVICULAR FX W-INT FIXJ,25628,HCPCS,,,RT,Outpatient,,,11783.44,2945.86,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7729.94,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8248.41,Percent of Total Billed Charges, ,,85,,10015.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8012.74,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6598.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7070.06,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25628 - OPEN TX CARPAL SCAPHOID NAVICULAR FX W-INT FIXJ,25628,HCPCS,,,LT,Outpatient,,,10665.79,2666.4475,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6996.76,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7466.05,Percent of Total Billed Charges, ,,85,,9065.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7252.74,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5972.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6399.47,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25630 - CLTX CARPAL BONE FX W-O MNPJ EACH BONE,25630,HCPCS,,,RT,Outpatient,,,5991.66,1497.915,228.06,5092.91,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3930.53,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4194.16,Percent of Total Billed Charges, ,,85,,5092.91,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4074.33,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3355.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3595,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25645 - OPEN TX CARPAL BONE FRACTURE OTH-THN SCAPHOID EA,25645,HCPCS,,,RT,Outpatient,,,5945.68,1486.42,1078.11,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3900.37,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4161.98,Percent of Total Billed Charges, ,,85,,5053.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4043.06,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3329.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3567.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25645 - OPEN TX CARPAL BONE FRACTURE OTH-THN SCAPHOID EA,25645,HCPCS,,,LT,Outpatient,,,14231.5,3557.875,1078.11,12096.78,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9335.86,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9962.05,Percent of Total Billed Charges, ,,85,,12096.78,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9677.42,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7969.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8538.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25651 - PERQ SKELETAL FIXATION ULNAR STYLOID FRACTURE,25651,HCPCS,,,LT,Outpatient,,,9881.5,2470.375,882.09,8399.28,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6482.26,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6917.05,Percent of Total Billed Charges, ,,85,,8399.28,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6719.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5533.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5928.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25652 - OPEN TREATMENT ULNAR STYLOID FRACTURE,25652,HCPCS,,,RT,Outpatient,,,18186,4546.5,950.4,15458.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11930.02,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12730.2,Percent of Total Billed Charges, ,,85,,15458.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12366.48,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10184.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10911.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25652 - OPEN TREATMENT ULNAR STYLOID FRACTURE,25652,HCPCS,,,LT,Outpatient,,,11636.56,2909.14,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7633.58,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8145.59,Percent of Total Billed Charges, ,,85,,9891.08,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7912.86,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6516.47,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6981.94,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25800 - ARTHRODESIS WRIST COMPLETE W-O BONE GRAFT,25800,HCPCS,,,RT,Outpatient,,,9403.26,2350.815,882.09,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6168.54,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6582.28,Percent of Total Billed Charges, ,,85,,7992.77,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6394.22,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5265.83,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5641.96,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25810 - ARTHRODESIS WRIST W-ILIAC-OTHER AUTOGRAFT,25810,HCPCS,,,RT,Outpatient,,,42727,10681.75,882.09,36317.95,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28028.91,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29908.9,Percent of Total Billed Charges, ,,85,,36317.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29054.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,23927.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,25636.2,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25810 - ARTHRODESIS WRIST W-ILIAC-OTHER AUTOGRAFT,25810,HCPCS,,,LT,Outpatient,,,6203.63,1550.9075,882.09,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4069.58,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4342.54,Percent of Total Billed Charges, ,,85,,5273.09,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4218.47,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3474.03,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3722.18,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25820 - ARTHRODESIS WRIST LIMITED W-O BONE GRAFT,25820,HCPCS,,,RT,Outpatient,,,10923.71,2730.9275,882.09,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7165.95,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7646.6,Percent of Total Billed Charges, ,,85,,9285.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7428.12,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6117.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6554.23,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25825 - ARTHRODESIS WRIST WITH AUTOGRAFT,25825,HCPCS,,,RT,Outpatient,,,7425.03,1856.2575,882.09,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4870.82,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5197.52,Percent of Total Billed Charges, ,,85,,6311.28,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5049.02,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4158.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4455.02,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25825 - ARTHRODESIS WRIST WITH AUTOGRAFT,25825,HCPCS,,,LT,Outpatient,,,11194,2798.5,882.09,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7343.26,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7835.8,Percent of Total Billed Charges, ,,85,,9514.9,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7611.92,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6268.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6716.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25830 - ARTHRD DSTL RAD-ULN JT SGMTL RSCJ ULNA W-WO BONE,25830,HCPCS,,,LT,Outpatient,,,9969.25,2492.3125,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6539.83,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6978.48,Percent of Total Billed Charges, ,,85,,8473.86,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6779.09,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5582.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5981.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25905 - AMP FOREARM THRU RADIUS AND ULNA OPEN CIRCULAR,25905,HCPCS,,,RT,Outpatient,,,17555,4388.75,0.01,14921.75,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11516.08,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12288.5,Percent of Total Billed Charges, ,,85,,14921.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11937.4,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9830.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10533,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
25999 - UNLISTED PROCEDURE FOREARM-WRIST,25999,HCPCS,,,RT,Outpatient,,,15772.34,3943.085,0.01,13406.49,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10346.66,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11040.64,Percent of Total Billed Charges, ,,85,,13406.49,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10725.19,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8832.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9463.4,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F6,Outpatient,,,6496,1624,188.91,5521.6,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4261.38,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4547.2,Percent of Total Billed Charges, ,,85,,5521.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4417.28,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3637.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3897.6,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F2,Outpatient,,,8808.5,2202.125,188.91,7487.23,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5778.38,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6165.95,Percent of Total Billed Charges, ,,85,,7487.23,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5989.78,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4932.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5285.1,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F1,Outpatient,,,10931,2732.75,188.91,9291.35,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7170.74,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7651.7,Percent of Total Billed Charges, ,,85,,9291.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7433.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6121.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6558.6,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26011 - DRAINAGE FINGER ABSCESS COMPLICATED,26011,HCPCS,,,XU,Outpatient,,,6948.5,1737.125,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4558.22,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4863.95,Percent of Total Billed Charges, ,,85,,5906.23,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4724.98,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3891.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4169.1,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26011 - DRAINAGE FINGER ABSCESS COMPLICATED,26011,HCPCS,,,F7,Outpatient,,,10655,2663.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6989.68,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7458.5,Percent of Total Billed Charges, ,,85,,9056.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7245.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5966.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6393,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26034 - INCISION BONE CORTEX HAND-FINGER,26034,HCPCS,,,RT,Outpatient,,,6871,1717.75,882.09,5840.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4507.38,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4809.7,Percent of Total Billed Charges, ,,85,,5840.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4672.28,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3847.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4122.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26034 - INCISION BONE CORTEX HAND-FINGER,26034,HCPCS,,,FA,Outpatient,,,6948.5,1737.125,882.09,5906.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4558.22,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4863.95,Percent of Total Billed Charges, ,,85,,5906.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4724.98,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3891.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4169.1,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26045 - FASCIOTOMY PALMAR OPEN PARTIAL,26045,HCPCS,,,RT,Outpatient,,,12587,3146.75,882.09,10698.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8257.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8810.9,Percent of Total Billed Charges, ,,85,,10698.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8559.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7048.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7552.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26045 - FASCIOTOMY PALMAR OPEN PARTIAL,26045,HCPCS,,,LT,Outpatient,,,9037.17,2259.2925,882.09,7681.59,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5928.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6326.02,Percent of Total Billed Charges, ,,85,,7681.59,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6145.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5060.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5422.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,XU,Outpatient,,,4044.43,1011.1075,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2653.15,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2831.1,Percent of Total Billed Charges, ,,85,,3437.77,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2750.21,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2264.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2426.66,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,XS,Outpatient,,,5125.21,1281.3025,742.5,4356.43,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3362.14,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3587.65,Percent of Total Billed Charges, ,,85,,4356.43,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3485.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2870.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3075.13,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,RT,Outpatient,,,8809,2202.25,742.5,7487.65,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5778.7,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6166.3,Percent of Total Billed Charges, ,,85,,7487.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5990.12,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4933.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5285.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,LT,Outpatient,,,15447,3861.75,742.5,13129.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10133.23,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10812.9,Percent of Total Billed Charges, ,,85,,13129.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10503.96,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8650.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9268.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,FA,Outpatient,,,7404.64,1851.16,742.5,6293.94,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4857.44,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5183.25,Percent of Total Billed Charges, ,,85,,6293.94,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5035.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4146.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4442.78,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F9,Outpatient,,,5654.01,1413.5025,742.5,4805.91,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3709.03,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3957.81,Percent of Total Billed Charges, ,,85,,4805.91,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3844.73,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3166.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3392.41,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F8,Outpatient,,,6217.23,1554.3075,742.5,5284.65,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4078.5,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4352.06,Percent of Total Billed Charges, ,,85,,5284.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4227.72,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3481.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3730.34,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F7,Outpatient,,,6585.03,1646.2575,742.5,5597.28,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4319.78,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4609.52,Percent of Total Billed Charges, ,,85,,5597.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4477.82,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3687.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3951.02,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F6,Outpatient,,,6194.62,1548.655,742.5,5265.43,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4063.67,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4336.23,Percent of Total Billed Charges, ,,85,,5265.43,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4212.34,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3468.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3716.77,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F5,Outpatient,,,6943.72,1735.93,742.5,5902.16,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4555.08,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4860.6,Percent of Total Billed Charges, ,,85,,5902.16,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4721.73,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3888.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4166.23,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F4,Outpatient,,,4292.82,1073.205,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2816.09,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3004.97,Percent of Total Billed Charges, ,,85,,3648.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2919.12,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2403.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2575.69,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F3,Outpatient,,,5627.2,1406.8,742.5,4783.12,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3691.44,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3939.04,Percent of Total Billed Charges, ,,85,,4783.12,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3826.5,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3151.23,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3376.32,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F2,Outpatient,,,6921.25,1730.3125,742.5,5883.06,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4540.34,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4844.88,Percent of Total Billed Charges, ,,85,,5883.06,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4706.45,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3875.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4152.75,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F1,Outpatient,,,5599.2,1399.8,742.5,4759.32,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3673.08,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3919.44,Percent of Total Billed Charges, ,,85,,4759.32,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3807.46,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3135.55,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3359.52,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26075 - ARTHRT EXPL DRG-RMVL LOOSE-FB MTCARPHLNGL JT EA,26075,HCPCS,,,XU,Outpatient,,,5398.44,1349.61,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3541.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3778.91,Percent of Total Billed Charges, ,,85,,4588.67,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3670.94,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3023.13,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3239.06,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26075 - ARTHRT EXPL DRG-RMVL LOOSE-FB MTCARPHLNGL JT EA,26075,HCPCS,,,F6,Outpatient,,,10008.8,2502.2,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6565.77,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7006.16,Percent of Total Billed Charges, ,,85,,8507.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6805.98,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5604.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6005.28,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26080 - ARTHRT EXPL DRG-RMVL LOOSE-FB IPHAL JT EA,26080,HCPCS,,,RT,Outpatient,,,6431.5,1607.875,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4219.06,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4502.05,Percent of Total Billed Charges, ,,85,,5466.78,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4373.42,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3601.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3858.9,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26080 - ARTHRT EXPL DRG-RMVL LOOSE-FB IPHAL JT EA,26080,HCPCS,,,FA,Outpatient,,,5908.25,1477.0625,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3875.81,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4135.78,Percent of Total Billed Charges, ,,85,,5022.01,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4017.61,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3308.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3544.95,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26080 - ARTHRT EXPL DRG-RMVL LOOSE-FB IPHAL JT EA,26080,HCPCS,,,F8,Outpatient,,,13742,3435.5,882.09,11680.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9014.75,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9619.4,Percent of Total Billed Charges, ,,85,,11680.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9344.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7695.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8245.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26080 - ARTHRT EXPL DRG-RMVL LOOSE-FB IPHAL JT EA,26080,HCPCS,,,F5,Outpatient,,,2608.37,652.0925,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1711.09,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1825.86,Percent of Total Billed Charges, ,,85,,2217.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1773.69,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1460.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1565.02,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26080 - ARTHRT EXPL DRG-RMVL LOOSE-FB IPHAL JT EA,26080,HCPCS,,,F4,Outpatient,,,13967,3491.75,882.09,11871.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9162.35,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9776.9,Percent of Total Billed Charges, ,,85,,11871.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9497.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7821.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8380.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26080 - ARTHRT EXPL DRG-RMVL LOOSE-FB IPHAL JT EA,26080,HCPCS,,,F2,Outpatient,,,13587,3396.75,882.09,11548.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8913.07,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9510.9,Percent of Total Billed Charges, ,,85,,11548.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9239.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7608.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8152.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26111 - EX TUM-VASC MALF SFT TISS HAND-FNGR SUBQ 1.5CM-GREATER THAN,26111,HCPCS,,,RT,Outpatient,,,5045.66,1261.415,950.4,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3309.95,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3531.96,Percent of Total Billed Charges, ,,85,,4288.81,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3431.05,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2825.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3027.4,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26111 - EX TUM-VASC MALF SFT TISS HAND-FNGR SUBQ 1.5CM-GREATER THAN,26111,HCPCS,,,LT,Outpatient,,,6389,1597.25,950.4,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4191.18,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4472.3,Percent of Total Billed Charges, ,,85,,5430.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4344.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3577.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3833.4,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26111 - EX TUM-VASC MALF SFT TISS HAND-FNGR SUBQ 1.5CM-GREATER THAN,26111,HCPCS,,,F7,Outpatient,,,15602,3900.5,950.4,13261.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10234.91,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10921.4,Percent of Total Billed Charges, ,,85,,13261.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10609.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8737.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9361.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26111 - EX TUM-VASC MALF SFT TISS HAND-FNGR SUBQ 1.5CM-GREATER THAN,26111,HCPCS,,,F3,Outpatient,,,4754.2,1188.55,950.4,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3118.76,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3327.94,Percent of Total Billed Charges, ,,85,,4041.07,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3232.86,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2662.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2852.52,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26113 - EX TUM-VASC MAL SFT TIS HAND-FNGR SUBFSC 1.5CM-GREATER THAN,26113,HCPCS,,,RT,Outpatient,,,8708.5,2177.125,950.4,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5712.78,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6095.95,Percent of Total Billed Charges, ,,85,,7402.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5921.78,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4876.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5225.1,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,RT,Outpatient,,,6478.03,1619.5075,742.5,5506.33,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4249.59,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4534.62,Percent of Total Billed Charges, ,,85,,5506.33,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4405.06,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3627.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3886.82,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,LT,Outpatient,,,8615.63,2153.9075,742.5,7323.29,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5651.85,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6030.94,Percent of Total Billed Charges, ,,85,,7323.29,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5858.63,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4824.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5169.38,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,FA,Outpatient,,,7417.75,1854.4375,742.5,6305.09,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4866.04,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5192.43,Percent of Total Billed Charges, ,,85,,6305.09,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5044.07,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4153.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4450.65,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,F9,Outpatient,,,14467,3616.75,742.5,12296.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9490.35,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10126.9,Percent of Total Billed Charges, ,,85,,12296.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9837.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8101.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8680.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,F8,Outpatient,,,12657,3164.25,742.5,10758.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8302.99,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8859.9,Percent of Total Billed Charges, ,,85,,10758.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8606.76,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7087.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7594.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,F7,Outpatient,,,6772.08,1693.02,742.5,5756.27,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4442.48,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4740.46,Percent of Total Billed Charges, ,,85,,5756.27,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4605.01,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3792.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4063.25,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,F6,Outpatient,,,11228.7,2807.175,742.5,9544.4,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7366.03,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7860.09,Percent of Total Billed Charges, ,,85,,9544.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7635.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6288.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6737.22,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,F5,Outpatient,,,5228,1307,742.5,4443.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3429.57,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3659.6,Percent of Total Billed Charges, ,,85,,4443.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3555.04,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2927.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3136.8,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,F3,Outpatient,,,10170.08,2542.52,742.5,8644.57,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6671.57,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7119.06,Percent of Total Billed Charges, ,,85,,8644.57,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6915.65,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5695.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6102.05,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,F2,Outpatient,,,6366.13,1591.5325,742.5,5411.21,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4176.18,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4456.29,Percent of Total Billed Charges, ,,85,,5411.21,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4328.97,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3565.03,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3819.68,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26115 - EXC TUM-VASC MAL SFT TISS HAND-FNGR SUBQ LESS THAN 1.5CM,26115,HCPCS,,,F1,Outpatient,,,7766.92,1941.73,742.5,6601.88,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5095.1,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5436.84,Percent of Total Billed Charges, ,,85,,6601.88,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5281.51,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4349.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4660.15,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26116 - EXC TUM-VAS MAL SFT TIS HAND-FNGR SUBFASCLESS THAN 1.5CM,26116,HCPCS,,,RT,Outpatient,,,10379,2594.75,742.5,8822.15,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6808.62,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7265.3,Percent of Total Billed Charges, ,,85,,8822.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7057.72,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5812.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6227.4,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26116 - EXC TUM-VAS MAL SFT TIS HAND-FNGR SUBFASCLESS THAN 1.5CM,26116,HCPCS,,,LT,Outpatient,,,9065,2266.25,742.5,7705.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5946.64,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6345.5,Percent of Total Billed Charges, ,,85,,7705.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6164.2,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5076.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5439,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26116 - EXC TUM-VAS MAL SFT TIS HAND-FNGR SUBFASCLESS THAN 1.5CM,26116,HCPCS,,,FA,Outpatient,,,12037,3009.25,742.5,10231.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7896.27,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8425.9,Percent of Total Billed Charges, ,,85,,10231.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8185.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6740.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7222.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26116 - EXC TUM-VAS MAL SFT TIS HAND-FNGR SUBFASCLESS THAN 1.5CM,26116,HCPCS,,,F1,Outpatient,,,4769.75,1192.4375,742.5,4054.29,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3128.96,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3338.83,Percent of Total Billed Charges, ,,85,,4054.29,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3243.43,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2671.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2861.85,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26117 - RAD RESECT TUMOR SOFT TISSUE HAND-FINGER LESS THAN 3CM,26117,HCPCS,,,RT,Outpatient,,,17152,4288,742.5,14579.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11251.71,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12006.4,Percent of Total Billed Charges, ,,85,,14579.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11663.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9605.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10291.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26121 - FASCT PALM W-WO Z-PLASTY TISSUE REARGMT-SKN GRFT,26121,HCPCS,,,RT,Outpatient,,,8770.24,2192.56,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5753.28,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6139.17,Percent of Total Billed Charges, ,,85,,7454.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5963.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4911.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5262.14,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26121 - FASCT PALM W-WO Z-PLASTY TISSUE REARGMT-SKN GRFT,26121,HCPCS,,,LT,Outpatient,,,5811.8,1452.95,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3812.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4068.26,Percent of Total Billed Charges, ,,85,,4940.03,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3952.02,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3254.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3487.08,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26121 - FASCT PALM W-WO Z-PLASTY TISSUE REARGMT-SKN GRFT,26121,HCPCS,,,F9,Outpatient,,,14207,3551.75,1078.11,12075.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9319.79,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9944.9,Percent of Total Billed Charges, ,,85,,12075.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9660.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7955.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8524.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W-WO RPR,26123,HCPCS,,,XS,Outpatient,,,7463.66,1865.915,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4896.16,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5224.56,Percent of Total Billed Charges, ,,85,,6344.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5075.29,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4179.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4478.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W-WO RPR,26123,HCPCS,,,RT,Outpatient,,,14076.67,3519.1675,742.5,11965.17,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9234.3,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9853.67,Percent of Total Billed Charges, ,,85,,11965.17,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9572.14,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7882.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8446,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W-WO RPR,26123,HCPCS,,,LT,Outpatient,,,11586.75,2896.6875,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7600.91,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8110.73,Percent of Total Billed Charges, ,,85,,9848.74,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7878.99,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6488.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6952.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W-WO RPR,26123,HCPCS,,,F9,Outpatient,,,11133.96,2783.49,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7303.88,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7793.77,Percent of Total Billed Charges, ,,85,,9463.87,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7571.09,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6235.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6680.38,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W-WO RPR,26123,HCPCS,,,F8,Outpatient,,,8605.67,2151.4175,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5645.32,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6023.97,Percent of Total Billed Charges, ,,85,,7314.82,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5851.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4819.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5163.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W-WO RPR,26123,HCPCS,,,F7,Outpatient,,,20177,5044.25,742.5,17150.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13236.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14123.9,Percent of Total Billed Charges, ,,85,,17150.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13720.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11299.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12106.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W-WO RPR,26123,HCPCS,,,F6,Outpatient,,,5051,1262.75,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3313.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3535.7,Percent of Total Billed Charges, ,,85,,4293.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3434.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2828.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3030.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W-WO RPR,26123,HCPCS,,,F4,Outpatient,,,14437.67,3609.4175,742.5,12272.02,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9471.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10106.37,Percent of Total Billed Charges, ,,85,,12272.02,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9817.62,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8085.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8662.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W-WO RPR,26123,HCPCS,,,F3,Outpatient,,,9470.38,2367.595,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6212.57,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6629.27,Percent of Total Billed Charges, ,,85,,8049.82,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6439.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5303.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5682.23,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26125 - FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W-WO RPR,26125,HCPCS,,,LT,Outpatient,,,8240.5,2060.125,0.01,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5405.77,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5768.35,Percent of Total Billed Charges, ,,85,,7004.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5603.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4614.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4944.3,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26125 - FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W-WO RPR,26125,HCPCS,,,FA,Outpatient,,,12218.5,3054.625,0.01,10385.73,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8015.34,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8552.95,Percent of Total Billed Charges, ,,85,,10385.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8308.58,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6842.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7331.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26125 - FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W-WO RPR,26125,HCPCS,,,F9,Outpatient,,,6271,1567.75,0.01,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4113.78,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4389.7,Percent of Total Billed Charges, ,,85,,5330.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4264.28,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3511.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3762.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26125 - FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W-WO RPR,26125,HCPCS,,,F8,Outpatient,,,4623.33,1155.8325,0.01,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3032.9,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3236.33,Percent of Total Billed Charges, ,,85,,3929.83,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3143.86,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2589.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2774,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26125 - FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W-WO RPR,26125,HCPCS,,,F7,Outpatient,,,5051,1262.75,0.01,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3313.46,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3535.7,Percent of Total Billed Charges, ,,85,,4293.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3434.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2828.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3030.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26125 - FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W-WO RPR,26125,HCPCS,,,F3,Outpatient,,,11375.5,2843.875,0.01,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7462.33,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7962.85,Percent of Total Billed Charges, ,,85,,9669.18,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7735.34,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6370.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6825.3,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26130 - SYNOVECTOMY CARPOMETACARPAL JOINT,26130,HCPCS,,,XU,Outpatient,,,14543.5,3635.875,742.5,12361.98,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9540.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10180.45,Percent of Total Billed Charges, ,,85,,12361.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9889.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8144.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8726.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26135 - SYNVCT MTCARPHLNGL JT W-INTRNSC RLSANDXTNSR HOOD,26135,HCPCS,,,F6,Outpatient,,,8033.5,2008.375,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5269.98,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5623.45,Percent of Total Billed Charges, ,,85,,6828.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5462.78,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4498.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4820.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26135 - SYNVCT MTCARPHLNGL JT W-INTRNSC RLSANDXTNSR HOOD,26135,HCPCS,,,F3,Outpatient,,,8352.33,2088.0825,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5479.13,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5846.63,Percent of Total Billed Charges, ,,85,,7099.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5679.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4677.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5011.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26135 - SYNVCT MTCARPHLNGL JT W-INTRNSC RLSANDXTNSR HOOD,26135,HCPCS,,,F2,Outpatient,,,8352.34,2088.085,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5479.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5846.64,Percent of Total Billed Charges, ,,85,,7099.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5679.59,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4677.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5011.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,XU,Outpatient,,,4686.76,1171.69,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3074.51,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3280.73,Percent of Total Billed Charges, ,,85,,3983.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3187,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2624.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2812.06,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,LT,Outpatient,,,9179.75,2294.9375,742.5,7802.79,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6021.92,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6425.83,Percent of Total Billed Charges, ,,85,,7802.79,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6242.23,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5140.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5507.85,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,FA,Outpatient,,,5559.11,1389.7775,742.5,4725.24,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3646.78,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3891.38,Percent of Total Billed Charges, ,,85,,4725.24,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3780.19,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3113.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3335.47,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,F8,Outpatient,,,4374,1093.5,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2869.34,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3061.8,Percent of Total Billed Charges, ,,85,,3717.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2974.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2449.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2624.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,F7,Outpatient,,,3670.78,917.695,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2408.03,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2569.55,Percent of Total Billed Charges, ,,85,,3120.16,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2496.13,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2055.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2202.47,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,F6,Outpatient,,,4580.67,1145.1675,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3004.92,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3206.47,Percent of Total Billed Charges, ,,85,,3893.57,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3114.86,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2565.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2748.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,F5,Outpatient,,,6960.92,1740.23,742.5,5916.78,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4566.36,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4872.64,Percent of Total Billed Charges, ,,85,,5916.78,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4733.43,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3898.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4176.55,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,F4,Outpatient,,,1567.22,391.805,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1028.1,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1097.05,Percent of Total Billed Charges, ,,85,,1332.14,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1065.71,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,877.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,940.33,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,F3,Outpatient,,,1567.22,391.805,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1028.1,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1097.05,Percent of Total Billed Charges, ,,85,,1332.14,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1065.71,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,877.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,940.33,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,F2,Outpatient,,,12263.64,3065.91,742.5,10424.09,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8044.95,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8584.55,Percent of Total Billed Charges, ,,85,,10424.09,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8339.28,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6867.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7358.18,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26145 - SYNVCT TDN SHTH RAD FLXR TDN PALMAND-FNGR EA TDN,26145,HCPCS,,,F1,Outpatient,,,3570.79,892.6975,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2342.44,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2499.55,Percent of Total Billed Charges, ,,85,,3035.17,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2428.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1999.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2142.47,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,XU,Outpatient,,,6700.63,1675.1575,742.5,5695.54,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4395.61,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4690.44,Percent of Total Billed Charges, ,,85,,5695.54,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4556.43,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3752.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4020.38,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,XS,Outpatient,,,3664.67,916.1675,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2404.02,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2565.27,Percent of Total Billed Charges, ,,85,,3114.97,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2491.98,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2052.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2198.8,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,RT,Outpatient,,,10908.9,2727.225,742.5,9272.57,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7156.24,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7636.23,Percent of Total Billed Charges, ,,85,,9272.57,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7418.05,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6108.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6545.34,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,LT,Outpatient,,,9194.67,2298.6675,742.5,7815.47,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6031.7,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6436.27,Percent of Total Billed Charges, ,,85,,7815.47,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6252.38,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5149.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5516.8,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,F8,Outpatient,,,13587,3396.75,742.5,11548.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8913.07,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9510.9,Percent of Total Billed Charges, ,,85,,11548.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9239.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7608.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8152.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,F7,Outpatient,,,8546.78,2136.695,742.5,7264.76,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5606.69,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5982.75,Percent of Total Billed Charges, ,,85,,7264.76,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5811.81,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4786.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5128.07,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,F6,Outpatient,,,7813.75,1953.4375,742.5,6641.69,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5125.82,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5469.63,Percent of Total Billed Charges, ,,85,,6641.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5313.35,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4375.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4688.25,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,F5,Outpatient,,,7922.25,1980.5625,742.5,6733.91,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5197,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5545.58,Percent of Total Billed Charges, ,,85,,6733.91,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5387.13,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4436.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4753.35,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,F3,Outpatient,,,7258.5,1814.625,742.5,6169.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4761.58,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5080.95,Percent of Total Billed Charges, ,,85,,6169.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4935.78,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4064.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4355.1,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,F2,Outpatient,,,6044.5,1511.125,742.5,5137.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3965.19,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4231.15,Percent of Total Billed Charges, ,,85,,5137.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4110.26,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3384.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3626.7,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26160 - EXC LESION TDN SHTH-JT CAPSL HAND-FNGR,26160,HCPCS,,,F1,Outpatient,,,7057.33,1764.3325,742.5,5998.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4629.61,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4940.13,Percent of Total Billed Charges, ,,85,,5998.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4798.98,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3952.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4234.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26170 - EXCISION TENDON PALM FLEXOR-EXTENSOR SINGLE EACH,26170,HCPCS,,,XU,Outpatient,,,4477.33,1119.3325,950.4,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2937.13,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3134.13,Percent of Total Billed Charges, ,,85,,3805.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3044.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2507.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2686.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26180 - EXCISION TENDON FINGER FLEXOR-EXTENSOR EACH,26180,HCPCS,,,F7,Outpatient,,,10793.5,2698.375,742.5,9174.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7080.54,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7555.45,Percent of Total Billed Charges, ,,85,,9174.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7339.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6044.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6476.1,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26200 - EXCISION-CURETTAGE CYST-TUMOR METACARPAL,26200,HCPCS,,,LT,Outpatient,,,8188.5,2047.125,950.4,6960.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5371.66,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5731.95,Percent of Total Billed Charges, ,,85,,6960.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5568.18,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4585.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4913.1,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26210 - EXCISION-CURETTAGE CYST-TUMOR PHALANX FINGER,26210,HCPCS,,,RT,Outpatient,,,5029.42,1257.355,882.09,4275.01,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3299.3,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3520.59,Percent of Total Billed Charges, ,,85,,4275.01,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3420.01,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2816.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3017.65,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26210 - EXCISION-CURETTAGE CYST-TUMOR PHALANX FINGER,26210,HCPCS,,,F9,Outpatient,,,14381,3595.25,882.09,12223.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9433.94,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10066.7,Percent of Total Billed Charges, ,,85,,12223.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9779.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8053.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8628.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26210 - EXCISION-CURETTAGE CYST-TUMOR PHALANX FINGER,26210,HCPCS,,,F7,Outpatient,,,6561,1640.25,882.09,5576.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4304.02,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4592.7,Percent of Total Billed Charges, ,,85,,5576.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4461.48,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3674.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3936.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26210 - EXCISION-CURETTAGE CYST-TUMOR PHALANX FINGER,26210,HCPCS,,,F6,Outpatient,,,8639,2159.75,882.09,7343.15,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5667.18,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6047.3,Percent of Total Billed Charges, ,,85,,7343.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5874.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4837.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5183.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26210 - EXCISION-CURETTAGE CYST-TUMOR PHALANX FINGER,26210,HCPCS,,,F5,Outpatient,,,8149.75,2037.4375,882.09,6927.29,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5346.24,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5704.83,Percent of Total Billed Charges, ,,85,,6927.29,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5541.83,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4563.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4889.85,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26210 - EXCISION-CURETTAGE CYST-TUMOR PHALANX FINGER,26210,HCPCS,,,F3,Outpatient,,,8033.5,2008.375,882.09,6828.48,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5269.98,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5623.45,Percent of Total Billed Charges, ,,85,,6828.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5462.78,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4498.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4820.1,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26210 - EXCISION-CURETTAGE CYST-TUMOR PHALANX FINGER,26210,HCPCS,,,F2,Outpatient,,,9816,2454,882.09,8343.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6439.3,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6871.2,Percent of Total Billed Charges, ,,85,,8343.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6674.88,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5496.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5889.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26230 - PARTIAL EXCISION BONE METACARPAL,26230,HCPCS,,,RT,Outpatient,,,10143,2535.75,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6653.81,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7100.1,Percent of Total Billed Charges, ,,85,,8621.55,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6897.24,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5680.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6085.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26236 - PARTIAL EXCISION DISTAL PHALANX FINGER,26236,HCPCS,,,F5,Outpatient,,,7801,1950.25,0.01,6630.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5117.46,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5460.7,Percent of Total Billed Charges, ,,85,,6630.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5304.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4368.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4680.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26320 - REMOVAL IMPLANT FROM FINGER-HAND,26320,HCPCS,,,RT,Outpatient,,,7503.33,1875.8325,742.5,6377.83,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4922.18,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5252.33,Percent of Total Billed Charges, ,,85,,6377.83,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5102.26,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4201.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4502,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26340 - MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,26340,HCPCS,,,XU,Outpatient,,,4058.33,1014.5825,674,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2662.26,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2840.83,Percent of Total Billed Charges, ,,85,,3449.58,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2759.66,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2272.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2435,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26340 - MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,26340,HCPCS,,,F4,Outpatient,,,5122,1280.5,674,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3360.03,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3585.4,Percent of Total Billed Charges, ,,85,,4353.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3482.96,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2868.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3073.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26340 - MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,26340,HCPCS,,,F3,Outpatient,,,5122,1280.5,674,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3360.03,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3585.4,Percent of Total Billed Charges, ,,85,,4353.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3482.96,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2868.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3073.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26340 - MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,26340,HCPCS,,,F2,Outpatient,,,5122,1280.5,674,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3360.03,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3585.4,Percent of Total Billed Charges, ,,85,,4353.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3482.96,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2868.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3073.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26350 - RPR-ADVMNT FLXR TDN N-Z-2 W-O FR GRAFT EA TENDON,26350,HCPCS,,,XU,Outpatient,,,9282.33,2320.5825,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6089.21,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6497.63,Percent of Total Billed Charges, ,,85,,7889.98,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6311.98,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5198.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5569.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26350 - RPR-ADVMNT FLXR TDN N-Z-2 W-O FR GRAFT EA TENDON,26350,HCPCS,,,RT,Outpatient,,,24185,6046.25,882.09,20557.25,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15865.36,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16929.5,Percent of Total Billed Charges, ,,85,,20557.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16445.8,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13543.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14511,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26350 - RPR-ADVMNT FLXR TDN N-Z-2 W-O FR GRAFT EA TENDON,26350,HCPCS,,,F9,Outpatient,,,9118.5,2279.625,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5981.74,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6382.95,Percent of Total Billed Charges, ,,85,,7750.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6200.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5106.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5471.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26350 - RPR-ADVMNT FLXR TDN N-Z-2 W-O FR GRAFT EA TENDON,26350,HCPCS,,,F5,Outpatient,,,8972.34,2243.085,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5885.86,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6280.64,Percent of Total Billed Charges, ,,85,,7626.49,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6101.19,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5024.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5383.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26350 - RPR-ADVMNT FLXR TDN N-Z-2 W-O FR GRAFT EA TENDON,26350,HCPCS,,,F2,Outpatient,,,13764.33,3441.0825,882.09,11699.68,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9029.4,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9635.03,Percent of Total Billed Charges, ,,85,,11699.68,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9359.74,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7708.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8258.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26350 - RPR-ADVMNT FLXR TDN N-Z-2 W-O FR GRAFT EA TENDON,26350,HCPCS,,,F1,Outpatient,,,8455.68,2113.92,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5546.93,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5918.98,Percent of Total Billed Charges, ,,85,,7187.33,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5749.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4735.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5073.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26352 - RPR-ADVMNT FLXR TDN N-Z-2 W-FR GRAFT EA TENDON,26352,HCPCS,,,F3,Outpatient,,,17549,4387.25,1078.11,14916.65,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11512.14,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12284.3,Percent of Total Billed Charges, ,,85,,14916.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11933.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9827.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10529.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26356 - RPR-ADVMNT FLXR TDN ZONE 2 W-O FR GRFT EA TENDON,26356,HCPCS,,,XU,Outpatient,,,5823,1455.75,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3819.89,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4076.1,Percent of Total Billed Charges, ,,85,,4949.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3959.64,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3260.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3493.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26356 - RPR-ADVMNT FLXR TDN ZONE 2 W-O FR GRFT EA TENDON,26356,HCPCS,,,RT,Outpatient,,,10207.92,2551.98,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6696.4,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7145.54,Percent of Total Billed Charges, ,,85,,8676.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6941.39,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5716.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6124.75,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26356 - RPR-ADVMNT FLXR TDN ZONE 2 W-O FR GRFT EA TENDON,26356,HCPCS,,,LT,Outpatient,,,6727.66,1681.915,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4413.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4709.36,Percent of Total Billed Charges, ,,85,,5718.51,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4574.81,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3767.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4036.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26356 - RPR-ADVMNT FLXR TDN ZONE 2 W-O FR GRFT EA TENDON,26356,HCPCS,,,F9,Outpatient,,,11017.5,2754.375,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7227.48,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7712.25,Percent of Total Billed Charges, ,,85,,9364.88,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7491.9,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6169.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6610.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26356 - RPR-ADVMNT FLXR TDN ZONE 2 W-O FR GRFT EA TENDON,26356,HCPCS,,,F7,Outpatient,,,6363.17,1590.7925,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4174.24,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4454.22,Percent of Total Billed Charges, ,,85,,5408.69,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4326.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3563.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3817.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26356 - RPR-ADVMNT FLXR TDN ZONE 2 W-O FR GRFT EA TENDON,26356,HCPCS,,,F6,Outpatient,,,31257,7814.25,742.5,26568.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20504.59,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21879.9,Percent of Total Billed Charges, ,,85,,26568.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21254.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17503.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18754.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26356 - RPR-ADVMNT FLXR TDN ZONE 2 W-O FR GRFT EA TENDON,26356,HCPCS,,,F2,Outpatient,,,10929.17,2732.2925,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7169.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7650.42,Percent of Total Billed Charges, ,,85,,9289.79,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7431.84,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6120.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6557.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26356 - RPR-ADVMNT FLXR TDN ZONE 2 W-O FR GRFT EA TENDON,26356,HCPCS,,,F1,Outpatient,,,19942,4985.5,742.5,16950.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13081.95,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13959.4,Percent of Total Billed Charges, ,,85,,16950.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13560.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11167.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11965.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26358 - RPR-ADVMNT FLXR TDN ZONE 2 W-FR GRAFT EA TENDON,26358,HCPCS,,,F2,Outpatient,,,12362.33,3090.5825,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8109.69,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8653.63,Percent of Total Billed Charges, ,,85,,10507.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8406.38,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6922.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7417.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26370 - RPR-ADVMNT TDN W-NTC SUPFCIS TDN PRIM EA TDN,26370,HCPCS,,,F9,Outpatient,,,30947,7736.75,742.5,26304.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20301.23,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21662.9,Percent of Total Billed Charges, ,,85,,26304.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21043.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17330.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18568.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26370 - RPR-ADVMNT TDN W-NTC SUPFCIS TDN PRIM EA TDN,26370,HCPCS,,,F5,Outpatient,,,12141,3035.25,742.5,10319.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7964.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8498.7,Percent of Total Billed Charges, ,,85,,10319.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8255.88,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6798.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7284.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26370 - RPR-ADVMNT TDN W-NTC SUPFCIS TDN PRIM EA TDN,26370,HCPCS,,,F2,Outpatient,,,7250.95,1812.7375,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4756.62,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5075.67,Percent of Total Billed Charges, ,,85,,6163.31,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4930.65,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4060.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4350.57,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26372 - RPR-ADVMNT TDN W-NTC SUPFCIS TDN W-FREE GRAFT EA,26372,HCPCS,,,F7,Outpatient,,,14668.5,3667.125,1078.11,12468.23,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9622.54,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10267.95,Percent of Total Billed Charges, ,,85,,12468.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9974.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8214.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8801.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26372 - RPR-ADVMNT TDN W-NTC SUPFCIS TDN W-FREE GRAFT EA,26372,HCPCS,,,F3,Outpatient,,,13226,3306.5,1078.11,11242.1,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8676.26,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9258.2,Percent of Total Billed Charges, ,,85,,11242.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8993.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7406.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7935.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26390 - EXC FLXR TDN W-IMPLTJ SYNTH ROD DLYD TDN GRF H-F,26390,HCPCS,,,RT,Outpatient,,,7954.25,1988.5625,950.4,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5217.99,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5567.98,Percent of Total Billed Charges, ,,85,,6761.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5408.89,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4454.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4772.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26390 - EXC FLXR TDN W-IMPLTJ SYNTH ROD DLYD TDN GRF H-F,26390,HCPCS,,,F7,Outpatient,,,26297,6574.25,950.4,22352.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17250.83,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18407.9,Percent of Total Billed Charges, ,,85,,22352.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17881.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14726.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15778.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26390 - EXC FLXR TDN W-IMPLTJ SYNTH ROD DLYD TDN GRF H-F,26390,HCPCS,,,F6,Outpatient,,,7891.75,1972.9375,950.4,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5176.99,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5524.23,Percent of Total Billed Charges, ,,85,,6707.99,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5366.39,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4419.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4735.05,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26410 - REPAIR EXTENSOR TENDON HAND W-O GRAFT EACH,26410,HCPCS,,,RT,Outpatient,,,12725,3181.25,882.09,10816.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8347.6,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8907.5,Percent of Total Billed Charges, ,,85,,10816.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8653,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7126,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7635,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26410 - REPAIR EXTENSOR TENDON HAND W-O GRAFT EACH,26410,HCPCS,,,LT,Outpatient,,,18323.33,4580.8325,882.09,15574.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12020.1,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12826.33,Percent of Total Billed Charges, ,,85,,15574.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12459.86,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10261.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10994,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26410 - REPAIR EXTENSOR TENDON HAND W-O GRAFT EACH,26410,HCPCS,,,F5,Outpatient,,,2608.37,652.0925,882.09,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1711.09,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1825.86,Percent of Total Billed Charges, ,,85,,2217.11,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1773.69,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1460.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1565.02,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26410 - REPAIR EXTENSOR TENDON HAND W-O GRAFT EACH,26410,HCPCS,,,F4,Outpatient,,,6079,1519.75,882.09,5167.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3987.82,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4255.3,Percent of Total Billed Charges, ,,85,,5167.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4133.72,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3404.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3647.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26410 - REPAIR EXTENSOR TENDON HAND W-O GRAFT EACH,26410,HCPCS,,,F3,Outpatient,,,6079,1519.75,882.09,5167.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3987.82,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4255.3,Percent of Total Billed Charges, ,,85,,5167.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4133.72,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3404.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3647.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26418 - REPAIR EXTENSOR TENDON FINGER W-O GRAFT EACH,26418,HCPCS,,,RT,Outpatient,,,6638.5,1659.625,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4354.86,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4646.95,Percent of Total Billed Charges, ,,85,,5642.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4514.18,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3717.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3983.1,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26418 - REPAIR EXTENSOR TENDON FINGER W-O GRAFT EACH,26418,HCPCS,,,FA,Outpatient,,,12259.17,3064.7925,742.5,10420.29,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8042.02,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8581.42,Percent of Total Billed Charges, ,,85,,10420.29,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8336.24,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6865.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7355.5,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26418 - REPAIR EXTENSOR TENDON FINGER W-O GRAFT EACH,26418,HCPCS,,,F7,Outpatient,,,12449,3112.25,742.5,10581.65,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8166.54,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8714.3,Percent of Total Billed Charges, ,,85,,10581.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8465.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6971.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7469.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26418 - REPAIR EXTENSOR TENDON FINGER W-O GRAFT EACH,26418,HCPCS,,,F5,Outpatient,,,4016.75,1004.1875,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2634.99,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2811.73,Percent of Total Billed Charges, ,,85,,3414.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2731.39,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2249.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2410.05,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26418 - REPAIR EXTENSOR TENDON FINGER W-O GRAFT EACH,26418,HCPCS,,,F3,Outpatient,,,4754.2,1188.55,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3118.76,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3327.94,Percent of Total Billed Charges, ,,85,,4041.07,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3232.86,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2662.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2852.52,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26418 - REPAIR EXTENSOR TENDON FINGER W-O GRAFT EACH,26418,HCPCS,,,F2,Outpatient,,,14071.9,3517.975,742.5,11961.12,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9231.17,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9850.33,Percent of Total Billed Charges, ,,85,,11961.12,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9568.89,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7880.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8443.14,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26418 - REPAIR EXTENSOR TENDON FINGER W-O GRAFT EACH,26418,HCPCS,,,F1,Outpatient,,,13967,3491.75,742.5,11871.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9162.35,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9776.9,Percent of Total Billed Charges, ,,85,,11871.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9497.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7821.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8380.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26420 - REPAIR EXTENSOR TENDON FINGER W-GRAFT EACH,26420,HCPCS,,,F9,Outpatient,,,7063,1765.75,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4633.33,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4944.1,Percent of Total Billed Charges, ,,85,,6003.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4802.84,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3955.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4237.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26420 - REPAIR EXTENSOR TENDON FINGER W-GRAFT EACH,26420,HCPCS,,,F8,Outpatient,,,7063,1765.75,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4633.33,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4944.1,Percent of Total Billed Charges, ,,85,,6003.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4802.84,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3955.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4237.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26426 - RPR XTNSR TDN CNTRL SLIP TISS W-LAT BAND EA FNGR,26426,HCPCS,,,F8,Outpatient,,,16997,4249.25,1078.11,14447.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11150.03,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11897.9,Percent of Total Billed Charges, ,,85,,14447.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11557.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9518.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10198.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26426 - RPR XTNSR TDN CNTRL SLIP TISS W-LAT BAND EA FNGR,26426,HCPCS,,,F2,Outpatient,,,21337,5334.25,1078.11,18136.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13997.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14935.9,Percent of Total Billed Charges, ,,85,,18136.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14509.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11948.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12802.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26428 - RPR XTNSR TDN CNTRL SLIP SEC W-FR GRFT EA FINGER,26428,HCPCS,,,F8,Outpatient,,,20252,5063,1078.11,17214.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13285.31,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14176.4,Percent of Total Billed Charges, ,,85,,17214.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13771.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11341.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12151.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26432 - CLTX DSTL XTNSR TDN INSJ W-WO PERCUTAN PINNING,26432,HCPCS,,,RT,Outpatient,,,11882,2970.5,742.5,10099.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7794.59,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8317.4,Percent of Total Billed Charges, ,,85,,10099.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8079.76,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6653.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7129.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26432 - CLTX DSTL XTNSR TDN INSJ W-WO PERCUTAN PINNING,26432,HCPCS,,,F9,Outpatient,,,9551,2387.75,742.5,8118.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6265.46,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6685.7,Percent of Total Billed Charges, ,,85,,8118.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6494.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5348.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5730.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26432 - CLTX DSTL XTNSR TDN INSJ W-WO PERCUTAN PINNING,26432,HCPCS,,,F8,Outpatient,,,4747.68,1186.92,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3114.48,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3323.38,Percent of Total Billed Charges, ,,85,,4035.53,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3228.42,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2658.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2848.61,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26433 - REPAIR EXTENSOR TENDON DISTAL INSERTION W-O GRF,26433,HCPCS,,,F9,Outpatient,,,12725,3181.25,882.09,10816.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8347.6,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8907.5,Percent of Total Billed Charges, ,,85,,10816.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8653,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7126,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7635,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26433 - REPAIR EXTENSOR TENDON DISTAL INSERTION W-O GRF,26433,HCPCS,,,F7,Outpatient,,,16222,4055.5,882.09,13788.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10641.63,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11355.4,Percent of Total Billed Charges, ,,85,,13788.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11030.96,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9084.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9733.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26433 - REPAIR EXTENSOR TENDON DISTAL INSERTION W-O GRF,26433,HCPCS,,,F2,Outpatient,,,14052,3513,882.09,11944.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9218.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9836.4,Percent of Total Billed Charges, ,,85,,11944.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9555.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7869.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8431.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26433 - REPAIR EXTENSOR TENDON DISTAL INSERTION W-O GRF,26433,HCPCS,,,F1,Outpatient,,,5166.4,1291.6,882.09,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3389.16,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3616.48,Percent of Total Billed Charges, ,,85,,4391.44,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3513.15,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2893.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3099.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26437 - REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,26437,HCPCS,,,XU,Outpatient,,,2608.37,652.0925,882.09,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1711.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1825.86,Percent of Total Billed Charges, ,,85,,2217.11,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1773.69,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1460.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1565.02,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26437 - REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,26437,HCPCS,,,RT,Outpatient,,,4559.25,1139.8125,882.09,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2990.87,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3191.48,Percent of Total Billed Charges, ,,85,,3875.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3100.29,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2553.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2735.55,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26437 - REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,26437,HCPCS,,,F4,Outpatient,,,11785,2946.25,882.09,10017.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7730.96,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8249.5,Percent of Total Billed Charges, ,,85,,10017.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8013.8,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6599.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7071,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26437 - REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,26437,HCPCS,,,F3,Outpatient,,,6389,1597.25,882.09,5430.65,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4191.18,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4472.3,Percent of Total Billed Charges, ,,85,,5430.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4344.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3577.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3833.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26437 - REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,26437,HCPCS,,,F2,Outpatient,,,6389,1597.25,882.09,5430.65,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4191.18,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4472.3,Percent of Total Billed Charges, ,,85,,5430.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4344.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3577.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3833.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26440 - TENOLYSIS FLEXOR TENDON PALM-FINGER EACH TENDON,26440,HCPCS,,,XU,Outpatient,,,6087.7,1521.925,742.5,5174.55,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3993.53,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4261.39,Percent of Total Billed Charges, ,,85,,5174.55,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4139.64,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3409.11,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3652.62,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26440 - TENOLYSIS FLEXOR TENDON PALM-FINGER EACH TENDON,26440,HCPCS,,,XS,Outpatient,,,6337.34,1584.335,742.5,5386.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4157.3,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4436.14,Percent of Total Billed Charges, ,,85,,5386.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4309.39,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3548.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3802.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26440 - TENOLYSIS FLEXOR TENDON PALM-FINGER EACH TENDON,26440,HCPCS,,,RT,Outpatient,,,4322.33,1080.5825,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2835.45,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3025.63,Percent of Total Billed Charges, ,,85,,3673.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2939.18,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2420.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2593.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26440 - TENOLYSIS FLEXOR TENDON PALM-FINGER EACH TENDON,26440,HCPCS,,,LT,Outpatient,,,18547,4636.75,742.5,15764.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12166.83,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12982.9,Percent of Total Billed Charges, ,,85,,15764.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12611.96,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10386.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11128.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26440 - TENOLYSIS FLEXOR TENDON PALM-FINGER EACH TENDON,26440,HCPCS,,,F7,Outpatient,,,7179.85,1794.9625,742.5,6102.87,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4709.98,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5025.9,Percent of Total Billed Charges, ,,85,,6102.87,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4882.3,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4020.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4307.91,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26440 - TENOLYSIS FLEXOR TENDON PALM-FINGER EACH TENDON,26440,HCPCS,,,F6,Outpatient,,,15826.33,3956.5825,742.5,13452.38,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10382.07,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11078.43,Percent of Total Billed Charges, ,,85,,13452.38,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10761.9,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8862.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9495.8,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26440 - TENOLYSIS FLEXOR TENDON PALM-FINGER EACH TENDON,26440,HCPCS,,,F5,Outpatient,,,12141,3035.25,742.5,10319.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7964.5,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8498.7,Percent of Total Billed Charges, ,,85,,10319.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8255.88,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6798.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7284.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26440 - TENOLYSIS FLEXOR TENDON PALM-FINGER EACH TENDON,26440,HCPCS,,,F3,Outpatient,,,13226,3306.5,742.5,11242.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8676.26,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9258.2,Percent of Total Billed Charges, ,,85,,11242.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8993.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7406.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7935.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26440 - TENOLYSIS FLEXOR TENDON PALM-FINGER EACH TENDON,26440,HCPCS,,,F2,Outpatient,,,20252,5063,742.5,17214.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13285.31,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14176.4,Percent of Total Billed Charges, ,,85,,17214.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13771.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11341.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12151.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26442 - TENOLYSIS FLEXOR TENDON PALMANDFINGER EACH TENDO,26442,HCPCS,,,XU,Outpatient,,,8084.03,2021.0075,950.4,6871.43,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5303.12,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5658.82,Percent of Total Billed Charges, ,,85,,6871.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5497.14,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4527.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4850.42,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26442 - TENOLYSIS FLEXOR TENDON PALMANDFINGER EACH TENDO,26442,HCPCS,,,F9,Outpatient,,,6225.5,1556.375,950.4,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4083.93,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4357.85,Percent of Total Billed Charges, ,,85,,5291.68,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4233.34,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3486.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3735.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26442 - TENOLYSIS FLEXOR TENDON PALMANDFINGER EACH TENDO,26442,HCPCS,,,F8,Outpatient,,,6225.5,1556.375,950.4,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4083.93,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4357.85,Percent of Total Billed Charges, ,,85,,5291.68,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4233.34,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3486.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3735.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,XU,Outpatient,,,5011.4,1252.85,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3287.48,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3507.98,Percent of Total Billed Charges, ,,85,,4259.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3407.75,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2806.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3006.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,RT,Outpatient,,,6621.5,1655.375,950.4,5628.28,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4343.7,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4635.05,Percent of Total Billed Charges, ,,85,,5628.28,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4502.62,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3708.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3972.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,LT,Outpatient,,,7030.42,1757.605,950.4,5975.86,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4611.96,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4921.29,Percent of Total Billed Charges, ,,85,,5975.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4780.69,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3937.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4218.25,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,FA,Outpatient,,,8808.5,2202.125,950.4,7487.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5778.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6165.95,Percent of Total Billed Charges, ,,85,,7487.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5989.78,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4932.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5285.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,F8,Outpatient,,,11644.83,2911.2075,950.4,9898.11,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7639.01,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8151.38,Percent of Total Billed Charges, ,,85,,9898.11,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7918.48,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6521.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6986.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,F7,Outpatient,,,11866.89,2966.7225,950.4,10086.86,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7784.68,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8306.82,Percent of Total Billed Charges, ,,85,,10086.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8069.49,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6645.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7120.13,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,F6,Outpatient,,,5011.4,1252.85,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3287.48,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3507.98,Percent of Total Billed Charges, ,,85,,4259.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3407.75,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2806.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3006.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,F4,Outpatient,,,6148,1537,950.4,5225.8,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4033.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4303.6,Percent of Total Billed Charges, ,,85,,5225.8,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4180.64,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3442.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3688.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,F3,Outpatient,,,6238.5,1559.625,950.4,5302.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4092.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4366.95,Percent of Total Billed Charges, ,,85,,5302.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4242.18,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3493.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3743.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,F2,Outpatient,,,3655.25,913.8125,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2397.84,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2558.68,Percent of Total Billed Charges, ,,85,,3106.96,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2485.57,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2046.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2193.15,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,F1,Outpatient,,,6238.5,1559.625,950.4,5302.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4092.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4366.95,Percent of Total Billed Charges, ,,85,,5302.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4242.18,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3493.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3743.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26455 - TENOTOMY FLEXOR FINGER OPEN EACH TENDON,26455,HCPCS,,,F2,Outpatient,,,4055.5,1013.875,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2660.41,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2838.85,Percent of Total Billed Charges, ,,85,,3447.18,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2757.74,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2271.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2433.3,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26460 - TENOTOMY EXTENSOR HAND-FINGER OPEN EACH TENDON,26460,HCPCS,,,F9,Outpatient,,,5123.4,1280.85,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3360.95,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3586.38,Percent of Total Billed Charges, ,,85,,4354.89,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3483.91,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2869.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3074.04,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26460 - TENOTOMY EXTENSOR HAND-FINGER OPEN EACH TENDON,26460,HCPCS,,,F5,Outpatient,,,4621.75,1155.4375,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3031.87,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3235.23,Percent of Total Billed Charges, ,,85,,3928.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3142.79,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2588.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2773.05,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26471 - TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH,26471,HCPCS,,,F3,Outpatient,,,8085.5,2021.375,882.09,6872.68,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5304.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5659.85,Percent of Total Billed Charges, ,,85,,6872.68,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5498.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4527.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4851.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26471 - TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH,26471,HCPCS,,,F2,Outpatient,,,8085.5,2021.375,882.09,6872.68,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5304.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5659.85,Percent of Total Billed Charges, ,,85,,6872.68,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5498.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4527.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4851.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26474 - TENODESIS DISTAL JOINT EACH,26474,HCPCS,,,F1,Outpatient,,,5383.4,1345.85,882.09,4575.89,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3531.51,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3768.38,Percent of Total Billed Charges, ,,85,,4575.89,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3660.71,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3014.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3230.04,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26480 - TR-TRNSPL TDN CARP-MTCRPL HAND W-O FR GRF EA TDN,26480,HCPCS,,,RT,Outpatient,,,6041.34,1510.335,1078.11,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3963.12,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4228.94,Percent of Total Billed Charges, ,,85,,5135.14,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4108.11,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3383.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3624.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26480 - TR-TRNSPL TDN CARP-MTCRPL HAND W-O FR GRF EA TDN,26480,HCPCS,,,LT,Outpatient,,,8883.59,2220.8975,1078.11,7551.05,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5827.64,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6218.51,Percent of Total Billed Charges, ,,85,,7551.05,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6040.84,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4974.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5330.15,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26480 - TR-TRNSPL TDN CARP-MTCRPL HAND W-O FR GRF EA TDN,26480,HCPCS,,,FA,Outpatient,,,6134.2,1533.55,1078.11,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4024.04,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4293.94,Percent of Total Billed Charges, ,,85,,5214.07,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4171.26,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3435.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3680.52,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26485 - TRANSFER-TRANSPLANT TENDON PALMAR W-O GRAFT EACH,26485,HCPCS,,,LT,Outpatient,,,12175.66,3043.915,1078.11,10349.31,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7987.23,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8522.96,Percent of Total Billed Charges, ,,85,,10349.31,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8279.45,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6818.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7305.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26498 - TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS,26498,HCPCS,,,RT,Outpatient,,,5051,1262.75,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3313.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3535.7,Percent of Total Billed Charges, ,,85,,4293.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3434.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2828.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3030.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26502 - RCNSTJ TDN PULLEY EA TDN W-TDN-FSCAL GRF SPX,26502,HCPCS,,,F3,Outpatient,,,36217,9054.25,1078.11,30784.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23758.35,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25351.9,Percent of Total Billed Charges, ,,85,,30784.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24627.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20281.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21730.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26508 - RELEASE THENAR MUSCLE,26508,HCPCS,,,RT,Outpatient,,,21281,5320.25,1078.11,18088.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13960.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14896.7,Percent of Total Billed Charges, ,,85,,18088.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14471.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11917.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12768.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26510 - CROSS INTRINSIC TRANSFER EACH TENDON,26510,HCPCS,,,F3,Outpatient,,,8352.33,2088.0825,1078.11,7099.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5479.13,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5846.63,Percent of Total Billed Charges, ,,85,,7099.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5679.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4677.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5011.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26516 - CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT,26516,HCPCS,,,RT,Outpatient,,,7577.33,1894.3325,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4970.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5304.13,Percent of Total Billed Charges, ,,85,,6440.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5152.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4243.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4546.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26516 - CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT,26516,HCPCS,,,F5,Outpatient,,,6094.25,1523.5625,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3997.83,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4265.98,Percent of Total Billed Charges, ,,85,,5180.11,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4144.09,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3412.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3656.55,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26520 - CAPSULECTOMY-CAPSULOTOMY MTCARPHLNGL JOINT EACH,26520,HCPCS,,,F6,Outpatient,,,5011.4,1252.85,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3287.48,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3507.98,Percent of Total Billed Charges, ,,85,,4259.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3407.75,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2806.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3006.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26520 - CAPSULECTOMY-CAPSULOTOMY MTCARPHLNGL JOINT EACH,26520,HCPCS,,,F4,Outpatient,,,3655.25,913.8125,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2397.84,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2558.68,Percent of Total Billed Charges, ,,85,,3106.96,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2485.57,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2046.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2193.15,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26520 - CAPSULECTOMY-CAPSULOTOMY MTCARPHLNGL JOINT EACH,26520,HCPCS,,,F3,Outpatient,,,3655.25,913.8125,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2397.84,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2558.68,Percent of Total Billed Charges, ,,85,,3106.96,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2485.57,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2046.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2193.15,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26520 - CAPSULECTOMY-CAPSULOTOMY MTCARPHLNGL JOINT EACH,26520,HCPCS,,,F2,Outpatient,,,3655.25,913.8125,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2397.84,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2558.68,Percent of Total Billed Charges, ,,85,,3106.96,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2485.57,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2046.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2193.15,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26520 - CAPSULECTOMY-CAPSULOTOMY MTCARPHLNGL JOINT EACH,26520,HCPCS,,,F1,Outpatient,,,3655.25,913.8125,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2397.84,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2558.68,Percent of Total Billed Charges, ,,85,,3106.96,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2485.57,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2046.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2193.15,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,XU,Outpatient,,,5123.4,1280.85,950.4,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3360.95,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3586.38,Percent of Total Billed Charges, ,,85,,4354.89,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3483.91,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2869.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3074.04,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,RT,Outpatient,,,10048.5,2512.125,950.4,8541.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6591.82,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7033.95,Percent of Total Billed Charges, ,,85,,8541.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6832.98,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5627.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6029.1,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,LT,Outpatient,,,6337.33,1584.3325,950.4,5386.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4157.29,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4436.13,Percent of Total Billed Charges, ,,85,,5386.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4309.38,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3548.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3802.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,FA,Outpatient,,,6826.5,1706.625,950.4,5802.53,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4478.18,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4778.55,Percent of Total Billed Charges, ,,85,,5802.53,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4642.02,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3822.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4095.9,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,F8,Outpatient,,,10212.33,2553.0825,950.4,8680.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6699.29,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7148.63,Percent of Total Billed Charges, ,,85,,8680.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6944.38,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5718.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6127.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,F6,Outpatient,,,5011.4,1252.85,950.4,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3287.48,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3507.98,Percent of Total Billed Charges, ,,85,,4259.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3407.75,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2806.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3006.84,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,F5,Outpatient,,,9965,2491.25,950.4,8470.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6537.04,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6975.5,Percent of Total Billed Charges, ,,85,,8470.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6776.2,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5580.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5979,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,F4,Outpatient,,,7116.75,1779.1875,950.4,6049.24,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4668.59,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4981.73,Percent of Total Billed Charges, ,,85,,6049.24,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4839.39,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3985.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4270.05,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,F3,Outpatient,,,1567.22,391.805,877.64,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1028.1,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1097.05,Percent of Total Billed Charges, ,,85,,1332.14,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1065.71,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,877.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,940.33,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,F2,Outpatient,,,9073.88,2268.47,950.4,7712.8,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5952.47,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6351.72,Percent of Total Billed Charges, ,,85,,7712.8,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6170.24,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5081.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5444.33,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26531 - ARTHRP MTCARPHLNGL JT W-PROSTC IMPLT EA JT,26531,HCPCS,,,RT,Outpatient,,,7137.29,1784.3225,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4682.06,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4996.1,Percent of Total Billed Charges, ,,85,,6066.7,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4853.36,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3996.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4282.37,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26531 - ARTHRP MTCARPHLNGL JT W-PROSTC IMPLT EA JT,26531,HCPCS,,,FA,Outpatient,,,19167,4791.75,1078.11,16291.95,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12573.55,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13416.9,Percent of Total Billed Charges, ,,85,,16291.95,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13033.56,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10733.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11500.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26536 - ARTHROPLASTY INTERPHALANGEAL JT W-PROSTHETIC EA,26536,HCPCS,,,F8,Outpatient,,,24437,6109.25,1078.11,20771.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16030.67,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17105.9,Percent of Total Billed Charges, ,,85,,20771.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16617.16,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13684.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14662.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26536 - ARTHROPLASTY INTERPHALANGEAL JT W-PROSTHETIC EA,26536,HCPCS,,,F7,Outpatient,,,14233.5,3558.375,1078.11,12098.48,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9337.18,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9963.45,Percent of Total Billed Charges, ,,85,,12098.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9678.78,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7970.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8540.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26536 - ARTHROPLASTY INTERPHALANGEAL JT W-PROSTHETIC EA,26536,HCPCS,,,F5,Outpatient,,,7009,1752.25,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4597.9,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4906.3,Percent of Total Billed Charges, ,,85,,5957.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4766.12,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3925.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4205.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26536 - ARTHROPLASTY INTERPHALANGEAL JT W-PROSTHETIC EA,26536,HCPCS,,,F4,Outpatient,,,15912,3978,1078.11,13525.2,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10438.27,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11138.4,Percent of Total Billed Charges, ,,85,,13525.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10820.16,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8910.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9547.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26536 - ARTHROPLASTY INTERPHALANGEAL JT W-PROSTHETIC EA,26536,HCPCS,,,F3,Outpatient,,,23213,5803.25,1078.11,19731.05,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15227.73,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16249.1,Percent of Total Billed Charges, ,,85,,19731.05,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15784.84,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12999.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13927.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26536 - ARTHROPLASTY INTERPHALANGEAL JT W-PROSTHETIC EA,26536,HCPCS,,,F2,Outpatient,,,15150.25,3787.5625,1078.11,12877.71,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9938.56,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10605.18,Percent of Total Billed Charges, ,,85,,12877.71,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10302.17,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8484.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9090.15,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26540 - RPR COLTRL LIGM MTCARPHLNGL-IPHAL JT,26540,HCPCS,,,RT,Outpatient,,,22267,5566.75,742.5,18926.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14607.15,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15586.9,Percent of Total Billed Charges, ,,85,,18926.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15141.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12469.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13360.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26540 - RPR COLTRL LIGM MTCARPHLNGL-IPHAL JT,26540,HCPCS,,,FA,Outpatient,,,7646,1911.5,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5015.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5352.2,Percent of Total Billed Charges, ,,85,,6499.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5199.28,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4281.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4587.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26540 - RPR COLTRL LIGM MTCARPHLNGL-IPHAL JT,26540,HCPCS,,,F5,Outpatient,,,16357,4089.25,742.5,13903.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10730.19,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11449.9,Percent of Total Billed Charges, ,,85,,13903.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11122.76,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9159.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9814.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26540 - RPR COLTRL LIGM MTCARPHLNGL-IPHAL JT,26540,HCPCS,,,F4,Outpatient,,,11352.75,2838.1875,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7447.4,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7946.93,Percent of Total Billed Charges, ,,85,,9649.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7719.87,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6357.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6811.65,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26540 - RPR COLTRL LIGM MTCARPHLNGL-IPHAL JT,26540,HCPCS,,,F2,Outpatient,,,4477.34,1119.335,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2937.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3134.14,Percent of Total Billed Charges, ,,85,,3805.74,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3044.59,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2507.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2686.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26541 - RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W-TDN-FSCAL GRF,26541,HCPCS,,,RT,Outpatient,,,10668.5,2667.125,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6998.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7467.95,Percent of Total Billed Charges, ,,85,,9068.23,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7254.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5974.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6401.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26542 - RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W-LOCAL TISS,26542,HCPCS,,,FA,Outpatient,,,9631,2407.75,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6317.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6741.7,Percent of Total Billed Charges, ,,85,,8186.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6549.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5393.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5778.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26545 - RCNSTJ COLTRL LIGM IPHAL JT 1 W-GRF EA JT,26545,HCPCS,,,F7,Outpatient,,,7949.5,1987.375,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5214.87,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5564.65,Percent of Total Billed Charges, ,,85,,6757.08,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5405.66,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4451.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4769.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26545 - RCNSTJ COLTRL LIGM IPHAL JT 1 W-GRF EA JT,26545,HCPCS,,,F6,Outpatient,,,7026,1756.5,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4609.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4918.2,Percent of Total Billed Charges, ,,85,,5972.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4777.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3934.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4215.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26546 - RPR NON-UNION MTCRPL-PHALANX,26546,HCPCS,,,F4,Outpatient,,,22732,5683,742.5,19322.2,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14912.19,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15912.4,Percent of Total Billed Charges, ,,85,,19322.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15457.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12729.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13639.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26548 - RPR AND RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL,26548,HCPCS,,,XU,Outpatient,,,8662.33,2165.5825,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5682.49,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6063.63,Percent of Total Billed Charges, ,,85,,7362.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5890.38,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4850.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5197.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26548 - RPR AND RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL,26548,HCPCS,,,F9,Outpatient,,,7328.5,1832.125,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4807.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5129.95,Percent of Total Billed Charges, ,,85,,6229.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4983.38,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4103.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4397.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26548 - RPR AND RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL,26548,HCPCS,,,F6,Outpatient,,,4979.66,1244.915,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3266.66,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3485.76,Percent of Total Billed Charges, ,,85,,4232.71,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3386.17,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2788.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2987.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26548 - RPR AND RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL,26548,HCPCS,,,F3,Outpatient,,,15757,3939.25,742.5,13393.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10336.59,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11029.9,Percent of Total Billed Charges, ,,85,,13393.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10714.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8823.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9454.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26548 - RPR AND RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL,26548,HCPCS,,,F2,Outpatient,,,4477.33,1119.3325,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2937.13,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3134.13,Percent of Total Billed Charges, ,,85,,3805.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3044.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2507.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2686.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26565 - OSTEOTOMY METACARPAL EACH,26565,HCPCS,,,T2,Outpatient,,,3673.14,918.285,742.5,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2409.58,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2571.2,Percent of Total Billed Charges, ,,85,,3122.17,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2497.74,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2056.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2203.88,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26565 - OSTEOTOMY METACARPAL EACH,26565,HCPCS,,,T1,Outpatient,,,3673.14,918.285,742.5,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2409.58,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2571.2,Percent of Total Billed Charges, ,,85,,3122.17,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2497.74,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2056.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2203.88,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26567 - OSTEOTOMY PHALANX FINGER EACH,26567,HCPCS,,,F5,Outpatient,,,12330.68,3082.67,742.5,10481.08,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8088.93,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8631.48,Percent of Total Billed Charges, ,,85,,10481.08,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8384.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6905.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7398.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26567 - OSTEOTOMY PHALANX FINGER EACH,26567,HCPCS,,,F4,Outpatient,,,13148.5,3287.125,742.5,11176.23,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8625.42,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9203.95,Percent of Total Billed Charges, ,,85,,11176.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8940.98,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7363.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7889.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26567 - OSTEOTOMY PHALANX FINGER EACH,26567,HCPCS,,,F2,Outpatient,,,20562,5140.5,742.5,17477.7,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13488.67,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14393.4,Percent of Total Billed Charges, ,,85,,17477.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13982.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11514.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12337.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26593 - RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE,26593,HCPCS,,,XU,Outpatient,,,6793.5,1698.375,882.09,5774.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4456.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4755.45,Percent of Total Billed Charges, ,,85,,5774.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4619.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3804.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4076.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26593 - RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE,26593,HCPCS,,,LT,Outpatient,,,6793.5,1698.375,882.09,5774.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4456.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4755.45,Percent of Total Billed Charges, ,,85,,5774.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4619.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3804.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4076.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26596 - EXC CONSTRICTING RING FNGR W-MLT Z-PLASTIES,26596,HCPCS,,,F9,Outpatient,,,7328.5,1832.125,882.09,6229.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4807.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5129.95,Percent of Total Billed Charges, ,,85,,6229.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4983.38,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4103.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4397.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26608 - PRQ SKELETAL FIXJ METACARPAL FX EACH BONE,26608,HCPCS,,,XU,Outpatient,,,4371,1092.75,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2867.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3059.7,Percent of Total Billed Charges, ,,85,,3715.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2972.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2447.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2622.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26608 - PRQ SKELETAL FIXJ METACARPAL FX EACH BONE,26608,HCPCS,,,XS,Outpatient,,,7949.5,1987.375,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5214.87,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5564.65,Percent of Total Billed Charges, ,,85,,6757.08,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5405.66,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4451.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4769.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26608 - PRQ SKELETAL FIXJ METACARPAL FX EACH BONE,26608,HCPCS,,,RT,Outpatient,,,10964.58,2741.145,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7192.76,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7675.21,Percent of Total Billed Charges, ,,85,,9319.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7455.91,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6140.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6578.75,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26608 - PRQ SKELETAL FIXJ METACARPAL FX EACH BONE,26608,HCPCS,,,LT,Outpatient,,,9708.5,2427.125,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6368.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6795.95,Percent of Total Billed Charges, ,,85,,8252.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6601.78,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5436.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5825.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,XU,Outpatient,,,8746.58,2186.645,742.5,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5737.76,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6122.61,Percent of Total Billed Charges, ,,85,,7434.59,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5947.67,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4898.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5247.95,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,XS,Outpatient,,,14698.5,3674.625,742.5,12493.73,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9642.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10288.95,Percent of Total Billed Charges, ,,85,,12493.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9994.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8231.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8819.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,RT,Outpatient,,,13544.24,3386.06,742.5,11512.6,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8885.02,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9480.97,Percent of Total Billed Charges, ,,85,,11512.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9210.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7584.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8126.54,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,LT,Outpatient,,,14288.69,3572.1725,742.5,12145.39,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9373.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10002.08,Percent of Total Billed Charges, ,,85,,12145.39,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9716.31,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8001.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8573.21,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,FA,Outpatient,,,14162.5,3540.625,742.5,12038.13,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9290.6,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9913.75,Percent of Total Billed Charges, ,,85,,12038.13,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9630.5,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7931,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8497.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,F9,Outpatient,,,10425.83,2606.4575,742.5,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6839.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7298.08,Percent of Total Billed Charges, ,,85,,8861.96,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7089.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5838.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6255.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,F8,Outpatient,,,11122.17,2780.5425,742.5,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7296.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7785.52,Percent of Total Billed Charges, ,,85,,9453.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7563.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6228.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6673.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,F6,Outpatient,,,9727.33,2431.8325,742.5,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6381.13,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6809.13,Percent of Total Billed Charges, ,,85,,8268.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6614.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5447.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5836.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,F4,Outpatient,,,14827,3706.75,742.5,12602.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9726.51,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10378.9,Percent of Total Billed Charges, ,,85,,12602.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10082.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8303.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8896.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,F2,Outpatient,,,17617,4404.25,742.5,14974.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11556.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12331.9,Percent of Total Billed Charges, ,,85,,14974.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11979.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9865.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10570.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE,26615,HCPCS,,,F1,Outpatient,,,13896.25,3474.0625,742.5,11811.81,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9115.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9727.38,Percent of Total Billed Charges, ,,85,,11811.81,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9449.45,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7781.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8337.75,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26650 - PRQ SKELETAL FIX CARPO-METACARPAL FX DISLC THUMB,26650,HCPCS,,,RT,Outpatient,,,10456,2614,882.09,8887.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6859.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7319.2,Percent of Total Billed Charges, ,,85,,8887.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7110.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5855.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6273.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26650 - PRQ SKELETAL FIX CARPO-METACARPAL FX DISLC THUMB,26650,HCPCS,,,F5,Outpatient,,,16067,4016.75,882.09,13656.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10539.95,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11246.9,Percent of Total Billed Charges, ,,85,,13656.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10925.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8997.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9640.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26665 - OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB,26665,HCPCS,,,F5,Outpatient,,,11443.5,2860.875,742.5,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7506.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8010.45,Percent of Total Billed Charges, ,,85,,9726.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7781.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6408.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6866.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26676 - PRQ SKEL FIXJ CARPO-MTCRPL DISLC THMB MANJ EA JT,26676,HCPCS,,,RT,Outpatient,,,8576,2144,882.09,7289.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5625.86,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6003.2,Percent of Total Billed Charges, ,,85,,7289.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5831.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4802.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5145.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26676 - PRQ SKEL FIXJ CARPO-MTCRPL DISLC THMB MANJ EA JT,26676,HCPCS,,,F9,Outpatient,,,6420.68,1605.17,882.09,5457.58,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4211.97,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4494.48,Percent of Total Billed Charges, ,,85,,5457.58,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4366.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3595.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3852.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26685 - OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB,26685,HCPCS,,,RT,Outpatient,,,9708.5,2427.125,950.4,8252.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6368.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6795.95,Percent of Total Billed Charges, ,,85,,8252.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6601.78,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5436.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5825.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26685 - OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB,26685,HCPCS,,,LT,Outpatient,,,19012,4753,950.4,16160.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12471.87,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13308.4,Percent of Total Billed Charges, ,,85,,16160.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12928.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10646.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11407.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26685 - OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB,26685,HCPCS,,,F9,Outpatient,,,7680.66,1920.165,950.4,6528.56,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5038.51,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5376.46,Percent of Total Billed Charges, ,,85,,6528.56,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5222.85,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4301.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4608.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26715 - OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION,26715,HCPCS,,,F1,Outpatient,,,17617,4404.25,950.4,14974.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11556.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12331.9,Percent of Total Billed Charges, ,,85,,14974.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11979.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9865.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10570.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26725 - CLTX PHLNGL FX PROX-MIDDLE PX-F-T W-MANJ EA,26725,HCPCS,,,F3,Outpatient,,,9583.5,2395.875,228.06,8145.98,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6286.78,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6708.45,Percent of Total Billed Charges, ,,85,,8145.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6516.78,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5366.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5750.1,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26727 - PRQ SKEL FIXJ PHLNGL SHFT FX PROX-MIDDLE PX-F-T,26727,HCPCS,,,XU,Outpatient,,,11873.38,2968.345,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7788.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8311.37,Percent of Total Billed Charges, ,,85,,10092.37,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8073.9,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6649.09,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7124.03,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26727 - PRQ SKEL FIXJ PHLNGL SHFT FX PROX-MIDDLE PX-F-T,26727,HCPCS,,,FA,Outpatient,,,11572,2893,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7591.23,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8100.4,Percent of Total Billed Charges, ,,85,,9836.2,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7868.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6480.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6943.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26727 - PRQ SKEL FIXJ PHLNGL SHFT FX PROX-MIDDLE PX-F-T,26727,HCPCS,,,F9,Outpatient,,,10461,2615.25,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6862.42,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7322.7,Percent of Total Billed Charges, ,,85,,8891.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7113.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5858.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6276.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26727 - PRQ SKEL FIXJ PHLNGL SHFT FX PROX-MIDDLE PX-F-T,26727,HCPCS,,,F6,Outpatient,,,11572,2893,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7591.23,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8100.4,Percent of Total Billed Charges, ,,85,,9836.2,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7868.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6480.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6943.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26727 - PRQ SKEL FIXJ PHLNGL SHFT FX PROX-MIDDLE PX-F-T,26727,HCPCS,,,F4,Outpatient,,,9482.42,2370.605,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6220.47,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6637.69,Percent of Total Billed Charges, ,,85,,8060.06,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6448.05,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5310.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5689.45,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26727 - PRQ SKEL FIXJ PHLNGL SHFT FX PROX-MIDDLE PX-F-T,26727,HCPCS,,,F3,Outpatient,,,8971.25,2242.8125,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5885.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6279.88,Percent of Total Billed Charges, ,,85,,7625.56,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6100.45,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5023.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5382.75,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26727 - PRQ SKEL FIXJ PHLNGL SHFT FX PROX-MIDDLE PX-F-T,26727,HCPCS,,,F2,Outpatient,,,9581,2395.25,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6285.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6706.7,Percent of Total Billed Charges, ,,85,,8143.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6515.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5365.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5748.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26727 - PRQ SKEL FIXJ PHLNGL SHFT FX PROX-MIDDLE PX-F-T,26727,HCPCS,,,F1,Outpatient,,,5166.4,1291.6,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3389.16,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3616.48,Percent of Total Billed Charges, ,,85,,4391.44,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3513.15,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2893.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3099.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,RT,Outpatient,,,9799,2449.75,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6428.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6859.3,Percent of Total Billed Charges, ,,85,,8329.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6663.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5487.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5879.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,LT,Outpatient,,,7646,1911.5,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5015.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5352.2,Percent of Total Billed Charges, ,,85,,6499.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5199.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4281.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4587.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,F9,Outpatient,,,13381,3345.25,742.5,11373.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8777.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9366.7,Percent of Total Billed Charges, ,,85,,11373.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9099.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7493.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8028.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,F8,Outpatient,,,14596.75,3649.1875,742.5,12407.24,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9575.47,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10217.73,Percent of Total Billed Charges, ,,85,,12407.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9925.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8174.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8758.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,F7,Outpatient,,,18013.33,4503.3325,742.5,15311.33,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11816.74,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12609.33,Percent of Total Billed Charges, ,,85,,15311.33,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12249.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10087.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10808,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,F6,Outpatient,,,19167,4791.75,742.5,16291.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12573.55,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13416.9,Percent of Total Billed Charges, ,,85,,16291.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13033.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10733.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11500.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,F5,Outpatient,,,12812.81,3203.2025,742.5,10890.89,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8405.2,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8968.97,Percent of Total Billed Charges, ,,85,,10890.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8712.71,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7175.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7687.69,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,F4,Outpatient,,,14806.5,3701.625,742.5,12585.53,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9713.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10364.55,Percent of Total Billed Charges, ,,85,,12585.53,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10068.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8291.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8883.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,F3,Outpatient,,,18710.53,4677.6325,742.5,15903.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12274.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13097.37,Percent of Total Billed Charges, ,,85,,15903.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12723.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10477.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11226.32,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,F2,Outpatient,,,12790.38,3197.595,742.5,10871.82,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8390.49,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8953.27,Percent of Total Billed Charges, ,,85,,10871.82,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8697.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7162.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7674.23,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX-MIDDLE EA,26735,HCPCS,,,F1,Outpatient,,,23972,5993,742.5,20376.2,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15725.63,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16780.4,Percent of Total Billed Charges, ,,85,,20376.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16300.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13424.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14383.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26740 - CLTX ARTCLR FX INVG MTCRPHLNGL-IPHAL JT W-O MANJ,26740,HCPCS,,,XU,Outpatient,,,10281,2570.25,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6744.34,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7196.7,Percent of Total Billed Charges, ,,85,,8738.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6991.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5757.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6168.6,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26746 - OPEN TX ARTICULAR FRACTURE MCP-IP JOINT EA,26746,HCPCS,,,RT,Outpatient,,,17831,4457.75,742.5,15156.35,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11697.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12481.7,Percent of Total Billed Charges, ,,85,,15156.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12125.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9985.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10698.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26746 - OPEN TX ARTICULAR FRACTURE MCP-IP JOINT EA,26746,HCPCS,,,LT,Outpatient,,,10281,2570.25,742.5,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6744.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7196.7,Percent of Total Billed Charges, ,,85,,8738.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6991.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5757.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6168.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26746 - OPEN TX ARTICULAR FRACTURE MCP-IP JOINT EA,26746,HCPCS,,,FA,Outpatient,,,15886.5,3971.625,742.5,13503.53,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10421.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11120.55,Percent of Total Billed Charges, ,,85,,13503.53,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10802.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8896.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9531.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26746 - OPEN TX ARTICULAR FRACTURE MCP-IP JOINT EA,26746,HCPCS,,,F9,Outpatient,,,17636.25,4409.0625,742.5,14990.81,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11569.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12345.38,Percent of Total Billed Charges, ,,85,,14990.81,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11992.65,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9876.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10581.75,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26746 - OPEN TX ARTICULAR FRACTURE MCP-IP JOINT EA,26746,HCPCS,,,F8,Outpatient,,,28002,7000.5,742.5,23801.7,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18369.31,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19601.4,Percent of Total Billed Charges, ,,85,,23801.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19041.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15681.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16801.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26746 - OPEN TX ARTICULAR FRACTURE MCP-IP JOINT EA,26746,HCPCS,,,F7,Outpatient,,,17927,4481.75,742.5,15237.95,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11760.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12548.9,Percent of Total Billed Charges, ,,85,,15237.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12190.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10039.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10756.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26746 - OPEN TX ARTICULAR FRACTURE MCP-IP JOINT EA,26746,HCPCS,,,F5,Outpatient,,,17927,4481.75,742.5,15237.95,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11760.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12548.9,Percent of Total Billed Charges, ,,85,,15237.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12190.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10039.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10756.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26746 - OPEN TX ARTICULAR FRACTURE MCP-IP JOINT EA,26746,HCPCS,,,F4,Outpatient,,,15920.83,3980.2075,742.5,13532.71,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10444.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11144.58,Percent of Total Billed Charges, ,,85,,13532.71,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10826.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8915.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9552.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26746 - OPEN TX ARTICULAR FRACTURE MCP-IP JOINT EA,26746,HCPCS,,,F1,Outpatient,,,17307,4326.75,742.5,14710.95,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11353.39,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12114.9,Percent of Total Billed Charges, ,,85,,14710.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11768.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9691.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10384.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26756 - PRQ SKEL FIXJ DSTL PHLNGL FX FNGR-THMB EA,26756,HCPCS,,,XU,Outpatient,,,4946.75,1236.6875,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3245.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3462.73,Percent of Total Billed Charges, ,,85,,4204.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3363.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2770.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2968.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26756 - PRQ SKEL FIXJ DSTL PHLNGL FX FNGR-THMB EA,26756,HCPCS,,,F9,Outpatient,,,12289.28,3072.32,742.5,10445.89,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8061.77,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8602.5,Percent of Total Billed Charges, ,,85,,10445.89,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8356.71,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6882,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7373.57,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26756 - PRQ SKEL FIXJ DSTL PHLNGL FX FNGR-THMB EA,26756,HCPCS,,,F8,Outpatient,,,10655,2663.75,742.5,9056.75,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6989.68,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7458.5,Percent of Total Billed Charges, ,,85,,9056.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7245.4,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5966.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6393,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26756 - PRQ SKEL FIXJ DSTL PHLNGL FX FNGR-THMB EA,26756,HCPCS,,,F7,Outpatient,,,12502,3125.5,742.5,10626.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8201.31,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8751.4,Percent of Total Billed Charges, ,,85,,10626.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8501.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7001.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7501.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26756 - PRQ SKEL FIXJ DSTL PHLNGL FX FNGR-THMB EA,26756,HCPCS,,,F5,Outpatient,,,5489.25,1372.3125,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3600.95,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3842.48,Percent of Total Billed Charges, ,,85,,4665.86,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3732.69,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3073.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3293.55,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26756 - PRQ SKEL FIXJ DSTL PHLNGL FX FNGR-THMB EA,26756,HCPCS,,,F4,Outpatient,,,8972.63,2243.1575,742.5,7626.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5886.05,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6280.84,Percent of Total Billed Charges, ,,85,,7626.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6101.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5024.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5383.58,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26756 - PRQ SKEL FIXJ DSTL PHLNGL FX FNGR-THMB EA,26756,HCPCS,,,F3,Outpatient,,,6311.5,1577.875,742.5,5364.78,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4140.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4418.05,Percent of Total Billed Charges, ,,85,,5364.78,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4291.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3534.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3786.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26765 - OPEN TX DISTAL PHALANGEAL FRACTURE EACH,26765,HCPCS,,,LT,Outpatient,,,8416.17,2104.0425,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5521.01,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5891.32,Percent of Total Billed Charges, ,,85,,7153.74,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5723,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4713.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5049.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26765 - OPEN TX DISTAL PHALANGEAL FRACTURE EACH,26765,HCPCS,,,F9,Outpatient,,,6243.08,1560.77,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4095.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4370.16,Percent of Total Billed Charges, ,,85,,5306.62,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4245.29,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3496.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3745.85,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26765 - OPEN TX DISTAL PHALANGEAL FRACTURE EACH,26765,HCPCS,,,F8,Outpatient,,,6328.5,1582.125,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4151.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4429.95,Percent of Total Billed Charges, ,,85,,5379.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4303.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3543.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3797.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26765 - OPEN TX DISTAL PHALANGEAL FRACTURE EACH,26765,HCPCS,,,F7,Outpatient,,,5975.67,1493.9175,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3920.04,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4182.97,Percent of Total Billed Charges, ,,85,,5079.32,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4063.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3346.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3585.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26765 - OPEN TX DISTAL PHALANGEAL FRACTURE EACH,26765,HCPCS,,,F3,Outpatient,,,10829.33,2707.3325,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7104.04,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7580.53,Percent of Total Billed Charges, ,,85,,9204.93,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7363.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6064.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6497.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26765 - OPEN TX DISTAL PHALANGEAL FRACTURE EACH,26765,HCPCS,,,F2,Outpatient,,,4946.75,1236.6875,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3245.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3462.73,Percent of Total Billed Charges, ,,85,,4204.74,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3363.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2770.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2968.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26765 - OPEN TX DISTAL PHALANGEAL FRACTURE EACH,26765,HCPCS,,,F1,Outpatient,,,5510.66,1377.665,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3614.99,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3857.46,Percent of Total Billed Charges, ,,85,,4684.06,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3747.25,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3085.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3306.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26775 - CLTX IPHAL JT DISLC W-MANJ REQ ANES,26775,HCPCS,,,RT,Outpatient,,,6875.91,1718.9775,252.5,6015,,,,,,,Service Paid at Rev Code level,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4510.6,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4813.14,Percent of Total Billed Charges, ,,85,,5844.52,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4675.62,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3850.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4125.55,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26775 - CLTX IPHAL JT DISLC W-MANJ REQ ANES,26775,HCPCS,,,LT,Outpatient,,,9048,2262,252.5,7690.8,,,,,,,Service Paid at Rev Code level,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5935.49,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6333.6,Percent of Total Billed Charges, ,,85,,7690.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6152.64,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5066.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5428.8,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26776 - PRQ SKEL FIXJ IPHAL JT DISLC W-MANJ,26776,HCPCS,,,F9,Outpatient,,,7575.83,1893.9575,742.5,6439.46,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4969.74,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5303.08,Percent of Total Billed Charges, ,,85,,6439.46,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5151.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4242.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4545.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26776 - PRQ SKEL FIXJ IPHAL JT DISLC W-MANJ,26776,HCPCS,,,F4,Outpatient,,,12502,3125.5,742.5,10626.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8201.31,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8751.4,Percent of Total Billed Charges, ,,85,,10626.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8501.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7001.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7501.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26785 - OPEN TX INTERPHALANGEAL JOINT DISLOCATION,26785,HCPCS,,,RT,Outpatient,,,6638.5,1659.625,950.4,5642.73,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4354.86,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4646.95,Percent of Total Billed Charges, ,,85,,5642.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4514.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3717.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3983.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26785 - OPEN TX INTERPHALANGEAL JOINT DISLOCATION,26785,HCPCS,,,F5,Outpatient,,,10312.5,2578.125,950.4,8765.63,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6765,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7218.75,Percent of Total Billed Charges, ,,85,,8765.63,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7012.5,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5775,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6187.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26841 - ARTHRD CARPO-METACARPAL JT THUMB W-WO INT FIXJ,26841,HCPCS,,,LT,Outpatient,,,9583.5,2395.875,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6286.78,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6708.45,Percent of Total Billed Charges, ,,85,,8145.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6516.78,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5366.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5750.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26850 - ARTHRODESIS METACARPOPHALANGEAL JT W-WO INT FIXJ,26850,HCPCS,,,XS,Outpatient,,,8148,2037,882.09,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5345.09,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5703.6,Percent of Total Billed Charges, ,,85,,6925.8,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5540.64,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4562.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4888.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26850 - ARTHRODESIS METACARPOPHALANGEAL JT W-WO INT FIXJ,26850,HCPCS,,,T5,Outpatient,,,6110.68,1527.67,882.09,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4008.61,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4277.48,Percent of Total Billed Charges, ,,85,,5194.08,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4155.26,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3421.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3666.41,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26850 - ARTHRODESIS METACARPOPHALANGEAL JT W-WO INT FIXJ,26850,HCPCS,,,FA,Outpatient,,,6828.4,1707.1,882.09,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4479.43,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4779.88,Percent of Total Billed Charges, ,,85,,5804.14,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4643.31,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3823.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4097.04,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26850 - ARTHRODESIS METACARPOPHALANGEAL JT W-WO INT FIXJ,26850,HCPCS,,,F9,Outpatient,,,9674.25,2418.5625,882.09,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6346.31,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6771.98,Percent of Total Billed Charges, ,,85,,8223.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6578.49,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5417.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5804.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26850 - ARTHRODESIS METACARPOPHALANGEAL JT W-WO INT FIXJ,26850,HCPCS,,,F8,Outpatient,,,9674.25,2418.5625,882.09,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6346.31,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6771.98,Percent of Total Billed Charges, ,,85,,8223.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6578.49,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5417.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5804.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26850 - ARTHRODESIS METACARPOPHALANGEAL JT W-WO INT FIXJ,26850,HCPCS,,,F7,Outpatient,,,9674.25,2418.5625,882.09,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6346.31,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6771.98,Percent of Total Billed Charges, ,,85,,8223.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6578.49,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5417.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5804.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26852 - ARTHRODESIS MTCRPL JT W-WO INT FIXJ W-AUTOGRAFT,26852,HCPCS,,,F5,Outpatient,,,10716,2679,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7029.7,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7501.2,Percent of Total Billed Charges, ,,85,,9108.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7286.88,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6000.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6429.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26860 - ARTHRODESIS INTERPHALANGEAL JT W-WO INT FIXJ,26860,HCPCS,,,RT,Outpatient,,,7101.75,1775.4375,1078.11,6036.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4658.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4971.23,Percent of Total Billed Charges, ,,85,,6036.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4829.19,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3976.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4261.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26860 - ARTHRODESIS INTERPHALANGEAL JT W-WO INT FIXJ,26860,HCPCS,,,F9,Outpatient,,,16532,4133,1078.11,14052.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10844.99,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11572.4,Percent of Total Billed Charges, ,,85,,14052.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11241.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9257.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9919.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26860 - ARTHRODESIS INTERPHALANGEAL JT W-WO INT FIXJ,26860,HCPCS,,,F8,Outpatient,,,19763,4940.75,1078.11,16798.55,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12964.53,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13834.1,Percent of Total Billed Charges, ,,85,,16798.55,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13438.84,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11067.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11857.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26860 - ARTHRODESIS INTERPHALANGEAL JT W-WO INT FIXJ,26860,HCPCS,,,F7,Outpatient,,,12141,3035.25,1078.11,10319.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7964.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8498.7,Percent of Total Billed Charges, ,,85,,10319.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8255.88,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6798.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7284.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26860 - ARTHRODESIS INTERPHALANGEAL JT W-WO INT FIXJ,26860,HCPCS,,,F6,Outpatient,,,15428.67,3857.1675,1078.11,13114.37,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10121.21,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10800.07,Percent of Total Billed Charges, ,,85,,13114.37,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10491.5,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8640.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9257.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26860 - ARTHRODESIS INTERPHALANGEAL JT W-WO INT FIXJ,26860,HCPCS,,,F5,Outpatient,,,8661.33,2165.3325,1078.11,7362.13,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5681.83,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6062.93,Percent of Total Billed Charges, ,,85,,7362.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5889.7,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4850.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5196.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26860 - ARTHRODESIS INTERPHALANGEAL JT W-WO INT FIXJ,26860,HCPCS,,,F4,Outpatient,,,19787,4946.75,1078.11,16818.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12980.27,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13850.9,Percent of Total Billed Charges, ,,85,,16818.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13455.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11080.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11872.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26860 - ARTHRODESIS INTERPHALANGEAL JT W-WO INT FIXJ,26860,HCPCS,,,F3,Outpatient,,,11589.67,2897.4175,1078.11,9851.22,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7602.82,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8112.77,Percent of Total Billed Charges, ,,85,,9851.22,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7880.98,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6490.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6953.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26860 - ARTHRODESIS INTERPHALANGEAL JT W-WO INT FIXJ,26860,HCPCS,,,F1,Outpatient,,,10884.42,2721.105,1078.11,9251.76,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7140.18,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7619.09,Percent of Total Billed Charges, ,,85,,9251.76,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7401.41,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6095.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6530.65,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26861 - ARTHRODESIS IPHAL JT W-WO INT FIXJ EA IPHAL JT,26861,HCPCS,,,F9,Outpatient,,,10244,2561,0.01,8707.4,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6720.06,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7170.8,Percent of Total Billed Charges, ,,85,,8707.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6965.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5736.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6146.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26861 - ARTHRODESIS IPHAL JT W-WO INT FIXJ EA IPHAL JT,26861,HCPCS,,,F7,Outpatient,,,13193.5,3298.375,0.01,11214.48,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8654.94,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9235.45,Percent of Total Billed Charges, ,,85,,11214.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8971.58,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7388.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7916.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26861 - ARTHRODESIS IPHAL JT W-WO INT FIXJ EA IPHAL JT,26861,HCPCS,,,F6,Outpatient,,,12235.83,3058.9575,0.01,10400.46,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8026.7,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8565.08,Percent of Total Billed Charges, ,,85,,10400.46,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8320.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6852.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7341.5,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26861 - ARTHRODESIS IPHAL JT W-WO INT FIXJ EA IPHAL JT,26861,HCPCS,,,F2,Outpatient,,,5908.25,1477.0625,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3875.81,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4135.78,Percent of Total Billed Charges, ,,85,,5022.01,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4017.61,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3308.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3544.95,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26862 - ARTHRODESIS IPHAL JT W-WO INT FIXJ W-AUTOGRAFT,26862,HCPCS,,,FA,Outpatient,,,7767.5,1941.875,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5095.48,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5437.25,Percent of Total Billed Charges, ,,85,,6602.38,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5281.9,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4349.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4660.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26862 - ARTHRODESIS IPHAL JT W-WO INT FIXJ W-AUTOGRAFT,26862,HCPCS,,,F7,Outpatient,,,8938,2234.5,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5863.33,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6256.6,Percent of Total Billed Charges, ,,85,,7597.3,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6077.84,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5005.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5362.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26863 - ARTHRODESIS IPHAL JT W-WO INT FIXJ W-AGRFT EA JT,26863,HCPCS,,,F9,Outpatient,,,8938,2234.5,0.01,7597.3,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5863.33,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6256.6,Percent of Total Billed Charges, ,,85,,7597.3,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6077.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5005.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5362.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26863 - ARTHRODESIS IPHAL JT W-WO INT FIXJ W-AGRFT EA JT,26863,HCPCS,,,F8,Outpatient,,,8938,2234.5,0.01,7597.3,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5863.33,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6256.6,Percent of Total Billed Charges, ,,85,,7597.3,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6077.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5005.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5362.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26910 - AMP MTCRPL W-FINGER-THUMB W-WO INTEROSS TRANSFER,26910,HCPCS,,,F6,Outpatient,,,20252,5063,742.5,17214.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13285.31,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14176.4,Percent of Total Billed Charges, ,,85,,17214.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13771.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11341.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12151.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26910 - AMP MTCRPL W-FINGER-THUMB W-WO INTEROSS TRANSFER,26910,HCPCS,,,F3,Outpatient,,,15137,3784.25,742.5,12866.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9929.87,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10595.9,Percent of Total Billed Charges, ,,85,,12866.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10293.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8476.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9082.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26910 - AMP MTCRPL W-FINGER-THUMB W-WO INTEROSS TRANSFER,26910,HCPCS,,,F1,Outpatient,,,21005,5251.25,742.5,17854.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13779.28,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14703.5,Percent of Total Billed Charges, ,,85,,17854.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14283.4,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11762.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12603,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,XU,Outpatient,,,9525.5,2381.375,742.5,8096.68,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6248.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6667.85,Percent of Total Billed Charges, ,,85,,8096.68,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6477.34,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5334.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5715.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,RT,Outpatient,,,17145,4286.25,742.5,14573.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11247.12,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12001.5,Percent of Total Billed Charges, ,,85,,14573.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11658.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9601.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10287,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,F9,Outpatient,,,11271.5,2817.875,742.5,9580.78,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7394.1,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7890.05,Percent of Total Billed Charges, ,,85,,9580.78,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7664.62,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6312.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6762.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,F8,Outpatient,,,5741.5,1435.375,742.5,4880.28,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3766.42,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4019.05,Percent of Total Billed Charges, ,,85,,4880.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3904.22,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3215.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3444.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,F7,Outpatient,,,13042.5,3260.625,742.5,11086.13,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8555.88,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9129.75,Percent of Total Billed Charges, ,,85,,11086.13,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8868.9,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7303.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7825.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,F6,Outpatient,,,11057.43,2764.3575,742.5,9398.82,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7253.67,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7740.2,Percent of Total Billed Charges, ,,85,,9398.82,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7519.05,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6192.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6634.46,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,F5,Outpatient,,,5665.68,1416.42,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3716.69,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3965.98,Percent of Total Billed Charges, ,,85,,4815.83,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3852.66,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3172.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3399.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,F4,Outpatient,,,4210.5,1052.625,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2762.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2947.35,Percent of Total Billed Charges, ,,85,,3578.93,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2863.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2357.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2526.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,F3,Outpatient,,,4210.5,1052.625,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2762.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2947.35,Percent of Total Billed Charges, ,,85,,3578.93,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2863.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2357.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2526.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,F2,Outpatient,,,9512.98,2378.245,742.5,8086.03,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6240.51,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6659.09,Percent of Total Billed Charges, ,,85,,8086.03,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6468.83,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5327.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5707.79,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26951 - AMP F-TH 1-2 JT-PHALANX W-NEURECT W-DIR CLSR,26951,HCPCS,,,F1,Outpatient,,,8452.38,2113.095,742.5,7184.52,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5544.76,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5916.67,Percent of Total Billed Charges, ,,85,,7184.52,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5747.62,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4733.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5071.43,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26952 - AMP F-TH 1-2 JT-PHALANX W-NEURECT LOCAL FLAP,26952,HCPCS,,,FA,Outpatient,,,16222,4055.5,1078.11,13788.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10641.63,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11355.4,Percent of Total Billed Charges, ,,85,,13788.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11030.96,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9084.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9733.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26952 - AMP F-TH 1-2 JT-PHALANX W-NEURECT LOCAL FLAP,26952,HCPCS,,,F9,Outpatient,,,12587,3146.75,1078.11,10698.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8257.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8810.9,Percent of Total Billed Charges, ,,85,,10698.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8559.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7048.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7552.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26952 - AMP F-TH 1-2 JT-PHALANX W-NEURECT LOCAL FLAP,26952,HCPCS,,,F8,Outpatient,,,14421.5,3605.375,1078.11,12258.28,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9460.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10095.05,Percent of Total Billed Charges, ,,85,,12258.28,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9806.62,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8076.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8652.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26952 - AMP F-TH 1-2 JT-PHALANX W-NEURECT LOCAL FLAP,26952,HCPCS,,,F6,Outpatient,,,6337.33,1584.3325,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4157.29,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4436.13,Percent of Total Billed Charges, ,,85,,5386.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4309.38,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3548.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3802.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26952 - AMP F-TH 1-2 JT-PHALANX W-NEURECT LOCAL FLAP,26952,HCPCS,,,F2,Outpatient,,,15343,3835.75,1078.11,13041.55,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10065.01,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10740.1,Percent of Total Billed Charges, ,,85,,13041.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10433.24,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8592.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9205.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26952 - AMP F-TH 1-2 JT-PHALANX W-NEURECT LOCAL FLAP,26952,HCPCS,,,F1,Outpatient,,,15602,3900.5,1078.11,13261.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10234.91,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10921.4,Percent of Total Billed Charges, ,,85,,13261.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10609.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8737.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9361.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26990 - IANDD PELVIS-HIP JT AREA DEEP ABSCESS-HEMATOMA,26990,HCPCS,,,LT,Outpatient,,,12967,3241.75,882.09,11021.95,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8506.35,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9076.9,Percent of Total Billed Charges, ,,85,,11021.95,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8817.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7261.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7780.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27001 - TENOTOMY ADDUCTOR HIP OPEN,27001,HCPCS,,,RT,Outpatient,,,9902.34,2475.585,1078.11,8416.99,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6495.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6931.64,Percent of Total Billed Charges, ,,85,,8416.99,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6733.59,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5545.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5941.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27001 - TENOTOMY ADDUCTOR HIP OPEN,27001,HCPCS,,,LT,Outpatient,,,31412,7853,1078.11,26700.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20606.27,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21988.4,Percent of Total Billed Charges, ,,85,,26700.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21360.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17590.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18847.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27006 - TENOTOMY ABDUCTORSAND-EXTENSOR HIP OPEN SPX,27006,HCPCS,,,RT,Outpatient,,,7164,1791,742.5,9034,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4699.58,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5014.8,Percent of Total Billed Charges, ,,85,,6089.4,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4871.52,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4011.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4298.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27030 - ARTHROTOMY HIP W-DRAINAGE,27030,HCPCS,,,RT,Outpatient,,,13207.5,3301.875,0.01,11226.38,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8664.12,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9245.25,Percent of Total Billed Charges, ,,85,,11226.38,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8981.1,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7396.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7924.5,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27033 - ARTHROTOMY HIP EXPLORATION-REMOVAL FOREIGN BODY,27033,HCPCS,,,LT,Outpatient,,,22191,5547.75,1078.11,18862.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14557.3,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15533.7,Percent of Total Billed Charges, ,,85,,18862.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15089.88,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12426.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13314.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27043 - EXCISION TUMOR SOFT TISSUE PELVISANDHIP SUBQ 3CM-GREATER THAN,27043,HCPCS,,,RT,Outpatient,,,6957.33,1739.3325,1078.11,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4564.01,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4870.13,Percent of Total Billed Charges, ,,85,,5913.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4730.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3896.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4174.4,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27048 - EXC TUMOR SOFT TISSUE PELVIS AND HIP SUBFASC LESS THAN 5CM,27048,HCPCS,,,RT,Outpatient,,,12365.5,3091.375,882.09,10510.68,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8111.77,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8655.85,Percent of Total Billed Charges, ,,85,,10510.68,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8408.54,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6924.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7419.3,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27048 - EXC TUMOR SOFT TISSUE PELVIS AND HIP SUBFASC LESS THAN 5CM,27048,HCPCS,,,LT,Outpatient,,,33582,8395.5,882.09,28544.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,22029.79,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23507.4,Percent of Total Billed Charges, ,,85,,28544.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22835.76,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18805.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,20149.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27062 - EXCISION TROCHANTERIC BURSA-CALCIFICATION,27062,HCPCS,,,RT,Outpatient,,,4732.83,1183.2075,742.5,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3104.74,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3312.98,Percent of Total Billed Charges, ,,85,,4022.91,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3218.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2650.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2839.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27062 - EXCISION TROCHANTERIC BURSA-CALCIFICATION,27062,HCPCS,,,LT,Outpatient,,,8869,2217.25,742.5,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5818.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6208.3,Percent of Total Billed Charges, ,,85,,7538.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6030.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4966.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5321.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27087 - REMOVAL FOREIGN BODY PELVIS-HIP DEEP,27087,HCPCS,,,LT,Outpatient,,,14052,3513,742.5,11944.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9218.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9836.4,Percent of Total Billed Charges, ,,85,,11944.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9555.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7869.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8431.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27097 - RELEASE-RECESSION HAMSTRING PROXIMAL,27097,HCPCS,,,50,Outpatient,,,9902.33,2475.5825,0.01,8416.98,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6495.93,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6931.63,Percent of Total Billed Charges, ,,85,,8416.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6733.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5545.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5941.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27130 - ARTHRP ACETBLR-PROX FEM PROSTC AGRFT-ALGRFT,27130,HCPCS,,,RT,Outpatient,,,31324.76,7831.19,6015,26626.05,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20549.04,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21927.33,Percent of Total Billed Charges, ,,85,,26626.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21300.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17541.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18794.86,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27130 - ARTHRP ACETBLR-PROX FEM PROSTC AGRFT-ALGRFT,27130,HCPCS,,,LT,Outpatient,,,30475.36,7618.84,6015,25904.06,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19991.84,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21332.75,Percent of Total Billed Charges, ,,85,,25904.06,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,20723.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17066.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18285.22,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27130 - ARTHRP ACETBLR-PROX FEM PROSTC AGRFT-ALGRFT,27130,HCPCS,,,74,Outpatient,,,5027,1256.75,2815.12,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3297.71,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3518.9,Percent of Total Billed Charges, ,,85,,4272.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3418.36,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2815.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3016.2,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27130 - ARTHRP ACETBLR-PROX FEM PROSTC AGRFT-ALGRFT,27130,HCPCS,,,50,Outpatient,,,33501,8375.25,6015,28475.85,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21976.66,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23450.7,Percent of Total Billed Charges, ,,85,,28475.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,22780.68,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18760.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,20100.6,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27130 - ARTHRP ACETBLR-PROX FEM PROSTC AGRFT-ALGRFT,27130,HCPCS,,,22,Outpatient,,,26651.17,6662.7925,6015,22653.49,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17483.17,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18655.82,Percent of Total Billed Charges, ,,85,,22653.49,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,18122.8,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14924.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15990.7,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27132 - CONV PREV HIP TOT HIP ARTHRP W-WO AGRFT-ALGRFT,27132,HCPCS,,,RT,Outpatient,,,30114,7528.5,0.01,25596.9,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19754.78,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21079.8,Percent of Total Billed Charges, ,,85,,25596.9,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,20477.52,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16863.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18068.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27132 - CONV PREV HIP TOT HIP ARTHRP W-WO AGRFT-ALGRFT,27132,HCPCS,,,LT,Outpatient,,,25497,6374.25,0.01,21672.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16726.03,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17847.9,Percent of Total Billed Charges, ,,85,,21672.45,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17337.96,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14278.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15298.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27235 - PRQ SKEL FIXJ FEMORAL FX PROX END NECK,27235,HCPCS,,,RT,Outpatient,,,13432,3358,742.5,11417.2,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8811.39,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9402.4,Percent of Total Billed Charges, ,,85,,11417.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9133.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7521.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8059.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27235 - PRQ SKEL FIXJ FEMORAL FX PROX END NECK,27235,HCPCS,,,LT,Outpatient,,,15291,3822.75,742.5,12997.35,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10030.9,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10703.7,Percent of Total Billed Charges, ,,85,,12997.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10397.88,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8562.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9174.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27236 - OPTX FEM FX PROX END NCK INT FIXJ-PROSTC RPLCMT,27236,HCPCS,,,LT,Outpatient,,,14519,3629.75,0.01,12341.15,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9524.46,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10163.3,Percent of Total Billed Charges, ,,85,,12341.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9872.92,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8130.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8711.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27245 - TX INTER-PR-SUBTRCHNTRIC FEM FX IMED IMPLTSCREW,27245,HCPCS,,,LT,Outpatient,,,25987,6496.75,0.01,22088.95,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17047.47,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18190.9,Percent of Total Billed Charges, ,,85,,22088.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,17671.16,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14552.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15592.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27248 - OPEN TREATMENT GREATER TROCHANTERIC FRACTURE,27248,HCPCS,,,RT,Outpatient,,,18883.5,4720.875,0.01,16050.98,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12387.58,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13218.45,Percent of Total Billed Charges, ,,85,,16050.98,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12840.78,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10574.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11330.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27252 - CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA,27252,HCPCS,,,RT,Outpatient,,,4417,1104.25,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2897.55,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3091.9,Percent of Total Billed Charges, ,,85,,3754.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3003.56,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2473.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2650.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27266 - CLTX POST HIP ARTHRP DISLC REQ ANES,27266,HCPCS,,,LT,Outpatient,,,12931,3232.75,742.5,10991.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8482.74,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9051.7,Percent of Total Billed Charges, ,,85,,10991.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8793.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7241.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7758.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27279 - ARTHRODESIS SI JOINT PERCUTANEOUS-MIN INVASIVE,27279,HCPCS,,,RT,Outpatient,,,9480.15,2370.0375,1078.11,35521.64,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6218.98,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6636.11,Percent of Total Billed Charges, ,,85,,8058.13,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6446.5,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5308.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5688.09,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27279 - ARTHRODESIS SI JOINT PERCUTANEOUS-MIN INVASIVE,27279,HCPCS,,,LT,Outpatient,,,11055.82,2763.955,1078.11,35521.64,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7252.62,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7739.07,Percent of Total Billed Charges, ,,85,,9397.45,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7517.96,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6191.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6633.49,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27279 - ARTHRODESIS SI JOINT PERCUTANEOUS-MIN INVASIVE,27279,HCPCS,,,50,Outpatient,,,8524.5,2131.125,1078.11,35521.64,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5592.07,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5967.15,Percent of Total Billed Charges, ,,85,,7245.83,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5796.66,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4773.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5114.7,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27301 - IANDD DEEP ABSC BURSA-HEMATOMA THIGH-KNEE REGION,27301,HCPCS,,,RT,Outpatient,,,16622.75,4155.6875,742.5,14129.34,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10904.52,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11635.93,Percent of Total Billed Charges, ,,85,,14129.34,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11303.47,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9308.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9973.65,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27301 - IANDD DEEP ABSC BURSA-HEMATOMA THIGH-KNEE REGION,27301,HCPCS,,,LT,Outpatient,,,12311,3077.75,742.5,10464.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8076.02,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8617.7,Percent of Total Billed Charges, ,,85,,10464.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8371.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6894.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7386.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27305 - FASCIOTOMY ILIOTIBIAL OPEN,27305,HCPCS,,,RT,Outpatient,,,4732.83,1183.2075,1078.11,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3104.74,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3312.98,Percent of Total Billed Charges, ,,85,,4022.91,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3218.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2650.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2839.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27305 - FASCIOTOMY ILIOTIBIAL OPEN,27305,HCPCS,,,LT,Outpatient,,,9116.75,2279.1875,1078.11,7749.24,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5980.59,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6381.73,Percent of Total Billed Charges, ,,85,,7749.24,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6199.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5105.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5470.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27307 - TENOTOMY PRQ ADDUCTOR-HAMSTRING MULTIPLE TENDON,27307,HCPCS,,,50,Outpatient,,,10633.83,2658.4575,742.5,9038.76,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6975.79,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7443.68,Percent of Total Billed Charges, ,,85,,9038.76,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7231,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5954.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6380.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27310 - ARTHRT KNE W-EXPL DRG-RMVL FB,27310,HCPCS,,,RT,Outpatient,,,16253.83,4063.4575,742.5,13815.76,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10662.51,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11377.68,Percent of Total Billed Charges, ,,85,,13815.76,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11052.6,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9102.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9752.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27327 - EXCISION TUMOR SOFT TISSUE THIGH-KNEE SUBQ LESS THAN 3CM,27327,HCPCS,,,XS,Outpatient,,,6086.5,1521.625,742.5,5173.53,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3992.74,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4260.55,Percent of Total Billed Charges, ,,85,,5173.53,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4138.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3408.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3651.9,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27327 - EXCISION TUMOR SOFT TISSUE THIGH-KNEE SUBQ LESS THAN 3CM,27327,HCPCS,,,LT,Outpatient,,,12121.38,3030.345,742.5,10303.17,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7951.63,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8484.97,Percent of Total Billed Charges, ,,85,,10303.17,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8242.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6787.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7272.83,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27331 - ARTHRT KNE W-JT EXPL BX-RMVL LOOSE-FB,27331,HCPCS,,,RT,Outpatient,,,17462,4365.5,882.09,14842.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11455.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12223.4,Percent of Total Billed Charges, ,,85,,14842.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11874.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9778.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10477.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27331 - ARTHRT KNE W-JT EXPL BX-RMVL LOOSE-FB,27331,HCPCS,,,LT,Outpatient,,,10364.5,2591.125,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6799.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7255.15,Percent of Total Billed Charges, ,,85,,8809.83,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7047.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5804.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6218.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27334 - ARTHROTOMY W-SYNOVECTOMY KNEE ANTERIOR-POSTERIOR,27334,HCPCS,,,LT,Outpatient,,,13738.5,3434.625,882.09,11677.73,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9012.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9616.95,Percent of Total Billed Charges, ,,85,,11677.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9342.18,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7693.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8243.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27337 - EXCISON TUMOR SOFT TISSUE THIGH-KNEE SUBQ 3 CM-GREATER THAN,27337,HCPCS,,,RT,Outpatient,,,14667.88,3666.97,950.4,12467.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9622.13,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10267.52,Percent of Total Billed Charges, ,,85,,12467.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9974.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8214.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8800.73,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27337 - EXCISON TUMOR SOFT TISSUE THIGH-KNEE SUBQ 3 CM-GREATER THAN,27337,HCPCS,,,LT,Outpatient,,,10657.43,2664.3575,950.4,9058.82,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6991.27,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7460.2,Percent of Total Billed Charges, ,,85,,9058.82,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7247.05,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5968.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6394.46,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27340 - EXCISION PREPATELLAR BURSA,27340,HCPCS,,,RT,Outpatient,,,12106.33,3026.5825,742.5,10290.38,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7941.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8474.43,Percent of Total Billed Charges, ,,85,,10290.38,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8232.3,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6779.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7263.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27340 - EXCISION PREPATELLAR BURSA,27340,HCPCS,,,LT,Outpatient,,,14052,3513,742.5,11944.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9218.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9836.4,Percent of Total Billed Charges, ,,85,,11944.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9555.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7869.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8431.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27355 - EXCISION-CURETTAGE CYST-TUMOR FEMUR,27355,HCPCS,,,LT,Outpatient,,,8869,2217.25,742.5,7538.65,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5818.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6208.3,Percent of Total Billed Charges, ,,85,,7538.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6030.92,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4966.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5321.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27369 - NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT-MRI KNE,27369,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27369 - NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT-MRI KNE,27369,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27372 - REMOVAL FOREIGN BODY DEEP THIGH-KNEE,27372,HCPCS,,,RT,Outpatient,,,10461.5,2615.375,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6862.74,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7323.05,Percent of Total Billed Charges, ,,85,,8892.28,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7113.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5858.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6276.9,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27380 - SUTURE INFRAPATELLAR TENDON PRIMARY,27380,HCPCS,,,RT,Outpatient,,,15780,3945,882.09,13413,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10351.68,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11046,Percent of Total Billed Charges, ,,85,,13413,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10730.4,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8836.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9468,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27380 - SUTURE INFRAPATELLAR TENDON PRIMARY,27380,HCPCS,,,LT,Outpatient,,,21539.5,5384.875,882.09,18308.58,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14129.91,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15077.65,Percent of Total Billed Charges, ,,85,,18308.58,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14646.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12062.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12923.7,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27381 - SUTR INFRAPATELLAR TDN 2 RCNSTJ W-FSCAL-TDN GRF,27381,HCPCS,,,LT,Outpatient,,,8369.55,2092.3875,0.01,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5490.42,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5858.69,Percent of Total Billed Charges, ,,85,,7114.12,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5691.29,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4686.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5021.73,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27385 - SUTURE QUADRICEPS-HAMSTRING RUPTURE PRIMARY,27385,HCPCS,,,RT,Outpatient,,,19356.4,4839.1,742.5,16452.94,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12697.8,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13549.48,Percent of Total Billed Charges, ,,85,,16452.94,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13162.35,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10839.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11613.84,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27385 - SUTURE QUADRICEPS-HAMSTRING RUPTURE PRIMARY,27385,HCPCS,,,LT,Outpatient,,,11790.75,2947.6875,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7734.73,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8253.53,Percent of Total Billed Charges, ,,85,,10022.14,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8017.71,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6602.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7074.45,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27385 - SUTURE QUADRICEPS-HAMSTRING RUPTURE PRIMARY,27385,HCPCS,,,50,Outpatient,,,29397,7349.25,742.5,24987.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19284.43,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20577.9,Percent of Total Billed Charges, ,,85,,24987.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19989.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16462.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17638.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27386 - SUTR QUADRICEPS-HAMSTRING MUSC RPT RCNSTJ,27386,HCPCS,,,RT,Outpatient,,,6914.5,1728.625,0.01,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4535.91,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4840.15,Percent of Total Billed Charges, ,,85,,5877.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4701.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3872.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4148.7,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27386 - SUTR QUADRICEPS-HAMSTRING MUSC RPT RCNSTJ,27386,HCPCS,,,LT,Outpatient,,,5665.66,1416.415,0.01,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3716.67,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3965.96,Percent of Total Billed Charges, ,,85,,4815.81,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3852.65,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3172.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3399.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27403 - ARTHROTOMY W-MENISCUS REPAIR KNEE,27403,HCPCS,,,RT,Outpatient,,,15410.68,3852.67,0.01,13099.08,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10109.41,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10787.48,Percent of Total Billed Charges, ,,85,,13099.08,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10479.26,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8629.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9246.41,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27405 - RPR PRIMARY TORN LIGMAND-CAPSULE KNEE COLLATERAL,27405,HCPCS,,,RT,Outpatient,,,24455,6113.75,882.09,20786.75,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16042.48,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17118.5,Percent of Total Billed Charges, ,,85,,20786.75,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16629.4,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13694.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14673,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27405 - RPR PRIMARY TORN LIGMAND-CAPSULE KNEE COLLATERAL,27405,HCPCS,,,LT,Outpatient,,,11718.25,2929.5625,882.09,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7687.17,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8202.78,Percent of Total Billed Charges, ,,85,,9960.51,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7968.41,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6562.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7030.95,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27412 - AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE,27412,HCPCS,,,LT,Outpatient,,,14045,3511.25,1078.11,107923.17,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,107923.17,,,107923.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9213.52,Percent of Total Billed Charges, ,107923.17,,,107923.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9831.5,Percent of Total Billed Charges, ,,85,,11938.25,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9550.6,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7865.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8427,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104540,,,104540,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27418 - ANTERIOR TIBIAL TUBERCLEPLASTY,27418,HCPCS,,,LT,Outpatient,,,8915.09,2228.7725,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5848.3,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6240.56,Percent of Total Billed Charges, ,,85,,7577.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6062.26,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4992.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5349.05,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27420 - RCNSTJ DISLOCATING PATELLA,27420,HCPCS,,,RT,Outpatient,,,10361.68,2590.42,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6797.26,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7253.18,Percent of Total Billed Charges, ,,85,,8807.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7045.94,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5802.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6217.01,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27422 - RCNSTJ DISLC PATELLA W-XTNSR RELIGNMTAND-MUSC RL,27422,HCPCS,,,RT,Outpatient,,,8707.17,2176.7925,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5711.9,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6095.02,Percent of Total Billed Charges, ,,85,,7401.09,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5920.88,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4876.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5224.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27422 - RCNSTJ DISLC PATELLA W-XTNSR RELIGNMTAND-MUSC RL,27422,HCPCS,,,LT,Outpatient,,,8155.28,2038.82,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5349.86,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5708.7,Percent of Total Billed Charges, ,,85,,6931.99,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5545.59,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4566.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4893.17,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27427 - LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR,27427,HCPCS,,,XS,Outpatient,,,8899.25,2224.8125,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5837.91,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6229.48,Percent of Total Billed Charges, ,,85,,7564.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6051.49,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4983.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5339.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27427 - LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR,27427,HCPCS,,,RT,Outpatient,,,9887.37,2471.8425,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6486.11,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6921.16,Percent of Total Billed Charges, ,,85,,8404.26,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6723.41,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5536.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5932.42,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27427 - LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR,27427,HCPCS,,,LT,Outpatient,,,10091.06,2522.765,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6619.74,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7063.74,Percent of Total Billed Charges, ,,85,,8577.4,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6861.92,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5650.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6054.64,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27428 - LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR,27428,HCPCS,,,RT,Outpatient,,,16218.5,4054.625,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10639.34,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11352.95,Percent of Total Billed Charges, ,,85,,13785.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11028.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9082.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9731.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27428 - LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR,27428,HCPCS,,,LT,Outpatient,,,10413.95,2603.4875,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6831.55,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7289.77,Percent of Total Billed Charges, ,,85,,8851.86,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7081.49,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5831.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6248.37,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27430 - QUADRICEPSPLASTY,27430,HCPCS,,,RT,Outpatient,,,13192.5,3298.125,1078.11,11213.63,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8654.28,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9234.75,Percent of Total Billed Charges, ,,85,,11213.63,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8970.9,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7387.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7915.5,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27430 - QUADRICEPSPLASTY,27430,HCPCS,,,LT,Outpatient,,,10126,2531.5,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6642.66,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7088.2,Percent of Total Billed Charges, ,,85,,8607.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6885.68,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5670.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6075.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27446 - ARTHRP KNEE CONDYLEANDPLATEAU MEDIAL-LAT CMPRT,27446,HCPCS,,,RT,Outpatient,,,26591.95,6647.9875,882.09,22603.16,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17444.32,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18614.37,Percent of Total Billed Charges, ,,85,,22603.16,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18082.53,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14891.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15955.17,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27446 - ARTHRP KNEE CONDYLEANDPLATEAU MEDIAL-LAT CMPRT,27446,HCPCS,,,LT,Outpatient,,,19352.88,4838.22,882.09,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12695.49,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13547.02,Percent of Total Billed Charges, ,,85,,16449.95,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13159.96,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10837.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11611.73,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27447 - ARTHRP KNE CONDYLEANDPLATU MEDIALANDLAT COMPARTMENTS,27447,HCPCS,,,RT,Outpatient,,,22085.13,5521.2825,950.4,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14487.85,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15459.59,Percent of Total Billed Charges, ,,85,,18772.36,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15017.89,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12367.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13251.08,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27447 - ARTHRP KNE CONDYLEANDPLATU MEDIALANDLAT COMPARTMENTS,27447,HCPCS,,,LT,Outpatient,,,22819.59,5704.8975,950.4,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14969.65,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15973.71,Percent of Total Billed Charges, ,,85,,19396.65,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15517.32,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12778.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13691.75,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27447 - ARTHRP KNE CONDYLEANDPLATU MEDIALANDLAT COMPARTMENTS,27447,HCPCS,,,79,Outpatient,,,20728,5182,950.4,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13597.57,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14509.6,Percent of Total Billed Charges, ,,85,,17618.8,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14095.04,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11607.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12436.8,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27447 - ARTHRP KNE CONDYLEANDPLATU MEDIALANDLAT COMPARTMENTS,27447,HCPCS,,,74,Outpatient,,,4539,1134.75,950.4,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2977.58,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3177.3,Percent of Total Billed Charges, ,,85,,3858.15,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3086.52,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2541.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2723.4,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27447 - ARTHRP KNE CONDYLEANDPLATU MEDIALANDLAT COMPARTMENTS,27447,HCPCS,,,50,Outpatient,,,36380.63,9095.1575,950.4,30923.54,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23865.69,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25466.44,Percent of Total Billed Charges, ,,85,,30923.54,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24738.83,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20373.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21828.38,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27447 - ARTHRP KNE CONDYLEANDPLATU MEDIALANDLAT COMPARTMENTS,27447,HCPCS,,,22,Outpatient,,,22904.42,5726.105,950.4,21166.19,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15025.3,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16033.09,Percent of Total Billed Charges, ,,85,,19468.76,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15575.01,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12826.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13742.65,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27450 - OSTEOTOMY FEMUR SHAFT-SUPRACONDYLAR W-FIXATION,27450,HCPCS,,,RT,Outpatient,,,13213.66,3303.415,0.01,11231.61,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8668.16,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9249.56,Percent of Total Billed Charges, ,,85,,11231.61,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8985.29,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7399.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7928.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27454 - OSTEOT MLT W-RELIGNMT IMED ROD FEM SHFT,27454,HCPCS,,,RT,Outpatient,,,14067.34,3516.835,0.01,11957.24,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9228.18,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9847.14,Percent of Total Billed Charges, ,,85,,11957.24,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9565.79,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7877.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8440.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27457 - OSTEOT PROX TIBIA FIB EXC-OSTEOT AFTER EPIPHYSL,27457,HCPCS,,,LT,Outpatient,,,8074,2018.5,0.01,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5296.54,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5651.8,Percent of Total Billed Charges, ,,85,,6862.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5490.32,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4521.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4844.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27472 - RPR NON-MAL FEMUR DSTL H-N W-ILIAC-AUTOG BONE,27472,HCPCS,,,RT,Outpatient,,,51717,12929.25,0.01,43959.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,33926.35,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,36201.9,Percent of Total Billed Charges, ,,85,,43959.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,35167.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,28961.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31030.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27486 - REVJ TOTAL KNEE ARTHRP W-WO ALGRFT 1 COMPONENT,27486,HCPCS,,,LT,Outpatient,,,13118.5,3279.625,0.01,11151,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8605.74,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9182.95,Percent of Total Billed Charges, ,,85,,11150.73,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8920.58,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7346.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7871.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27486 - REVJ TOTAL KNEE ARTHRP W-WO ALGRFT 1 COMPONENT,27486,HCPCS,,,52,Outpatient,,,22957.66,5739.415,0.01,19514.01,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15060.22,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16070.36,Percent of Total Billed Charges, ,,85,,19514.01,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,15611.21,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12856.29,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13774.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27487 - REVJ TOT KNEE ARTHRP FEMANDENTIRE TIBIAL COMPONE,27487,HCPCS,,,RT,Outpatient,,,15388.5,3847.125,0.01,13080.23,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10094.86,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10771.95,Percent of Total Billed Charges, ,,85,,13080.23,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10464.18,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8617.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9233.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27487 - REVJ TOT KNEE ARTHRP FEMANDENTIRE TIBIAL COMPONE,27487,HCPCS,,,LT,Outpatient,,,20268.75,5067.1875,0.01,17228.44,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13296.3,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14188.13,Percent of Total Billed Charges, ,,85,,17228.44,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13782.75,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11350.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12161.25,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27514 - OPEN TX FEMORAL FRACTURE DISTAL MED-LAT CONDYLE,27514,HCPCS,,,LT,Outpatient,,,14657,3664.25,0.01,12458.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9614.99,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10259.9,Percent of Total Billed Charges, ,,85,,12458.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9966.76,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8207.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8794.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27520 - CLOSED TX PATELLAR FRACTURE W-O MANIPULATION,27520,HCPCS,,,LT,Outpatient,,,6406,1601.5,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4202.34,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4484.2,Percent of Total Billed Charges, ,,85,,5445.1,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4356.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3587.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3843.6,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27524 - OPTX PATLLR FX W-INT FIXJ-PATLLCANDSOFT TISS RPR,27524,HCPCS,,,RT,Outpatient,,,14641.61,3660.4025,1078.11,12445.37,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9604.9,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10249.13,Percent of Total Billed Charges, ,,85,,12445.37,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9956.29,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8199.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8784.97,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27524 - OPTX PATLLR FX W-INT FIXJ-PATLLCANDSOFT TISS RPR,27524,HCPCS,,,LT,Outpatient,,,14409.8,3602.45,1078.11,12248.33,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9452.83,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10086.86,Percent of Total Billed Charges, ,,85,,12248.33,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9798.66,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8069.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8645.88,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27532 - CLTX TIBIAL FX PROXIMAL W-WO MANJ W-SKEL TRACJ,27532,HCPCS,,,RT,Outpatient,,,9610.5,2402.625,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6304.49,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6727.35,Percent of Total Billed Charges, ,,85,,8168.93,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6535.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5381.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5766.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27532 - CLTX TIBIAL FX PROXIMAL W-WO MANJ W-SKEL TRACJ,27532,HCPCS,,,LT,Outpatient,,,10898.75,2724.6875,742.5,9263.94,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7149.58,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7629.13,Percent of Total Billed Charges, ,,85,,9263.94,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7411.15,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6103.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6539.25,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27535 - OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR,27535,HCPCS,,,RT,Outpatient,,,15315.5,3828.875,0.01,13018.18,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10046.97,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10720.85,Percent of Total Billed Charges, ,,85,,13018.18,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10414.54,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8576.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9189.3,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27535 - OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR,27535,HCPCS,,,LT,Outpatient,,,15831,3957.75,0.01,13456.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10385.14,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11081.7,Percent of Total Billed Charges, ,,85,,13456.35,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10765.08,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8865.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9498.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27536 - OPTX TIBIAL FX PROX BICONDYLAR W-WO INT FIXJ,27536,HCPCS,,,LT,Outpatient,,,26271.5,6567.875,0.01,22330.78,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17234.1,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18390.05,Percent of Total Billed Charges, ,,85,,22330.78,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17864.62,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14712.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15762.9,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27540 - OPEN TX INTERCONDYLAR SPINE-TUBRST FRACTURE KNEE,27540,HCPCS,,,RT,Outpatient,,,23662,5915.5,0.01,20112.7,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15522.27,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16563.4,Percent of Total Billed Charges, ,,85,,20112.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16090.16,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13250.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14197.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27558 - OPEN TX KNEE DISLOCATION W-REPAIR-RECONSTRUCTION,27558,HCPCS,,,LT,Outpatient,,,9540.68,2385.17,0.01,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6258.69,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6678.48,Percent of Total Billed Charges, ,,85,,8109.58,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6487.66,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5342.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5724.41,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27566 - OPTX PATELLAR DISLC W-WO PRTL-TOT PATELLECTOMY,27566,HCPCS,,,RT,Outpatient,,,9024,2256,1078.11,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5919.74,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6316.8,Percent of Total Billed Charges, ,,85,,7670.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6136.32,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5053.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5414.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27566 - OPTX PATELLAR DISLC W-WO PRTL-TOT PATELLECTOMY,27566,HCPCS,,,LT,Outpatient,,,9191.5,2297.875,1078.11,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6029.62,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6434.05,Percent of Total Billed Charges, ,,85,,7812.78,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6250.22,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5147.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5514.9,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27570 - MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,27570,HCPCS,,,XU,Outpatient,,,7781.25,1945.3125,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5104.5,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5446.88,Percent of Total Billed Charges, ,,85,,6614.06,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5291.25,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4357.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4668.75,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27570 - MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,27570,HCPCS,,,RT,Outpatient,,,5802.91,1450.7275,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3806.71,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4062.04,Percent of Total Billed Charges, ,,85,,4932.47,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3945.98,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3249.63,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3481.75,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27570 - MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,27570,HCPCS,,,LT,Outpatient,,,5464.07,1366.0175,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3584.43,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3824.85,Percent of Total Billed Charges, ,,85,,4644.46,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3715.57,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3059.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3278.44,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27570 - MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,27570,HCPCS,,,78,Outpatient,,,5910,1477.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3876.96,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4137,Percent of Total Billed Charges, ,,85,,5023.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4018.8,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3309.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3546,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27570 - MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,27570,HCPCS,,,58,Outpatient,,,6561,1640.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4304.02,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4592.7,Percent of Total Billed Charges, ,,85,,5576.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4461.48,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3674.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3936.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27599 - UNLISTED PROCEDURE FEMUR-KNEE,27599,HCPCS,,,XU,Outpatient,,,10037.33,2509.3325,0.01,8531.73,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6584.49,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7026.13,Percent of Total Billed Charges, ,,85,,8531.73,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6825.38,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5620.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6022.4,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27600 - DCMPRN FASCT LEG ANTAND-LAT COMPARTMENTS ONLY,27600,HCPCS,,,LT,Outpatient,,,18547,4636.75,742.5,15764.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12166.83,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12982.9,Percent of Total Billed Charges, ,,85,,15764.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12611.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10386.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11128.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27601 - DCMPRN FASCT LEG POST COMPARTMENT ONLY,27601,HCPCS,,,RT,Outpatient,,,7055.5,1763.875,0.01,5997.18,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4628.41,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4938.85,Percent of Total Billed Charges, ,,85,,5997.18,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4797.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3951.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4233.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27602 - DCMPRN FASCT LEG ANTAND-LATANDPST CMPRT,27602,HCPCS,,,RT,Outpatient,,,16841,4210.25,742.5,14314.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11047.7,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11788.7,Percent of Total Billed Charges, ,,85,,14314.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11451.88,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9430.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10104.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27603 - INCISION AND DRAINAGE LEG-ANKLE ABSCESS-HEMATOMA,27603,HCPCS,,,RT,Outpatient,,,16532,4133,882.09,14052.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10844.99,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11572.4,Percent of Total Billed Charges, ,,85,,14052.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11241.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9257.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9919.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27603 - INCISION AND DRAINAGE LEG-ANKLE ABSCESS-HEMATOMA,27603,HCPCS,,,LT,Outpatient,,,8886,2221.5,882.09,7553.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5829.22,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6220.2,Percent of Total Billed Charges, ,,85,,7553.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6042.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4976.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5331.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES,27605,HCPCS,,,LT,Outpatient,,,9428.5,2357.125,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6185.1,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6599.95,Percent of Total Billed Charges, ,,85,,8014.23,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6411.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5279.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5657.1,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27606 - TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES,27606,HCPCS,,,RT,Outpatient,,,11296.11,2824.0275,742.5,9601.69,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7410.25,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7907.28,Percent of Total Billed Charges, ,,85,,9601.69,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7681.35,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6325.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6777.67,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27606 - TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES,27606,HCPCS,,,LT,Outpatient,,,8923,2230.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5853.49,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6246.1,Percent of Total Billed Charges, ,,85,,7584.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6067.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4996.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5353.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27607 - INCISION LEG-ANKLE,27607,HCPCS,,,RT,Outpatient,,,13967,3491.75,882.09,11871.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9162.35,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9776.9,Percent of Total Billed Charges, ,,85,,11871.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9497.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7821.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8380.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27607 - INCISION LEG-ANKLE,27607,HCPCS,,,78,Outpatient,,,7461.66,1865.415,882.09,6342.41,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4894.85,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5223.16,Percent of Total Billed Charges, ,,85,,6342.41,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5073.93,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4178.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4477,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27612 - ARTHRT PST CAPSUL RLS ANKLE W-WO ACHLL TDN LNGTH,27612,HCPCS,,,RT,Outpatient,,,6724.73,1681.1825,1078.11,5716.02,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4411.42,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4707.31,Percent of Total Billed Charges, ,,85,,5716.02,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4572.82,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3765.85,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4034.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27612 - ARTHRT PST CAPSUL RLS ANKLE W-WO ACHLL TDN LNGTH,27612,HCPCS,,,LT,Outpatient,,,4379.4,1094.85,1078.11,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2872.89,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3065.58,Percent of Total Billed Charges, ,,85,,3722.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2977.99,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2452.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2627.64,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27618 - EXC TUMOR SOFT TISSUE LEG-ANKLE SUBQ LESS THAN 3CM,27618,HCPCS,,,LT,Outpatient,,,7878.5,1969.625,742.5,6696.73,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5168.3,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5514.95,Percent of Total Billed Charges, ,,85,,6696.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5357.38,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4411.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4727.1,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27619 - EXC TUMOR SOFT TISSUE LEG-ANKLE SUBFASCIAL LESS THAN 5CM,27619,HCPCS,,,RT,Outpatient,,,11727,2931.75,882.09,9967.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7692.91,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8208.9,Percent of Total Billed Charges, ,,85,,9967.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7974.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6567.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7036.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27619 - EXC TUMOR SOFT TISSUE LEG-ANKLE SUBFASCIAL LESS THAN 5CM,27619,HCPCS,,,LT,Outpatient,,,11069,2767.25,882.09,9408.65,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7261.26,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7748.3,Percent of Total Billed Charges, ,,85,,9408.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7526.92,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6198.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6641.4,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27626 - ARTHROTOMY W-SYNOVECTOMY ANKLE TENOSYNOVECTOMY,27626,HCPCS,,,LT,Outpatient,,,21647,5411.75,0.01,18399.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14200.43,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15152.9,Percent of Total Billed Charges, ,,85,,18399.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14719.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12122.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12988.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27630 - EXCISION LESION TENDON SHEATH-CAPSULE LEGAND-ANK,27630,HCPCS,,,XU,Outpatient,,,5403.36,1350.84,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3544.6,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3782.35,Percent of Total Billed Charges, ,,85,,4592.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3674.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3025.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3242.02,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27630 - EXCISION LESION TENDON SHEATH-CAPSULE LEGAND-ANK,27630,HCPCS,,,RT,Outpatient,,,15912,3978,950.4,13525.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10438.27,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11138.4,Percent of Total Billed Charges, ,,85,,13525.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10820.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8910.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9547.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27630 - EXCISION LESION TENDON SHEATH-CAPSULE LEGAND-ANK,27630,HCPCS,,,LT,Outpatient,,,14672,3668,950.4,12471.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9624.83,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10270.4,Percent of Total Billed Charges, ,,85,,12471.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9976.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8216.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8803.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27632 - EXCISION TUMOR SOFT TISSUE LEG-ANKLE SUBQ 3 CM-GREATER THAN,27632,HCPCS,,,RT,Outpatient,,,14438.5,3609.625,950.4,12272.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9471.66,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10106.95,Percent of Total Billed Charges, ,,85,,12272.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9818.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8085.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8663.1,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27632 - EXCISION TUMOR SOFT TISSUE LEG-ANKLE SUBQ 3 CM-GREATER THAN,27632,HCPCS,,,LT,Outpatient,,,12587,3146.75,950.4,10698.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8257.07,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8810.9,Percent of Total Billed Charges, ,,85,,10698.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8559.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7048.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7552.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27635 - EXCISION-CURETTAGE BONE CYST-TUMOR TIBIA-FIBULA,27635,HCPCS,,,XU,Outpatient,,,4968.4,1242.1,742.5,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3259.27,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3477.88,Percent of Total Billed Charges, ,,85,,4223.14,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3378.51,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2782.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2981.04,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27635 - EXCISION-CURETTAGE BONE CYST-TUMOR TIBIA-FIBULA,27635,HCPCS,,,RT,Outpatient,,,16806.33,4201.5825,742.5,14285.38,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11024.95,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11764.43,Percent of Total Billed Charges, ,,85,,14285.38,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11428.3,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9411.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10083.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27635 - EXCISION-CURETTAGE BONE CYST-TUMOR TIBIA-FIBULA,27635,HCPCS,,,LT,Outpatient,,,8074,2018.5,742.5,6862.9,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5296.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5651.8,Percent of Total Billed Charges, ,,85,,6862.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5490.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4521.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4844.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27637 - EXC-CURETTAGE CYST-TUMOR TIBIA-FIBULA W-AGRAFT,27637,HCPCS,,,RT,Outpatient,,,10793.5,2698.375,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7080.54,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7555.45,Percent of Total Billed Charges, ,,85,,9174.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7339.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6044.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6476.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27640 - PARTIAL EXCISION BONE TIBIA,27640,HCPCS,,,RT,Outpatient,,,5577.68,1394.42,1078.11,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3658.96,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3904.38,Percent of Total Billed Charges, ,,85,,4741.03,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3792.82,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3123.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3346.61,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27640 - PARTIAL EXCISION BONE TIBIA,27640,HCPCS,,,LT,Outpatient,,,6086.5,1521.625,1078.11,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3992.74,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4260.55,Percent of Total Billed Charges, ,,85,,5173.53,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4138.82,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3408.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3651.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27641 - PARTIAL EXCISION BONE FIBULA,27641,HCPCS,,,LT,Outpatient,,,6989,1747.25,1078.11,5940.65,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4584.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4892.3,Percent of Total Billed Charges, ,,85,,5940.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4752.52,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3913.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4193.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27650 - REPAIR PRIMARY OPEN-PRQ RUPTURED ACHILLES TENDON,27650,HCPCS,,,RT,Outpatient,,,10556.91,2639.2275,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6925.33,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7389.84,Percent of Total Billed Charges, ,,85,,8973.37,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7178.7,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5911.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6334.15,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27650 - REPAIR PRIMARY OPEN-PRQ RUPTURED ACHILLES TENDON,27650,HCPCS,,,LT,Outpatient,,,11738.11,2934.5275,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7700.2,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8216.68,Percent of Total Billed Charges, ,,85,,9977.39,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7981.91,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6573.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7042.87,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27654 - REPAIR SECONDARY ACHILLES TENDON W-WO GRAFT,27654,HCPCS,,,RT,Outpatient,,,6826.01,1706.5025,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4477.86,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4778.21,Percent of Total Billed Charges, ,,85,,5802.11,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4641.69,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3822.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4095.61,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27654 - REPAIR SECONDARY ACHILLES TENDON W-WO GRAFT,27654,HCPCS,,,LT,Outpatient,,,7251.58,1812.895,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4757.04,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5076.11,Percent of Total Billed Charges, ,,85,,6163.84,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4931.07,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4060.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4350.95,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27654 - REPAIR SECONDARY ACHILLES TENDON W-WO GRAFT,27654,HCPCS,,,CG,Outpatient,,,6707.5,1676.875,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4400.12,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4695.25,Percent of Total Billed Charges, ,,85,,5701.38,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4561.1,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3756.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4024.5,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27654 - REPAIR SECONDARY ACHILLES TENDON W-WO GRAFT,27654,HCPCS,,,50,Outpatient,,,6716,1679,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4405.7,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4701.2,Percent of Total Billed Charges, ,,85,,5708.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4566.88,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3760.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4029.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27658 - REPAIR FLEXOR TENDON LEG PRIMARY W-O GRAFT EACH,27658,HCPCS,,,XU,Outpatient,,,6326.75,1581.6875,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4150.35,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4428.73,Percent of Total Billed Charges, ,,85,,5377.74,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4302.19,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3542.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3796.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27658 - REPAIR FLEXOR TENDON LEG PRIMARY W-O GRAFT EACH,27658,HCPCS,,,RT,Outpatient,,,7987.92,1996.98,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5240.08,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5591.54,Percent of Total Billed Charges, ,,85,,6789.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5431.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4473.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4792.75,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27658 - REPAIR FLEXOR TENDON LEG PRIMARY W-O GRAFT EACH,27658,HCPCS,,,LT,Outpatient,,,11657.94,2914.485,742.5,9909.25,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7647.61,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8160.56,Percent of Total Billed Charges, ,,85,,9909.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7927.4,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6528.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6994.76,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27659 - RPR FLEXOR TENDON LEG SECONDARY W-O GRAFT EACH,27659,HCPCS,,,RT,Outpatient,,,7360.12,1840.03,742.5,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4828.24,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5152.08,Percent of Total Billed Charges, ,,85,,6256.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5004.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4121.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4416.07,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27659 - RPR FLEXOR TENDON LEG SECONDARY W-O GRAFT EACH,27659,HCPCS,,,LT,Outpatient,,,6403.4,1600.85,742.5,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4200.63,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4482.38,Percent of Total Billed Charges, ,,85,,5442.89,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4354.31,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3585.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3842.04,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27664 - RPR EXTENSOR TENDON LEG PRIMARY W-O GRAFT EACH,27664,HCPCS,,,LT,Outpatient,,,15050.75,3762.6875,742.5,12793.14,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9873.29,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10535.53,Percent of Total Billed Charges, ,,85,,12793.14,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10234.51,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8428.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9030.45,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27665 - RPR EXTENSOR TENDON LEG SECONDRY W-WO GRAFT EACH,27665,HCPCS,,,LT,Outpatient,,,13685.68,3421.42,742.5,11632.83,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8977.81,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9579.98,Percent of Total Billed Charges, ,,85,,11632.83,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9306.26,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7663.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8211.41,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27675 - RPR DISLOC PERONEAL TENDON W-O FIBULAR OSTEOTOMY,27675,HCPCS,,,RT,Outpatient,,,5458.31,1364.5775,950.4,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3580.65,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3820.82,Percent of Total Billed Charges, ,,85,,4639.56,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3711.65,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3056.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3274.99,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27675 - RPR DISLOC PERONEAL TENDON W-O FIBULAR OSTEOTOMY,27675,HCPCS,,,LT,Outpatient,,,14823.5,3705.875,950.4,12599.98,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9724.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10376.45,Percent of Total Billed Charges, ,,85,,12599.98,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10079.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8301.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8894.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27676 - REPAIR DISLOCATING PERONEAL TENDON W-FIB OSTEOT,27676,HCPCS,,,LT,Outpatient,,,6970.5,1742.625,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4572.65,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4879.35,Percent of Total Billed Charges, ,,85,,5924.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4739.94,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3903.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4182.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27680 - TENOLYSIS FLXR-XTNSR TENDON LEGAND-ANKLE 1 EACH,27680,HCPCS,,,XU,Outpatient,,,5865.39,1466.3475,950.4,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3847.7,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4105.77,Percent of Total Billed Charges, ,,85,,4985.58,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3988.47,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3284.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3519.23,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27680 - TENOLYSIS FLXR-XTNSR TENDON LEGAND-ANKLE 1 EACH,27680,HCPCS,,,XS,Outpatient,,,14823.5,3705.875,950.4,12599.98,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9724.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10376.45,Percent of Total Billed Charges, ,,85,,12599.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10079.98,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8301.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8894.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27680 - TENOLYSIS FLXR-XTNSR TENDON LEGAND-ANKLE 1 EACH,27680,HCPCS,,,RT,Outpatient,,,5824.29,1456.0725,950.4,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3820.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4077,Percent of Total Billed Charges, ,,85,,4950.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3960.52,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3261.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3494.57,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27680 - TENOLYSIS FLXR-XTNSR TENDON LEGAND-ANKLE 1 EACH,27680,HCPCS,,,LT,Outpatient,,,7633.84,1908.46,950.4,6488.76,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5007.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5343.69,Percent of Total Billed Charges, ,,85,,6488.76,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5191.01,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4274.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4580.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27681 - TNOLS FLXR-XTNSR TDN LEGAND-ANKLE MLT TDN,27681,HCPCS,,,XU,Outpatient,,,6854.25,1713.5625,882.09,5826.11,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4496.39,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4797.98,Percent of Total Billed Charges, ,,85,,5826.11,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4660.89,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3838.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4112.55,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27681 - TNOLS FLXR-XTNSR TDN LEGAND-ANKLE MLT TDN,27681,HCPCS,,,RT,Outpatient,,,5187.27,1296.8175,882.09,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3402.85,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3631.09,Percent of Total Billed Charges, ,,85,,4409.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3527.34,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2904.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3112.36,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27681 - TNOLS FLXR-XTNSR TDN LEGAND-ANKLE MLT TDN,27681,HCPCS,,,LT,Outpatient,,,14274,3568.5,882.09,12132.9,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9363.74,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9991.8,Percent of Total Billed Charges, ,,85,,12132.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9706.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7993.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8564.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27685 - LNGTH-SHRT TENDON LEG-ANKLE 1 TENDON SPX,27685,HCPCS,,,XU,Outpatient,,,6018.63,1504.6575,882.09,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3948.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4213.04,Percent of Total Billed Charges, ,,85,,5115.84,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4092.67,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3370.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3611.18,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27685 - LNGTH-SHRT TENDON LEG-ANKLE 1 TENDON SPX,27685,HCPCS,,,XS,Outpatient,,,6345.2,1586.3,882.09,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4162.45,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4441.64,Percent of Total Billed Charges, ,,85,,5393.42,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4314.74,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3553.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3807.12,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27685 - LNGTH-SHRT TENDON LEG-ANKLE 1 TENDON SPX,27685,HCPCS,,,RT,Outpatient,,,9372.01,2343.0025,882.09,7966.21,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6148.04,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6560.41,Percent of Total Billed Charges, ,,85,,7966.21,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6372.97,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5248.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5623.21,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27685 - LNGTH-SHRT TENDON LEG-ANKLE 1 TENDON SPX,27685,HCPCS,,,LT,Outpatient,,,8155.26,2038.815,882.09,6931.97,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5349.85,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5708.68,Percent of Total Billed Charges, ,,85,,6931.97,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5545.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4566.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4893.16,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27686 - LNGTH-SHRT TDN LEG-ANKLE MLT TDN SAME INC EA,27686,HCPCS,,,RT,Outpatient,,,7426.83,1856.7075,950.4,6312.81,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4872,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5198.78,Percent of Total Billed Charges, ,,85,,6312.81,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5050.24,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4159.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4456.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27686 - LNGTH-SHRT TDN LEG-ANKLE MLT TDN SAME INC EA,27686,HCPCS,,,LT,Outpatient,,,2876.2,719.05,950.4,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1886.79,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2013.34,Percent of Total Billed Charges, ,,85,,2444.77,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1955.82,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1610.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1725.72,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27687 - GASTROCNEMIUS RECESSION,27687,HCPCS,,,RT,Outpatient,,,7017.55,1754.3875,950.4,5964.92,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4603.51,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4912.29,Percent of Total Billed Charges, ,,85,,5964.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4771.93,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3929.83,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4210.53,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27687 - GASTROCNEMIUS RECESSION,27687,HCPCS,,,LT,Outpatient,,,7271.12,1817.78,950.4,6180.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4769.85,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5089.78,Percent of Total Billed Charges, ,,85,,6180.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4944.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4071.83,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4362.67,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27690 - TR-TRNSPL 1 TDN W-MUSC REDIRION-REROUTING SUPFC,27690,HCPCS,,,LT,Outpatient,,,8094,2023.5,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5309.66,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5665.8,Percent of Total Billed Charges, ,,85,,6879.9,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5503.92,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4532.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4856.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27691 - TR-TRNSPL 1 TDN W-MUSC REDIRION-REROUTING DP,27691,HCPCS,,,RT,Outpatient,,,6199.98,1549.995,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4067.19,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4339.99,Percent of Total Billed Charges, ,,85,,5269.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4215.99,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3471.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3719.99,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27691 - TR-TRNSPL 1 TDN W-MUSC REDIRION-REROUTING DP,27691,HCPCS,,,LT,Outpatient,,,6982.3,1745.575,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4580.39,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4887.61,Percent of Total Billed Charges, ,,85,,5934.96,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4747.96,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3910.09,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4189.38,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27692 - TR-TRNSPL 1 TDN W-MUSC REDIRION-REROUTING EA TDN,27692,HCPCS,,,RT,Outpatient,,,5212.87,1303.2175,0.01,6015,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3419.64,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3649.01,Percent of Total Billed Charges, ,,85,,4430.94,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3544.75,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2919.21,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3127.72,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27695 - RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL,27695,HCPCS,,,XU,Outpatient,,,7361.42,1840.355,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4829.09,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5152.99,Percent of Total Billed Charges, ,,85,,6257.21,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5005.77,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4122.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4416.85,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27695 - RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL,27695,HCPCS,,,XS,Outpatient,,,9332,2333,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6121.79,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6532.4,Percent of Total Billed Charges, ,,85,,7932.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6345.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5225.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5599.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27695 - RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL,27695,HCPCS,,,RT,Outpatient,,,11938.9,2984.725,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7831.92,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8357.23,Percent of Total Billed Charges, ,,85,,10148.07,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8118.45,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6685.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7163.34,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27695 - RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL,27695,HCPCS,,,LT,Outpatient,,,8140.6,2035.15,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5340.23,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5698.42,Percent of Total Billed Charges, ,,85,,6919.51,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5535.61,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4558.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4884.36,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27696 - RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS,27696,HCPCS,,,LT,Outpatient,,,10295.68,2573.92,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6753.97,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7206.98,Percent of Total Billed Charges, ,,85,,8751.33,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7001.06,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5765.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6177.41,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27698 - REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL,27698,HCPCS,,,RT,Outpatient,,,6284.03,1571.0075,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4122.32,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4398.82,Percent of Total Billed Charges, ,,85,,5341.43,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4273.14,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3519.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3770.42,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27698 - REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL,27698,HCPCS,,,LT,Outpatient,,,6547.22,1636.805,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4294.98,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4583.05,Percent of Total Billed Charges, ,,85,,5565.14,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4452.11,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3666.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3928.33,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27702 - ARTHROPLASTY ANKLE W-IMPLANT,27702,HCPCS,,,RT,Outpatient,,,13990.69,3497.6725,4841,35521.64,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9177.89,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9793.48,Percent of Total Billed Charges, ,,85,,11892.09,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9513.67,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7834.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8394.41,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27702 - ARTHROPLASTY ANKLE W-IMPLANT,27702,HCPCS,,,LT,Outpatient,,,12140.95,3035.2375,4841,35521.64,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7964.46,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8498.67,Percent of Total Billed Charges, ,,85,,10319.81,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8255.85,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6798.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7284.57,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27702 - ARTHROPLASTY ANKLE W-IMPLANT,27702,HCPCS,,,74,Outpatient,,,5470.68,1367.67,3063.58,35521.64,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3588.77,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3829.48,Percent of Total Billed Charges, ,,85,,4650.08,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3720.06,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3063.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3282.41,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27705 - OSTEOTOMY TIBIA,27705,HCPCS,,,RT,Outpatient,,,11386.5,2846.625,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7469.54,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7970.55,Percent of Total Billed Charges, ,,85,,9678.53,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7742.82,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6376.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6831.9,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27705 - OSTEOTOMY TIBIA,27705,HCPCS,,,LT,Outpatient,,,7992.88,1998.22,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5243.33,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5595.02,Percent of Total Billed Charges, ,,85,,6793.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5435.16,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4476.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4795.73,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27707 - OSTEOTOMY FIBULA,27707,HCPCS,,,XU,Outpatient,,,6149.75,1537.4375,0.01,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4034.24,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4304.83,Percent of Total Billed Charges, ,,85,,5227.29,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4181.83,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3443.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3689.85,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27707 - OSTEOTOMY FIBULA,27707,HCPCS,,,LT,Outpatient,,,5457.83,1364.4575,0.01,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3580.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3820.48,Percent of Total Billed Charges, ,,85,,4639.16,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3711.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3056.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3274.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27709 - OSTEOTOMY TIBIA AND FIBULA,27709,HCPCS,,,RT,Outpatient,,,27847,6961.75,1078.11,23669.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18267.63,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19492.9,Percent of Total Billed Charges, ,,85,,23669.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18935.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15594.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16708.2,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27720 - REPAIR NONUNION-MALUNION TIBIA W-O GRAFT,27720,HCPCS,,,RT,Outpatient,,,6816.4,1704.1,950.4,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4471.56,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4771.48,Percent of Total Billed Charges, ,,85,,5793.94,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4635.15,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3817.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4089.84,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27720 - REPAIR NONUNION-MALUNION TIBIA W-O GRAFT,27720,HCPCS,,,LT,Outpatient,,,22732,5683,950.4,19322.2,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14912.19,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15912.4,Percent of Total Billed Charges, ,,85,,19322.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15457.76,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12729.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13639.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27722 - REPAIR NONUNION-MALUNION TIBIA W-SLIDING GRAFT,27722,HCPCS,,,RT,Outpatient,,,10295.66,2573.915,0.01,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6753.95,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7206.96,Percent of Total Billed Charges, ,,85,,8751.31,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7001.05,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5765.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6177.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27724 - RPR NON-MAL TIBIA W-ILIAC-OTH AGRFT,27724,HCPCS,,,RT,Outpatient,,,11738.68,2934.67,0.01,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7700.57,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8217.08,Percent of Total Billed Charges, ,,85,,9977.88,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7982.3,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6573.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7043.21,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27724 - RPR NON-MAL TIBIA W-ILIAC-OTH AGRFT,27724,HCPCS,,,LT,Outpatient,,,31826,7956.5,0.01,27052.1,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20877.86,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22278.2,Percent of Total Billed Charges, ,,85,,27052.1,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21641.68,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17822.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19095.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27726 - REPAIR FIBULA NONUNION-MALUNION W-INT FIXATION,27726,HCPCS,,,RT,Outpatient,,,8694.01,2173.5025,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5703.27,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6085.81,Percent of Total Billed Charges, ,,85,,7389.91,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5911.93,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4868.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5216.41,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27726 - REPAIR FIBULA NONUNION-MALUNION W-INT FIXATION,27726,HCPCS,,,LT,Outpatient,,,8177.33,2044.3325,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5364.33,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5724.13,Percent of Total Billed Charges, ,,85,,6950.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5560.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4579.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4906.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27745 - PROPH TX N-P-PLTWR W-WO METHYLMETHACRYLATE TIBIA,27745,HCPCS,,,XU,Outpatient,,,10629.54,2657.385,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6972.98,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7440.68,Percent of Total Billed Charges, ,,85,,9035.11,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7228.09,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5952.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6377.72,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27745 - PROPH TX N-P-PLTWR W-WO METHYLMETHACRYLATE TIBIA,27745,HCPCS,,,RT,Outpatient,,,8419.25,2104.8125,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5523.03,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5893.48,Percent of Total Billed Charges, ,,85,,7156.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5725.09,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4714.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5051.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27752 - CLTX TIBIAL SHAFT FX W-MANJ W-WO SKEL TRACJ,27752,HCPCS,,,LT,Outpatient,,,11182.5,2795.625,742.5,9505.13,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7335.72,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7827.75,Percent of Total Billed Charges, ,,85,,9505.13,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7604.1,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6262.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6709.5,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27758 - OPTX TIBIAL SHFT FX W-PLATE-SCREWS W-WO CERCLAGE,27758,HCPCS,,,RT,Outpatient,,,44463,11115.75,1078.11,37793.55,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29167.73,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31124.1,Percent of Total Billed Charges, ,,85,,37793.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30234.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24899.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26677.8,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27758 - OPTX TIBIAL SHFT FX W-PLATE-SCREWS W-WO CERCLAGE,27758,HCPCS,,,LT,Outpatient,,,22418.5,5604.625,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14706.54,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15692.95,Percent of Total Billed Charges, ,,85,,19055.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15244.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12554.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13451.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27759 - TX TIBL SHFT FX IMED IMPLT W-WO SCREWSAND-CERCLA,27759,HCPCS,,,RT,Outpatient,,,20698.35,5174.5875,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13578.12,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14488.85,Percent of Total Billed Charges, ,,85,,17593.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14074.88,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11591.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12419.01,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27759 - TX TIBL SHFT FX IMED IMPLT W-WO SCREWSAND-CERCLA,27759,HCPCS,,,LT,Outpatient,,,18964.92,4741.23,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12440.99,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13275.44,Percent of Total Billed Charges, ,,85,,16120.18,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12896.15,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10620.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11378.95,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27766 - OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE,27766,HCPCS,,,RT,Outpatient,,,12175.39,3043.8475,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7987.06,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8522.77,Percent of Total Billed Charges, ,,85,,10349.08,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8279.27,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6818.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7305.23,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27766 - OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE,27766,HCPCS,,,LT,Outpatient,,,11889.96,2972.49,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7799.81,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8322.97,Percent of Total Billed Charges, ,,85,,10106.47,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8085.17,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6658.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7133.98,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27780 - CLTX PROX FIBULA-SHFT FX W-O MANJ,27780,HCPCS,,,XU,Outpatient,,,5562.33,1390.5825,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3648.89,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3893.63,Percent of Total Billed Charges, ,,85,,4727.98,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3782.38,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3114.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3337.4,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27781 - CLTX PROX FIBULA-SHFT FX W-MANJ,27781,HCPCS,,,RT,Outpatient,,,6867.5,1716.875,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4505.08,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4807.25,Percent of Total Billed Charges, ,,85,,5837.38,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4669.9,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3845.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4120.5,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27786 - CLTX DSTL FIBULAR FX LAT MALLS W-O MANJ,27786,HCPCS,,,XU,Outpatient,,,5473.66,1368.415,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3590.72,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3831.56,Percent of Total Billed Charges, ,,85,,4652.61,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3722.09,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3065.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3284.2,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27788 - CLTX DSTL FIBULAR FX LAT MALLS W-MANJ,27788,HCPCS,,,RT,Outpatient,,,14504.5,3626.125,228.06,12328.83,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9514.95,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10153.15,Percent of Total Billed Charges, ,,85,,12328.83,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9863.06,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8122.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8702.7,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27792 - OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS,27792,HCPCS,,,RT,Outpatient,,,11864.81,2966.2025,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7783.32,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8305.37,Percent of Total Billed Charges, ,,85,,10085.09,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8068.07,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6644.29,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7118.89,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27792 - OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS,27792,HCPCS,,,LT,Outpatient,,,11673.05,2918.2625,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7657.52,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8171.14,Percent of Total Billed Charges, ,,85,,9922.09,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7937.67,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6536.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7003.83,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W-O MANJ,27808,HCPCS,,,LT,Outpatient,,,12226.5,3056.625,228.06,10392.53,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8020.58,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8558.55,Percent of Total Billed Charges, ,,85,,10392.53,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8314.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6846.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7335.9,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27814 - OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,HCPCS,,,RT,Outpatient,,,11219.5,2804.875,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7359.99,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7853.65,Percent of Total Billed Charges, ,,85,,9536.58,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7629.26,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6282.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6731.7,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27814 - OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,HCPCS,,,LT,Outpatient,,,12224.02,3056.005,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8018.96,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8556.81,Percent of Total Billed Charges, ,,85,,10390.42,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8312.33,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6845.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7334.41,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27818 - CLTX TRIMALLEOLAR ANKLE FX W-MANIPULATION,27818,HCPCS,,,RT,Outpatient,,,4416.63,1104.1575,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2897.31,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3091.64,Percent of Total Billed Charges, ,,85,,3754.14,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3003.31,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2473.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2649.98,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27818 - CLTX TRIMALLEOLAR ANKLE FX W-MANIPULATION,27818,HCPCS,,,LT,Outpatient,,,6437.25,1609.3125,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4222.84,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4506.08,Percent of Total Billed Charges, ,,85,,5471.66,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4377.33,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3604.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3862.35,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27822 - OPEN TX TRIMALLEOLAR ANKLE FX W-O FIXJ PST LIP,27822,HCPCS,,,RT,Outpatient,,,11078.35,2769.5875,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7267.4,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7754.85,Percent of Total Billed Charges, ,,85,,9416.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7533.28,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6203.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6647.01,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27822 - OPEN TX TRIMALLEOLAR ANKLE FX W-O FIXJ PST LIP,27822,HCPCS,,,LT,Outpatient,,,14063.44,3515.86,882.09,11953.92,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9225.62,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9844.41,Percent of Total Billed Charges, ,,85,,11953.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9563.14,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7875.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8438.06,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27823 - OPEN TX TRIMALLEOLAR ANKLE FX W-FIXJ PST LIP,27823,HCPCS,,,RT,Outpatient,,,15090.61,3772.6525,1078.11,12827.02,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9899.44,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10563.43,Percent of Total Billed Charges, ,,85,,12827.02,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10261.61,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8450.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9054.37,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27823 - OPEN TX TRIMALLEOLAR ANKLE FX W-FIXJ PST LIP,27823,HCPCS,,,LT,Outpatient,,,17130.52,4282.63,1078.11,14560.94,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11237.62,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11991.36,Percent of Total Billed Charges, ,,85,,14560.94,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11648.75,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9593.09,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10278.31,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W-SKEL TRACJ,27825,HCPCS,,,RT,Outpatient,,,13654,3413.5,882.09,11605.9,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8957.02,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9557.8,Percent of Total Billed Charges, ,,85,,11605.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9284.72,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7646.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8192.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27826 - OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA,27826,HCPCS,,,RT,Outpatient,,,7048,1762,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4623.49,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4933.6,Percent of Total Billed Charges, ,,85,,5990.8,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4792.64,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3946.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4228.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27827 - OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY,27827,HCPCS,,,RT,Outpatient,,,12756.07,3189.0175,950.4,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8367.98,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8929.25,Percent of Total Billed Charges, ,,85,,10842.66,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8674.13,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7143.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7653.64,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27827 - OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY,27827,HCPCS,,,LT,Outpatient,,,14452.88,3613.22,950.4,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9481.09,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10117.02,Percent of Total Billed Charges, ,,85,,12284.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9827.96,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8093.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8671.73,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27827 - OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY,27827,HCPCS,,,58,Outpatient,,,13071,3267.75,950.4,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8574.58,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9149.7,Percent of Total Billed Charges, ,,85,,11110.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8888.28,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7319.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7842.6,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27828 - OPEN TREATMENT FRACTURE DISTAL TIBIA AND FIBULA,27828,HCPCS,,,RT,Outpatient,,,17120.18,4280.045,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11230.84,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11984.13,Percent of Total Billed Charges, ,,85,,14552.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11641.72,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9587.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10272.11,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27828 - OPEN TREATMENT FRACTURE DISTAL TIBIA AND FIBULA,27828,HCPCS,,,LT,Outpatient,,,18082.83,4520.7075,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11862.34,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12657.98,Percent of Total Billed Charges, ,,85,,15370.41,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12296.32,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10126.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10849.7,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27828 - OPEN TREATMENT FRACTURE DISTAL TIBIA AND FIBULA,27828,HCPCS,,,58,Outpatient,,,17178.5,4294.625,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11269.1,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12024.95,Percent of Total Billed Charges, ,,85,,14601.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11681.38,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9619.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10307.1,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27829 - OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION,27829,HCPCS,,,RT,Outpatient,,,8784.41,2196.1025,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5762.57,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6149.09,Percent of Total Billed Charges, ,,85,,7466.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5973.4,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4919.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5270.65,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27829 - OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION,27829,HCPCS,,,LT,Outpatient,,,8806.38,2201.595,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5776.99,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6164.47,Percent of Total Billed Charges, ,,85,,7485.42,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5988.34,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4931.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5283.83,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27829 - OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION,27829,HCPCS,,,59,Outpatient,,,12296.5,3074.125,882.09,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8066.5,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8607.55,Percent of Total Billed Charges, ,,85,,10452.03,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8361.62,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6886.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7377.9,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27848 - OPTX ANKLE DISLOCATION W-REPAIR-INT-XTRNL FIXJ,27848,HCPCS,,,XU,Outpatient,,,5215.33,1303.8325,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3421.26,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3650.73,Percent of Total Billed Charges, ,,85,,4433.03,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3546.42,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2920.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3129.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27870 - ARTHRODESIS ANKLE OPEN,27870,HCPCS,,,RT,Outpatient,,,13844.95,3461.2375,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9082.29,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9691.47,Percent of Total Billed Charges, ,,85,,11768.21,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9414.57,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7753.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8306.97,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27870 - ARTHRODESIS ANKLE OPEN,27870,HCPCS,,,LT,Outpatient,,,10594.55,2648.6375,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6950.02,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7416.19,Percent of Total Billed Charges, ,,85,,9005.37,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7204.29,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5932.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6356.73,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27871 - ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL-DISTAL,27871,HCPCS,,,RT,Outpatient,,,6143.4,1535.85,0.01,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4030.07,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4300.38,Percent of Total Billed Charges, ,,85,,5221.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4177.51,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3440.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3686.04,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27871 - ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL-DISTAL,27871,HCPCS,,,LT,Outpatient,,,7048.62,1762.155,0.01,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4623.89,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4934.03,Percent of Total Billed Charges, ,,85,,5991.33,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4793.06,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3947.23,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4229.17,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27880 - AMPUTATION LEG THROUGH TIBIAANDFIBULA,27880,HCPCS,,,LT,Outpatient,,,24282,6070.5,0.01,20639.7,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15928.99,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16997.4,Percent of Total Billed Charges, ,,85,,20639.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,16511.76,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13597.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14569.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
27884 - AMP LEG THRU TIBIAANDFIBULA SEC CLOSURE-SCAR REV,27884,HCPCS,,,LT,Outpatient,,,11995.5,2998.875,882.09,10196.18,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7869.05,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8396.85,Percent of Total Billed Charges, ,,85,,10196.18,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8156.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6717.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7197.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27886 - AMP LEG THRU TIBIAANDFIBULA RE-AMPUTATION,27886,HCPCS,,,LT,Outpatient,,,13277,3319.25,0.01,11285.45,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8709.71,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9293.9,Percent of Total Billed Charges, ,,85,,11285.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9028.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7435.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7966.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
28002 - IANDD BELOW FASCIA FOOT 1 BURSAL SPACE,28002,HCPCS,,,RT,Outpatient,,,10074,2518.5,742.5,8562.9,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6608.54,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7051.8,Percent of Total Billed Charges, ,,85,,8562.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6850.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5641.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6044.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28002 - IANDD BELOW FASCIA FOOT 1 BURSAL SPACE,28002,HCPCS,,,LT,Outpatient,,,8202.08,2050.52,742.5,6971.77,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5380.56,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5741.46,Percent of Total Billed Charges, ,,85,,6971.77,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5577.41,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4593.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4921.25,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28003 - IANDD BELOW FASCIA FOOT MULTIPLE AREAS,28003,HCPCS,,,50,Outpatient,,,10203.5,2550.875,882.09,8672.98,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6693.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7142.45,Percent of Total Billed Charges, ,,85,,8672.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6938.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5713.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6122.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28005 - INCISION BONE CORTEX FOOT,28005,HCPCS,,,RT,Outpatient,,,8265.13,2066.2825,882.09,7025.36,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5421.93,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5785.59,Percent of Total Billed Charges, ,,85,,7025.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5620.29,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4628.47,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4959.08,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28005 - INCISION BONE CORTEX FOOT,28005,HCPCS,,,LT,Outpatient,,,7740.5,1935.125,882.09,6579.43,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5077.77,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5418.35,Percent of Total Billed Charges, ,,85,,6579.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5263.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4334.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4644.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28008 - FASCIOTOMY FOOTAND-TOE,28008,HCPCS,,,RT,Outpatient,,,10474.71,2618.6775,742.5,8903.5,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6871.41,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7332.3,Percent of Total Billed Charges, ,,85,,8903.5,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7122.8,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5865.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6284.83,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28008 - FASCIOTOMY FOOTAND-TOE,28008,HCPCS,,,LT,Outpatient,,,10215.7,2553.925,742.5,8683.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6701.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7150.99,Percent of Total Billed Charges, ,,85,,8683.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6946.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5720.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6129.42,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,28010,HCPCS,,,XU,Outpatient,,,3762.85,940.7125,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2468.43,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2634,Percent of Total Billed Charges, ,,85,,3198.42,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2558.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2107.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2257.71,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,28010,HCPCS,,,T9,Outpatient,,,4589.5,1147.375,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3010.71,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3212.65,Percent of Total Billed Charges, ,,85,,3901.08,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3120.86,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2570.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2753.7,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,28010,HCPCS,,,T8,Outpatient,,,6042.17,1510.5425,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3963.66,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4229.52,Percent of Total Billed Charges, ,,85,,5135.84,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4108.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3383.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3625.3,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,28010,HCPCS,,,T7,Outpatient,,,4787.34,1196.835,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3140.5,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3351.14,Percent of Total Billed Charges, ,,85,,4069.24,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3255.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2680.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2872.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,28010,HCPCS,,,T4,Outpatient,,,2876.2,719.05,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1886.79,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2013.34,Percent of Total Billed Charges, ,,85,,2444.77,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1955.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1610.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1725.72,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,28010,HCPCS,,,T3,Outpatient,,,2876.2,719.05,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1886.79,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2013.34,Percent of Total Billed Charges, ,,85,,2444.77,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1955.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1610.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1725.72,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,28010,HCPCS,,,T2,Outpatient,,,2876.2,719.05,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1886.79,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2013.34,Percent of Total Billed Charges, ,,85,,2444.77,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1955.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1610.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1725.72,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28011 - TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON,28011,HCPCS,,,T4,Outpatient,,,5710.32,1427.58,742.5,4853.77,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3745.97,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3997.22,Percent of Total Billed Charges, ,,85,,4853.77,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3883.02,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3197.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3426.19,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28011 - TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON,28011,HCPCS,,,T1,Outpatient,,,2876.2,719.05,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1886.79,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2013.34,Percent of Total Billed Charges, ,,85,,2444.77,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1955.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1610.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1725.72,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28011 - TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON,28011,HCPCS,,,LT,Outpatient,,,3354.34,838.585,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2200.45,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2348.04,Percent of Total Billed Charges, ,,85,,2851.19,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2280.95,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1878.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2012.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28022 - ARTHRT W-EXPL DRG-RMVL LOOSE-FB MTTARPHLNGL JT,28022,HCPCS,,,XU,Outpatient,,,6554.88,1638.72,742.5,5571.65,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4300,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4588.42,Percent of Total Billed Charges, ,,85,,5571.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4457.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3670.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3932.93,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28022 - ARTHRT W-EXPL DRG-RMVL LOOSE-FB MTTARPHLNGL JT,28022,HCPCS,,,XS,Outpatient,,,8204.4,2051.1,742.5,6973.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5382.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5743.08,Percent of Total Billed Charges, ,,85,,6973.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5578.99,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4594.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4922.64,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28022 - ARTHRT W-EXPL DRG-RMVL LOOSE-FB MTTARPHLNGL JT,28022,HCPCS,,,RT,Outpatient,,,6948.5,1737.125,742.5,5906.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4558.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4863.95,Percent of Total Billed Charges, ,,85,,5906.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4724.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3891.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4169.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28022 - ARTHRT W-EXPL DRG-RMVL LOOSE-FB MTTARPHLNGL JT,28022,HCPCS,,,LT,Outpatient,,,7221.7,1805.425,742.5,6138.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4737.44,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5055.19,Percent of Total Billed Charges, ,,85,,6138.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4910.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4044.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4333.02,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28024 - ARTHRT W-EXPL DRG-RMVL LOOSE-FB IPHAL JT,28024,HCPCS,,,TA,Outpatient,,,10995.5,2748.875,742.5,9346.18,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7213.05,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7696.85,Percent of Total Billed Charges, ,,85,,9346.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7476.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6157.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6597.3,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28035 - RELEASE TARSAL TUNNEL,28035,HCPCS,,,RT,Outpatient,,,7476.36,1869.09,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4904.49,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5233.45,Percent of Total Billed Charges, ,,85,,6354.91,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5083.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4186.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4485.82,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28035 - RELEASE TARSAL TUNNEL,28035,HCPCS,,,LT,Outpatient,,,7736.34,1934.085,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5075.04,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5415.44,Percent of Total Billed Charges, ,,85,,6575.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5260.71,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4332.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4641.8,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28039 - EXCISION TUMOR SOFT TIS FOOT-TOE SUBQ 1.5 CM-GREATER THAN,28039,HCPCS,,,RT,Outpatient,,,11549.56,2887.39,950.4,9817.13,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7576.51,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8084.69,Percent of Total Billed Charges, ,,85,,9817.13,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7853.7,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6467.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6929.74,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28039 - EXCISION TUMOR SOFT TIS FOOT-TOE SUBQ 1.5 CM-GREATER THAN,28039,HCPCS,,,LT,Outpatient,,,10091.6,2522.9,950.4,8577.86,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6620.09,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7064.12,Percent of Total Billed Charges, ,,85,,8577.86,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6862.29,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5651.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6054.96,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28041 - EXC TUMOR SOFT TISSUE FOOT-TOE SUBFASC 1.5 CM-GREATER THAN,28041,HCPCS,,,RT,Outpatient,,,11026,2756.5,950.4,9372.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7233.06,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7718.2,Percent of Total Billed Charges, ,,85,,9372.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7497.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6174.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6615.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28041 - EXC TUMOR SOFT TISSUE FOOT-TOE SUBFASC 1.5 CM-GREATER THAN,28041,HCPCS,,,LT,Outpatient,,,11570.25,2892.5625,950.4,9834.71,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7590.08,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8099.18,Percent of Total Billed Charges, ,,85,,9834.71,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7867.77,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6479.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6942.15,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28043 - EXCISION TUMOR SOFT TISSUE FOOT-TOE SUBQ LESS THAN 1.5CM,28043,HCPCS,,,XU,Outpatient,,,5786,1446.5,742.5,4918.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3795.62,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4050.2,Percent of Total Billed Charges, ,,85,,4918.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3934.48,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3240.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3471.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28043 - EXCISION TUMOR SOFT TISSUE FOOT-TOE SUBQ LESS THAN 1.5CM,28043,HCPCS,,,RT,Outpatient,,,9048.5,2262.125,742.5,7691.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5935.82,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6333.95,Percent of Total Billed Charges, ,,85,,7691.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6152.98,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5067.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5429.1,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28043 - EXCISION TUMOR SOFT TISSUE FOOT-TOE SUBQ LESS THAN 1.5CM,28043,HCPCS,,,LT,Outpatient,,,7678.6,1919.65,742.5,6526.81,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5037.16,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5375.02,Percent of Total Billed Charges, ,,85,,6526.81,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5221.45,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4300.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4607.16,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28045 - EXC TUMOR SOFT TISSUE FOOT-TOE SUBFASC LESS THAN 1.5CM,28045,HCPCS,,,RT,Outpatient,,,17927,4481.75,882.09,15237.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11760.11,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12548.9,Percent of Total Billed Charges, ,,85,,15237.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12190.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10039.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10756.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28045 - EXC TUMOR SOFT TISSUE FOOT-TOE SUBFASC LESS THAN 1.5CM,28045,HCPCS,,,LT,Outpatient,,,13691,3422.75,882.09,11637.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8981.3,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9583.7,Percent of Total Billed Charges, ,,85,,11637.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9309.88,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7666.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8214.6,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28047 - RAD RESECTION TUMOR SOFT TISSUE FOOT-TOE 3 CM-GREATER THAN,28047,HCPCS,,,RT,Outpatient,,,6285.68,1571.42,1078.11,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4123.41,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4399.98,Percent of Total Billed Charges, ,,85,,5342.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4274.26,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3519.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3771.41,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28060 - FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,HCPCS,,,XU,Outpatient,,,6389,1597.25,742.5,5430.65,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4191.18,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4472.3,Percent of Total Billed Charges, ,,85,,5430.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4344.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3577.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3833.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28060 - FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,HCPCS,,,RT,Outpatient,,,7889.82,1972.455,742.5,6706.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5175.72,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5522.87,Percent of Total Billed Charges, ,,85,,6706.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5365.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4418.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4733.89,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28060 - FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,HCPCS,,,LT,Outpatient,,,8302.29,2075.5725,742.5,7056.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5446.3,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5811.6,Percent of Total Billed Charges, ,,85,,7056.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5645.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4649.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4981.37,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28080 - EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH,28080,HCPCS,,,XU,Outpatient,,,5273,1318.25,742.5,4482.05,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3459.09,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3691.1,Percent of Total Billed Charges, ,,85,,4482.05,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3585.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2952.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3163.8,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28080 - EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH,28080,HCPCS,,,XS,Outpatient,,,10037.34,2509.335,742.5,8531.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6584.5,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7026.14,Percent of Total Billed Charges, ,,85,,8531.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6825.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5620.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6022.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28080 - EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH,28080,HCPCS,,,RT,Outpatient,,,12288.78,3072.195,742.5,10445.46,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8061.44,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8602.15,Percent of Total Billed Charges, ,,85,,10445.46,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8356.37,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6881.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7373.27,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28080 - EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH,28080,HCPCS,,,LT,Outpatient,,,12128.06,3032.015,742.5,10308.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7956.01,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8489.64,Percent of Total Billed Charges, ,,85,,10308.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8247.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6791.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7276.84,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28086 - SYNOVECTOMY TENDON SHEATH FOOT FLEXOR,28086,HCPCS,,,XS,Outpatient,,,9881.5,2470.375,1078.11,8399.28,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6482.26,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6917.05,Percent of Total Billed Charges, ,,85,,8399.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6719.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5533.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5928.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28088 - SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR,28088,HCPCS,,,LT,Outpatient,,,15551,3887.75,1078.11,13218.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10201.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10885.7,Percent of Total Billed Charges, ,,85,,13218.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10574.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8708.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9330.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28090 - EXC LESION TENDON SHEATH-CAPSULE W-SYNVCT FOOT,28090,HCPCS,,,XU,Outpatient,,,4684,1171,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3072.7,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3278.8,Percent of Total Billed Charges, ,,85,,3981.4,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3185.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2623.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2810.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28090 - EXC LESION TENDON SHEATH-CAPSULE W-SYNVCT FOOT,28090,HCPCS,,,RT,Outpatient,,,11806.04,2951.51,742.5,10035.13,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7744.76,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8264.23,Percent of Total Billed Charges, ,,85,,10035.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8028.11,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6611.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7083.62,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28090 - EXC LESION TENDON SHEATH-CAPSULE W-SYNVCT FOOT,28090,HCPCS,,,LT,Outpatient,,,10971.83,2742.9575,742.5,9326.06,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7197.52,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7680.28,Percent of Total Billed Charges, ,,85,,9326.06,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7460.84,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6144.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6583.1,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28092 - EXC LESION TENDON SHEATH-CAPSULE W-SYNVCT TOE EA,28092,HCPCS,,,XU,Outpatient,,,9196,2299,742.5,7816.6,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6032.58,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6437.2,Percent of Total Billed Charges, ,,85,,7816.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6253.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5149.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5517.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28092 - EXC LESION TENDON SHEATH-CAPSULE W-SYNVCT TOE EA,28092,HCPCS,,,TA,Outpatient,,,6589.68,1647.42,742.5,5601.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4322.83,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4612.78,Percent of Total Billed Charges, ,,85,,5601.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4480.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3690.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3953.81,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28092 - EXC LESION TENDON SHEATH-CAPSULE W-SYNVCT TOE EA,28092,HCPCS,,,T5,Outpatient,,,11069,2767.25,742.5,9408.65,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7261.26,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7748.3,Percent of Total Billed Charges, ,,85,,9408.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7526.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6198.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6641.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28092 - EXC LESION TENDON SHEATH-CAPSULE W-SYNVCT TOE EA,28092,HCPCS,,,T1,Outpatient,,,13956.5,3489.125,742.5,11863.03,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9155.46,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9769.55,Percent of Total Billed Charges, ,,85,,11863.03,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9490.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7815.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8373.9,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28100 - EXCISION-CURETTAGE CYST-TUMOR TALUS-CALCANEUS,28100,HCPCS,,,LT,Outpatient,,,6730.66,1682.665,742.5,5721.06,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4415.31,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4711.46,Percent of Total Billed Charges, ,,85,,5721.06,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4576.85,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3769.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4038.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28104 - EXC-CURTG BONE CYST-B9 TUMORTARSAL-METATARSAL,28104,HCPCS,,,XU,Outpatient,,,11228.5,2807.125,742.5,9544.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7365.9,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7859.95,Percent of Total Billed Charges, ,,85,,9544.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7635.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6287.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6737.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28104 - EXC-CURTG BONE CYST-B9 TUMORTARSAL-METATARSAL,28104,HCPCS,,,T1,Outpatient,,,6595.68,1648.92,742.5,5606.33,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4326.77,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4616.98,Percent of Total Billed Charges, ,,85,,5606.33,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4485.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3693.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3957.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28104 - EXC-CURTG BONE CYST-B9 TUMORTARSAL-METATARSAL,28104,HCPCS,,,LT,Outpatient,,,4684,1171,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3072.7,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3278.8,Percent of Total Billed Charges, ,,85,,3981.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3185.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2623.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2810.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28108 - EXC-CURTG CST-B9 TUM PHALANGES FOOT,28108,HCPCS,,,T3,Outpatient,,,5120.5,1280.125,882.09,4352.43,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3359.05,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3584.35,Percent of Total Billed Charges, ,,85,,4352.43,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3481.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2867.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3072.3,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28108 - EXC-CURTG CST-B9 TUM PHALANGES FOOT,28108,HCPCS,,,LT,Outpatient,,,3752.83,938.2075,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2461.86,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2626.98,Percent of Total Billed Charges, ,,85,,3189.91,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2551.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2101.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2251.7,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28110 - OSTECTOMY PRTL 5TH METAR HEAD SPX,28110,HCPCS,,,XU,Outpatient,,,5172.77,1293.1925,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3393.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3620.94,Percent of Total Billed Charges, ,,85,,4396.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3517.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2896.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3103.66,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28110 - OSTECTOMY PRTL 5TH METAR HEAD SPX,28110,HCPCS,,,XS,Outpatient,,,8046.75,2011.6875,742.5,6839.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5278.67,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5632.73,Percent of Total Billed Charges, ,,85,,6839.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5471.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4506.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4828.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28110 - OSTECTOMY PRTL 5TH METAR HEAD SPX,28110,HCPCS,,,RT,Outpatient,,,9830.02,2457.505,742.5,8355.52,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6448.49,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6881.01,Percent of Total Billed Charges, ,,85,,8355.52,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6684.41,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5504.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5898.01,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28110 - OSTECTOMY PRTL 5TH METAR HEAD SPX,28110,HCPCS,,,LT,Outpatient,,,10758.07,2689.5175,742.5,9144.36,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7057.29,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7530.65,Percent of Total Billed Charges, ,,85,,9144.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7315.49,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6024.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6454.84,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28110 - OSTECTOMY PRTL 5TH METAR HEAD SPX,28110,HCPCS,,,50,Outpatient,,,3427,856.75,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2248.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2398.9,Percent of Total Billed Charges, ,,85,,2912.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2330.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1919.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2056.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28111 - OSTECTOMY COMPLETE 1ST METATARSAL HEAD,28111,HCPCS,,,RT,Outpatient,,,7116.75,1779.1875,742.5,6049.24,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4668.59,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4981.73,Percent of Total Billed Charges, ,,85,,6049.24,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4839.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3985.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4270.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28112 - OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2-3-4,28112,HCPCS,,,XU,Outpatient,,,8498.5,2124.625,742.5,7223.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5575.02,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5948.95,Percent of Total Billed Charges, ,,85,,7223.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5778.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4759.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5099.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28112 - OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2-3-4,28112,HCPCS,,,XS,Outpatient,,,5248.37,1312.0925,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3442.93,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3673.86,Percent of Total Billed Charges, ,,85,,4461.11,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3568.89,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2939.09,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3149.02,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28112 - OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2-3-4,28112,HCPCS,,,RT,Outpatient,,,10055.13,2513.7825,742.5,8546.86,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6596.17,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7038.59,Percent of Total Billed Charges, ,,85,,8546.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6837.49,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5630.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6033.08,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28112 - OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2-3-4,28112,HCPCS,,,LT,Outpatient,,,7604.5,1901.125,742.5,6463.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4988.55,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5323.15,Percent of Total Billed Charges, ,,85,,6463.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5171.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4258.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4562.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28113 - OSTECTOMY COMPLETE 5TH METATARSAL HEAD,28113,HCPCS,,,RT,Outpatient,,,7116.75,1779.1875,742.5,6049.24,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4668.59,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4981.73,Percent of Total Billed Charges, ,,85,,6049.24,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4839.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3985.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4270.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28114 - OSTC COMPL ALL METAR HEADS W-PRTL PROX PHALANGC,28114,HCPCS,,,RT,Outpatient,,,3833.4,958.35,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2514.71,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2683.38,Percent of Total Billed Charges, ,,85,,3258.39,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2606.71,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2146.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2300.04,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28114 - OSTC COMPL ALL METAR HEADS W-PRTL PROX PHALANGC,28114,HCPCS,,,LT,Outpatient,,,3869.14,967.285,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2538.16,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2708.4,Percent of Total Billed Charges, ,,85,,3288.77,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2631.02,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2166.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2321.48,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28116 - OSTECTOMY TARSAL COALITION,28116,HCPCS,,,RT,Outpatient,,,5188,1297,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3403.33,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3631.6,Percent of Total Billed Charges, ,,85,,4409.8,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3527.84,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2905.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3112.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28116 - OSTECTOMY TARSAL COALITION,28116,HCPCS,,,LT,Outpatient,,,5704.94,1426.235,742.5,4849.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3742.44,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3993.46,Percent of Total Billed Charges, ,,85,,4849.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3879.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3194.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3422.96,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28118 - OSTECTOMY CALCANEUS,28118,HCPCS,,,RT,Outpatient,,,6883.32,1720.83,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4515.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4818.32,Percent of Total Billed Charges, ,,85,,5850.82,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4680.66,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3854.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4129.99,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28118 - OSTECTOMY CALCANEUS,28118,HCPCS,,,LT,Outpatient,,,8719.98,2179.995,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5720.31,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6103.99,Percent of Total Billed Charges, ,,85,,7411.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5929.59,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4883.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5231.99,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28119 - OSTECTOMY CALCANEUS SPUR W-WO PLNTAR FASCIAL RLS,28119,HCPCS,,,RT,Outpatient,,,7878.5,1969.625,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5168.3,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5514.95,Percent of Total Billed Charges, ,,85,,6696.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5357.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4411.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4727.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28120 - PARTIAL EXCISION BONE TALUS-CALCANEUS,28120,HCPCS,,,XU,Outpatient,,,6527.9,1631.975,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4282.3,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4569.53,Percent of Total Billed Charges, ,,85,,5548.72,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4438.97,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3655.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3916.74,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28120 - PARTIAL EXCISION BONE TALUS-CALCANEUS,28120,HCPCS,,,RT,Outpatient,,,9927.18,2481.795,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6512.23,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6949.03,Percent of Total Billed Charges, ,,85,,8438.1,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6750.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5559.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5956.31,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28120 - PARTIAL EXCISION BONE TALUS-CALCANEUS,28120,HCPCS,,,LT,Outpatient,,,7690.14,1922.535,742.5,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5044.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5383.1,Percent of Total Billed Charges, ,,85,,6536.62,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5229.3,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4306.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4614.08,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28122 - PRTL EXC B1 TARSAL-METAR B1 XCP TALUS-CALCANEUS,28122,HCPCS,,,XU,Outpatient,,,8838.75,2209.6875,950.4,7512.94,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5798.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6187.13,Percent of Total Billed Charges, ,,85,,7512.94,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6010.35,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4949.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5303.25,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28122 - PRTL EXC B1 TARSAL-METAR B1 XCP TALUS-CALCANEUS,28122,HCPCS,,,TA,Outpatient,,,4977.66,1244.415,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3265.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3484.36,Percent of Total Billed Charges, ,,85,,4231.01,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3384.81,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2787.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2986.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28122 - PRTL EXC B1 TARSAL-METAR B1 XCP TALUS-CALCANEUS,28122,HCPCS,,,RT,Outpatient,,,7767.75,1941.9375,950.4,6602.59,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5095.64,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5437.43,Percent of Total Billed Charges, ,,85,,6602.59,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5282.07,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4349.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4660.65,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28122 - PRTL EXC B1 TARSAL-METAR B1 XCP TALUS-CALCANEUS,28122,HCPCS,,,LT,Outpatient,,,12775.22,3193.805,950.4,10858.94,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8380.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8942.65,Percent of Total Billed Charges, ,,85,,10858.94,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8687.15,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7154.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7665.13,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28124 - PARTICAL EXCISION BONE PHALANX TOE,28124,HCPCS,,,XU,Outpatient,,,10048.5,2512.125,742.5,8541.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6591.82,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7033.95,Percent of Total Billed Charges, ,,85,,8541.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6832.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5627.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6029.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28124 - PARTICAL EXCISION BONE PHALANX TOE,28124,HCPCS,,,XS,Outpatient,,,13226,3306.5,742.5,11242.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8676.26,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9258.2,Percent of Total Billed Charges, ,,85,,11242.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8993.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7406.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7935.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28124 - PARTICAL EXCISION BONE PHALANX TOE,28124,HCPCS,,,TA,Outpatient,,,9493.33,2373.3325,742.5,8069.33,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6227.62,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6645.33,Percent of Total Billed Charges, ,,85,,8069.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6455.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5316.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5696,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28124 - PARTICAL EXCISION BONE PHALANX TOE,28124,HCPCS,,,T6,Outpatient,,,4241.66,1060.415,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2782.53,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2969.16,Percent of Total Billed Charges, ,,85,,3605.41,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2884.33,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2375.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2545,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28124 - PARTICAL EXCISION BONE PHALANX TOE,28124,HCPCS,,,T5,Outpatient,,,15954.5,3988.625,742.5,13561.33,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10466.15,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11168.15,Percent of Total Billed Charges, ,,85,,13561.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10849.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8934.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9572.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28124 - PARTICAL EXCISION BONE PHALANX TOE,28124,HCPCS,,,T3,Outpatient,,,7507.68,1876.92,742.5,6381.53,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4925.04,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5255.38,Percent of Total Billed Charges, ,,85,,6381.53,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5105.22,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4204.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4504.61,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28124 - PARTICAL EXCISION BONE PHALANX TOE,28124,HCPCS,,,T1,Outpatient,,,10048.5,2512.125,742.5,8541.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6591.82,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7033.95,Percent of Total Billed Charges, ,,85,,8541.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6832.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5627.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6029.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28124 - PARTICAL EXCISION BONE PHALANX TOE,28124,HCPCS,,,LT,Outpatient,,,20872,5218,742.5,17741.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13692.03,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14610.4,Percent of Total Billed Charges, ,,85,,17741.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14192.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11688.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12523.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28153 - RESECTION CONDYLE DISTAL END PHALANX EACH TOE,28153,HCPCS,,,TA,Outpatient,,,5663.8,1415.95,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3715.45,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3964.66,Percent of Total Billed Charges, ,,85,,4814.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3851.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3171.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3398.28,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28160 - HEMIPHALANGECTOMY-INTERPHALANGEAL JOINT EXC TOE,28160,HCPCS,,,T8,Outpatient,,,6957.33,1739.3325,742.5,5913.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4564.01,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4870.13,Percent of Total Billed Charges, ,,85,,5913.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4730.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3896.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4174.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28160 - HEMIPHALANGECTOMY-INTERPHALANGEAL JOINT EXC TOE,28160,HCPCS,,,T6,Outpatient,,,6957.33,1739.3325,742.5,5913.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4564.01,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4870.13,Percent of Total Billed Charges, ,,85,,5913.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4730.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3896.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4174.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28160 - HEMIPHALANGECTOMY-INTERPHALANGEAL JOINT EXC TOE,28160,HCPCS,,,T2,Outpatient,,,5786,1446.5,742.5,4918.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3795.62,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4050.2,Percent of Total Billed Charges, ,,85,,4918.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3934.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3240.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3471.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28160 - HEMIPHALANGECTOMY-INTERPHALANGEAL JOINT EXC TOE,28160,HCPCS,,,T1,Outpatient,,,6371.67,1592.9175,742.5,5415.92,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4179.82,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4460.17,Percent of Total Billed Charges, ,,85,,5415.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4332.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3568.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3823,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28173 - RADICAL RESECTION TUMOR METATARSAL,28173,HCPCS,,,T4,Outpatient,,,4273,1068.25,950.4,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2803.09,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2991.1,Percent of Total Billed Charges, ,,85,,3632.05,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2905.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2392.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2563.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,28190,HCPCS,,,T6,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,28190,HCPCS,,,RT,Outpatient,,,13327.5,3331.875,668.93,11328.38,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8742.84,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9329.25,Percent of Total Billed Charges, ,,85,,11328.38,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9062.7,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7463.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7996.5,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,28190,HCPCS,,,LT,Outpatient,,,12734.5,3183.625,668.93,10824.33,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8353.83,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8914.15,Percent of Total Billed Charges, ,,85,,10824.33,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8659.46,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7131.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7640.7,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28192 - REMOVAL FOREIGN BODY FOOT DEEP,28192,HCPCS,,,RT,Outpatient,,,11727,2931.75,742.5,9967.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7692.91,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8208.9,Percent of Total Billed Charges, ,,85,,9967.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7974.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6567.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7036.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28192 - REMOVAL FOREIGN BODY FOOT DEEP,28192,HCPCS,,,LT,Outpatient,,,12675,3168.75,742.5,10773.75,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8314.8,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8872.5,Percent of Total Billed Charges, ,,85,,10773.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8619,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7098,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7605,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28200 - RPR TDN FLXR FOOT 1-2 W-O FREE GRAFG EACH TENDON,28200,HCPCS,,,RT,Outpatient,,,11878.5,2969.625,742.5,10096.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7792.3,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8314.95,Percent of Total Billed Charges, ,,85,,10096.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8077.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6651.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7127.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28200 - RPR TDN FLXR FOOT 1-2 W-O FREE GRAFG EACH TENDON,28200,HCPCS,,,LT,Outpatient,,,12012.63,3003.1575,742.5,10210.74,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7880.29,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8408.84,Percent of Total Billed Charges, ,,85,,10210.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8168.59,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6727.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7207.58,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28208 - REPAIR TENDON EXTENSOR FOOT 1-2 EACH TENDON,28208,HCPCS,,,RT,Outpatient,,,7024.17,1756.0425,950.4,5970.54,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4607.86,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4916.92,Percent of Total Billed Charges, ,,85,,5970.54,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4776.44,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3933.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4214.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28208 - REPAIR TENDON EXTENSOR FOOT 1-2 EACH TENDON,28208,HCPCS,,,LT,Outpatient,,,22913.5,5728.375,950.4,19476.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15031.26,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16039.45,Percent of Total Billed Charges, ,,85,,19476.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15581.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12831.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13748.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28220 - TENOLYSIS FLEXOR FOOT SINGLE TENDON,28220,HCPCS,,,RT,Outpatient,,,5799.3,1449.825,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3804.34,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4059.51,Percent of Total Billed Charges, ,,85,,4929.41,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3943.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3247.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3479.58,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28220 - TENOLYSIS FLEXOR FOOT SINGLE TENDON,28220,HCPCS,,,LT,Outpatient,,,6389,1597.25,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4191.18,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4472.3,Percent of Total Billed Charges, ,,85,,5430.65,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4344.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3577.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3833.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28225 - TENOLYSIS EXTENSOR FOOT SINGLE TENDON,28225,HCPCS,,,RT,Outpatient,,,4503.4,1125.85,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2954.23,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3152.38,Percent of Total Billed Charges, ,,85,,3827.89,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3062.31,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2521.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2702.04,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28230 - TX OPN TENDON FLEXOR FOOT SINGLE-MULT TENDON SPX,28230,HCPCS,,,RT,Outpatient,,,3649.5,912.375,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2394.07,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2554.65,Percent of Total Billed Charges, ,,85,,3102.08,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2481.66,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2043.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2189.7,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28230 - TX OPN TENDON FLEXOR FOOT SINGLE-MULT TENDON SPX,28230,HCPCS,,,LT,Outpatient,,,3203,800.75,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2101.17,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2242.1,Percent of Total Billed Charges, ,,85,,2722.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2178.04,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1793.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1921.8,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,XU,Outpatient,,,3260.03,815.0075,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2138.58,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2282.02,Percent of Total Billed Charges, ,,85,,2771.03,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2216.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1825.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1956.02,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,T9,Outpatient,,,3012.58,753.145,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1976.25,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2108.81,Percent of Total Billed Charges, ,,85,,2560.69,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2048.55,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1687.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1807.55,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,T8,Outpatient,,,3066.88,766.72,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2011.87,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2146.82,Percent of Total Billed Charges, ,,85,,2606.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2085.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1717.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1840.13,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,T7,Outpatient,,,2642,660.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1733.15,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1849.4,Percent of Total Billed Charges, ,,85,,2245.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1796.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1479.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1585.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,T6,Outpatient,,,2642,660.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1733.15,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1849.4,Percent of Total Billed Charges, ,,85,,2245.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1796.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1479.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1585.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,T5,Outpatient,,,2642,660.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1733.15,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1849.4,Percent of Total Billed Charges, ,,85,,2245.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1796.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1479.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1585.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28234 - TENOTOMY OPEN EXTENSOR FOOT-TOE EACH TENDON,28234,HCPCS,,,LT,Outpatient,,,10832.34,2708.085,742.5,9207.49,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7106.02,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7582.64,Percent of Total Billed Charges, ,,85,,9207.49,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7365.99,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6066.11,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6499.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28238 - RCNSTJ PST TIBL TDN W-EXC ACCESSORY TARSL NAVCLR,28238,HCPCS,,,XU,Outpatient,,,3752.83,938.2075,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2461.86,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2626.98,Percent of Total Billed Charges, ,,85,,3189.91,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2551.92,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2101.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2251.7,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28238 - RCNSTJ PST TIBL TDN W-EXC ACCESSORY TARSL NAVCLR,28238,HCPCS,,,RT,Outpatient,,,9335.72,2333.93,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6124.23,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6535,Percent of Total Billed Charges, ,,85,,7935.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6348.29,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5228,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5601.43,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28238 - RCNSTJ PST TIBL TDN W-EXC ACCESSORY TARSL NAVCLR,28238,HCPCS,,,LT,Outpatient,,,5823,1455.75,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3819.89,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4076.1,Percent of Total Billed Charges, ,,85,,4949.55,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3959.64,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3260.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3493.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28250 - DIVISION PLANTAR FASCIA AND MUSCLE SPX,28250,HCPCS,,,RT,Outpatient,,,13277,3319.25,882.09,11285.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8709.71,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9293.9,Percent of Total Billed Charges, ,,85,,11285.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9028.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7435.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7966.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28250 - DIVISION PLANTAR FASCIA AND MUSCLE SPX,28250,HCPCS,,,LT,Outpatient,,,10319.89,2579.9725,882.09,8771.91,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6769.85,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7223.92,Percent of Total Billed Charges, ,,85,,8771.91,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7017.53,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5779.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6191.93,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28270 - CAPSUL MTTARPHLNGL JT W-WO TENORRHAPHY EA JT SPX,28270,HCPCS,,,XU,Outpatient,,,4236.62,1059.155,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2779.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2965.63,Percent of Total Billed Charges, ,,85,,3601.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2880.9,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2372.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2541.97,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28270 - CAPSUL MTTARPHLNGL JT W-WO TENORRHAPHY EA JT SPX,28270,HCPCS,,,XS,Outpatient,,,7139.03,1784.7575,742.5,6068.18,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4683.2,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4997.32,Percent of Total Billed Charges, ,,85,,6068.18,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4854.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3997.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4283.42,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28270 - CAPSUL MTTARPHLNGL JT W-WO TENORRHAPHY EA JT SPX,28270,HCPCS,,,TA,Outpatient,,,12063.5,3015.875,742.5,10253.98,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7913.66,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8444.45,Percent of Total Billed Charges, ,,85,,10253.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8203.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6755.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7238.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28270 - CAPSUL MTTARPHLNGL JT W-WO TENORRHAPHY EA JT SPX,28270,HCPCS,,,T6,Outpatient,,,6055.5,1513.875,742.5,5147.18,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3972.41,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4238.85,Percent of Total Billed Charges, ,,85,,5147.18,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4117.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3391.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3633.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28270 - CAPSUL MTTARPHLNGL JT W-WO TENORRHAPHY EA JT SPX,28270,HCPCS,,,RT,Outpatient,,,11469.2,2867.3,742.5,9748.82,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7523.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8028.44,Percent of Total Billed Charges, ,,85,,9748.82,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7799.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6422.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6881.52,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28270 - CAPSUL MTTARPHLNGL JT W-WO TENORRHAPHY EA JT SPX,28270,HCPCS,,,LT,Outpatient,,,9012,2253,742.5,7660.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5911.87,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6308.4,Percent of Total Billed Charges, ,,85,,7660.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6128.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5046.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5407.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,XU,Outpatient,,,4213.82,1053.455,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2764.27,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2949.67,Percent of Total Billed Charges, ,,85,,3581.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2865.4,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2359.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2528.29,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,XS,Outpatient,,,6395.93,1598.9825,742.5,5436.54,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4195.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4477.15,Percent of Total Billed Charges, ,,85,,5436.54,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4349.23,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3581.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3837.56,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,XP,Outpatient,,,3458.66,864.665,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2268.88,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2421.06,Percent of Total Billed Charges, ,,85,,2939.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2351.89,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1936.85,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2075.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,T9,Outpatient,,,5677.75,1419.4375,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3724.6,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3974.43,Percent of Total Billed Charges, ,,85,,4826.09,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3860.87,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3179.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3406.65,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,T8,Outpatient,,,5001.51,1250.3775,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3280.99,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3501.06,Percent of Total Billed Charges, ,,85,,4251.28,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3401.03,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2800.85,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3000.91,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,T7,Outpatient,,,6066.87,1516.7175,742.5,5156.84,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3979.87,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4246.81,Percent of Total Billed Charges, ,,85,,5156.84,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4125.47,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3397.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3640.12,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,T6,Outpatient,,,6783.2,1695.8,742.5,5765.72,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4449.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4748.24,Percent of Total Billed Charges, ,,85,,5765.72,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4612.58,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3798.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4069.92,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,T5,Outpatient,,,11572,2893,742.5,9836.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7591.23,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8100.4,Percent of Total Billed Charges, ,,85,,9836.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7868.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6480.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6943.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,T4,Outpatient,,,6347.82,1586.955,742.5,5395.65,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.17,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4443.47,Percent of Total Billed Charges, ,,85,,5395.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4316.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3554.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3808.69,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,T3,Outpatient,,,5755.04,1438.76,742.5,4891.78,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3775.31,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4028.53,Percent of Total Billed Charges, ,,85,,4891.78,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3913.43,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3222.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3453.02,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,T2,Outpatient,,,5654.07,1413.5175,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3709.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3957.85,Percent of Total Billed Charges, ,,85,,4805.96,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3844.77,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3166.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3392.44,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,T1,Outpatient,,,6478.37,1619.5925,742.5,5506.61,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4249.81,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4534.86,Percent of Total Billed Charges, ,,85,,5506.61,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4405.29,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3627.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3887.02,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,RT,Outpatient,,,10188.75,2547.1875,742.5,8660.44,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6683.82,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7132.13,Percent of Total Billed Charges, ,,85,,8660.44,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6928.35,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5705.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6113.25,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28285 - CORRECTION HAMMERTOE,28285,HCPCS,,,LT,Outpatient,,,8075.95,2018.9875,742.5,6864.56,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5297.82,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5653.17,Percent of Total Billed Charges, ,,85,,6864.56,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5491.65,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4522.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4845.57,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28286 - CORRECTION COCK-UP 5TH TOE W-PLASTIC CLOSURE,28286,HCPCS,,,T9,Outpatient,,,8046.75,2011.6875,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5278.67,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5632.73,Percent of Total Billed Charges, ,,85,,6839.74,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5471.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4506.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4828.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28286 - CORRECTION COCK-UP 5TH TOE W-PLASTIC CLOSURE,28286,HCPCS,,,T4,Outpatient,,,10857.33,2714.3325,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7122.41,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7600.13,Percent of Total Billed Charges, ,,85,,9228.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7382.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6080.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6514.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28286 - CORRECTION COCK-UP 5TH TOE W-PLASTIC CLOSURE,28286,HCPCS,,,LT,Outpatient,,,19426,4856.5,742.5,16512.1,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12743.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13598.2,Percent of Total Billed Charges, ,,85,,16512.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13209.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10878.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11655.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28288 - OSTC PRTL EXOSTC-CONDYLC METAR HEAD,28288,HCPCS,,,XU,Outpatient,,,5119.61,1279.9025,742.5,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3358.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3583.73,Percent of Total Billed Charges, ,,85,,4351.67,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3481.33,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2866.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3071.77,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28288 - OSTC PRTL EXOSTC-CONDYLC METAR HEAD,28288,HCPCS,,,T4,Outpatient,,,6561,1640.25,742.5,5576.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4304.02,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4592.7,Percent of Total Billed Charges, ,,85,,5576.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4461.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3674.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3936.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28288 - OSTC PRTL EXOSTC-CONDYLC METAR HEAD,28288,HCPCS,,,RT,Outpatient,,,11759,2939.75,742.5,9995.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7713.9,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8231.3,Percent of Total Billed Charges, ,,85,,9995.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7996.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6585.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7055.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28288 - OSTC PRTL EXOSTC-CONDYLC METAR HEAD,28288,HCPCS,,,LT,Outpatient,,,10012.5,2503.125,742.5,8510.63,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6568.2,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7008.75,Percent of Total Billed Charges, ,,85,,8510.63,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6808.5,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5607,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6007.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28289 - HALLUX RIGIDUS W-CHEILECTOMY 1ST MP JT W-O IMPLT,28289,HCPCS,,,TA,Outpatient,,,18056.5,4514.125,742.5,15348.03,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11845.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12639.55,Percent of Total Billed Charges, ,,85,,15348.03,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12278.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10111.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10833.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28289 - HALLUX RIGIDUS W-CHEILECTOMY 1ST MP JT W-O IMPLT,28289,HCPCS,,,T5,Outpatient,,,9339.7,2334.925,742.5,7938.75,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6126.84,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6537.79,Percent of Total Billed Charges, ,,85,,7938.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6351,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5230.23,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5603.82,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28289 - HALLUX RIGIDUS W-CHEILECTOMY 1ST MP JT W-O IMPLT,28289,HCPCS,,,RT,Outpatient,,,10945.45,2736.3625,742.5,9303.63,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7180.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7661.82,Percent of Total Billed Charges, ,,85,,9303.63,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7442.91,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6129.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6567.27,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28289 - HALLUX RIGIDUS W-CHEILECTOMY 1ST MP JT W-O IMPLT,28289,HCPCS,,,LT,Outpatient,,,12227.38,3056.845,742.5,10393.27,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8021.16,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8559.17,Percent of Total Billed Charges, ,,85,,10393.27,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8314.62,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6847.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7336.43,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28291 - HALLUX RIGIDUS W-CHEILECTOMY 1ST MP JT W-IMPLT,28291,HCPCS,,,TA,Outpatient,,,11767.5,2941.875,4145,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7719.48,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8237.25,Percent of Total Billed Charges, ,,85,,10002.38,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8001.9,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6589.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7060.5,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
28291 - HALLUX RIGIDUS W-CHEILECTOMY 1ST MP JT W-IMPLT,28291,HCPCS,,,T5,Outpatient,,,14287.17,3571.7925,4145,12144.09,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9372.38,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10001.02,Percent of Total Billed Charges, ,,85,,12144.09,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9715.28,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8000.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8572.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
28291 - HALLUX RIGIDUS W-CHEILECTOMY 1ST MP JT W-IMPLT,28291,HCPCS,,,RT,Outpatient,,,6619.09,1654.7725,3706.69,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4342.12,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4633.36,Percent of Total Billed Charges, ,,85,,5626.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4500.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3706.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3971.45,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
28291 - HALLUX RIGIDUS W-CHEILECTOMY 1ST MP JT W-IMPLT,28291,HCPCS,,,LT,Outpatient,,,13910.25,3477.5625,4145,11823.71,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9125.12,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9737.18,Percent of Total Billed Charges, ,,85,,11823.71,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9458.97,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7789.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8346.15,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
28292 - CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE,28292,HCPCS,,,TA,Outpatient,,,2904,726,742.5,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1905.02,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2032.8,Percent of Total Billed Charges, ,,85,,2468.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1974.72,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1626.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1742.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28292 - CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE,28292,HCPCS,,,T5,Outpatient,,,6273.43,1568.3575,742.5,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4115.37,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4391.4,Percent of Total Billed Charges, ,,85,,5332.42,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4265.93,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3513.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3764.06,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28292 - CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE,28292,HCPCS,,,RT,Outpatient,,,5181.37,1295.3425,742.5,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3398.98,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3626.96,Percent of Total Billed Charges, ,,85,,4404.16,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3523.33,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2901.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3108.82,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28292 - CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE,28292,HCPCS,,,LT,Outpatient,,,5125.55,1281.3875,742.5,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3362.36,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3587.89,Percent of Total Billed Charges, ,,85,,4356.72,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3485.37,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2870.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3075.33,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28295 - CORRJ HLX VLGS BNCTY SESMDC PROX METAR OSTEOT,28295,HCPCS,,,LT,Outpatient,,,7349.25,1837.3125,742.5,6246.86,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4821.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5144.48,Percent of Total Billed Charges, ,,85,,6246.86,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4997.49,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4115.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4409.55,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28296 - CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT,28296,HCPCS,,,TA,Outpatient,,,7026,1756.5,742.5,5972.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4609.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4918.2,Percent of Total Billed Charges, ,,85,,5972.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4777.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3934.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4215.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28296 - CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT,28296,HCPCS,,,T5,Outpatient,,,10546,2636.5,742.5,8964.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6918.18,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7382.2,Percent of Total Billed Charges, ,,85,,8964.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7171.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5905.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6327.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28296 - CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT,28296,HCPCS,,,RT,Outpatient,,,13125.06,3281.265,742.5,11156.3,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8610.04,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9187.54,Percent of Total Billed Charges, ,,85,,11156.3,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8925.04,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7350.03,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7875.04,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28296 - CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT,28296,HCPCS,,,LT,Outpatient,,,15446.08,3861.52,742.5,13129.17,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10132.63,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10812.26,Percent of Total Billed Charges, ,,85,,13129.17,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10503.33,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8649.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9267.65,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28297 - CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS,28297,HCPCS,,,TA,Outpatient,,,7393.95,1848.4875,742.5,19002.44,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4850.43,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5175.77,Percent of Total Billed Charges, ,,85,,6284.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5027.89,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4140.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4436.37,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28297 - CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS,28297,HCPCS,,,T5,Outpatient,,,8897.34,2224.335,742.5,19002.44,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5836.66,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6228.14,Percent of Total Billed Charges, ,,85,,7562.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6050.19,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4982.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5338.4,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28297 - CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS,28297,HCPCS,,,RT,Outpatient,,,14185.08,3546.27,742.5,19002.44,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9305.41,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9929.56,Percent of Total Billed Charges, ,,85,,12057.32,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9645.85,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7943.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8511.05,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28297 - CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS,28297,HCPCS,,,LT,Outpatient,,,16670.89,4167.7225,742.5,19002.44,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10936.1,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11669.62,Percent of Total Billed Charges, ,,85,,14170.26,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11336.21,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9335.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10002.53,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28298 - CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT,28298,HCPCS,,,XU,Outpatient,,,9004,2251,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5906.62,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6302.8,Percent of Total Billed Charges, ,,85,,7653.4,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6122.72,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5042.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5402.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28298 - CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT,28298,HCPCS,,,XS,Outpatient,,,12581.33,3145.3325,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8253.35,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8806.93,Percent of Total Billed Charges, ,,85,,10694.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8555.3,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7045.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7548.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28298 - CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT,28298,HCPCS,,,TA,Outpatient,,,5499.69,1374.9225,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3607.8,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3849.78,Percent of Total Billed Charges, ,,85,,4674.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3739.79,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3079.83,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3299.81,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28298 - CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT,28298,HCPCS,,,T5,Outpatient,,,3405.26,851.315,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2233.85,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2383.68,Percent of Total Billed Charges, ,,85,,2894.47,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2315.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1906.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2043.16,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28298 - CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT,28298,HCPCS,,,RT,Outpatient,,,10185.44,2546.36,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6681.65,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7129.81,Percent of Total Billed Charges, ,,85,,8657.62,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6926.1,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5703.85,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6111.26,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28298 - CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT,28298,HCPCS,,,LT,Outpatient,,,7070.15,1767.5375,742.5,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4638.02,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4949.11,Percent of Total Billed Charges, ,,85,,6009.63,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4807.7,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3959.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4242.09,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28299 - CORRJ HLX VLGS BNCTY SESMDC W-DOUBLE OSTEOTOMY,28299,HCPCS,,,TA,Outpatient,,,9243.91,2310.9775,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6064,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6470.74,Percent of Total Billed Charges, ,,85,,7857.32,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6285.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5176.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5546.35,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28299 - CORRJ HLX VLGS BNCTY SESMDC W-DOUBLE OSTEOTOMY,28299,HCPCS,,,T5,Outpatient,,,11234.69,2808.6725,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7369.96,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7864.28,Percent of Total Billed Charges, ,,85,,9549.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7639.59,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6291.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6740.81,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28299 - CORRJ HLX VLGS BNCTY SESMDC W-DOUBLE OSTEOTOMY,28299,HCPCS,,,RT,Outpatient,,,10606.7,2651.675,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6958,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7424.69,Percent of Total Billed Charges, ,,85,,9015.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7212.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5939.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6364.02,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28299 - CORRJ HLX VLGS BNCTY SESMDC W-DOUBLE OSTEOTOMY,28299,HCPCS,,,LT,Outpatient,,,10782.69,2695.6725,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7073.44,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7547.88,Percent of Total Billed Charges, ,,85,,9165.29,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7332.23,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6038.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6469.61,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28300 - OSTEOTOMY CALCANEUS W-WO INTERNAL FIXATION,28300,HCPCS,,,XU,Outpatient,,,6312.33,1578.0825,742.5,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4140.89,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4418.63,Percent of Total Billed Charges, ,,85,,5365.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4292.38,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3534.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3787.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28300 - OSTEOTOMY CALCANEUS W-WO INTERNAL FIXATION,28300,HCPCS,,,XS,Outpatient,,,9829.25,2457.3125,742.5,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6447.99,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6880.48,Percent of Total Billed Charges, ,,85,,8354.86,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6683.89,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5504.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5897.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28300 - OSTEOTOMY CALCANEUS W-WO INTERNAL FIXATION,28300,HCPCS,,,RT,Outpatient,,,5928.82,1482.205,742.5,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3889.31,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4150.17,Percent of Total Billed Charges, ,,85,,5039.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4031.6,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3320.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3557.29,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28300 - OSTEOTOMY CALCANEUS W-WO INTERNAL FIXATION,28300,HCPCS,,,LT,Outpatient,,,6652.68,1663.17,742.5,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4364.16,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4656.88,Percent of Total Billed Charges, ,,85,,5654.78,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4523.82,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3725.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3991.61,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28304 - OSTEOTOMY TARSAL BONES OTH-THN CALCANEUS-TALUS,28304,HCPCS,,,LT,Outpatient,,,9808.25,2452.0625,742.5,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6434.21,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6865.78,Percent of Total Billed Charges, ,,85,,8337.01,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6669.61,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5492.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5884.95,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28306 - OSTEOT W-WO LNGTH SHRT-CORRJ 1ST METAR,28306,HCPCS,,,RT,Outpatient,,,5630.98,1407.745,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3693.92,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3941.69,Percent of Total Billed Charges, ,,85,,4786.33,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3829.07,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3153.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3378.59,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28306 - OSTEOT W-WO LNGTH SHRT-CORRJ 1ST METAR,28306,HCPCS,,,LT,Outpatient,,,4379.4,1094.85,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2872.89,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3065.58,Percent of Total Billed Charges, ,,85,,3722.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2977.99,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2452.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2627.64,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,XU,Outpatient,,,5200.52,1300.13,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3411.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3640.36,Percent of Total Billed Charges, ,,85,,4420.44,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3536.35,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2912.29,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3120.31,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,XS,Outpatient,,,7893.61,1973.4025,742.5,6709.57,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5178.21,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5525.53,Percent of Total Billed Charges, ,,85,,6709.57,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5367.65,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4420.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4736.17,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,T9,Outpatient,,,10241,2560.25,742.5,8704.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6718.1,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7168.7,Percent of Total Billed Charges, ,,85,,8704.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6963.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5734.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6144.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,T7,Outpatient,,,3709.4,927.35,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2433.37,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2596.58,Percent of Total Billed Charges, ,,85,,3152.99,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2522.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2077.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2225.64,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,T6,Outpatient,,,5471.96,1367.99,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3589.61,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3830.37,Percent of Total Billed Charges, ,,85,,4651.17,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3720.93,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3064.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3283.18,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,T4,Outpatient,,,7101.16,1775.29,742.5,6035.99,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4658.36,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4970.81,Percent of Total Billed Charges, ,,85,,6035.99,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4828.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3976.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4260.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,T3,Outpatient,,,4554.44,1138.61,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2987.71,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3188.11,Percent of Total Billed Charges, ,,85,,3871.27,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3097.02,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2550.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2732.66,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,T2,Outpatient,,,4180.8,1045.2,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2742.6,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2926.56,Percent of Total Billed Charges, ,,85,,3553.68,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2842.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2341.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2508.48,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,T1,Outpatient,,,5817.02,1454.255,742.5,4944.47,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3815.97,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4071.91,Percent of Total Billed Charges, ,,85,,4944.47,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3955.57,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3257.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3490.21,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,RT,Outpatient,,,10101.14,2525.285,742.5,8585.97,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6626.35,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7070.8,Percent of Total Billed Charges, ,,85,,8585.97,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6868.78,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5656.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6060.68,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28308 - OSTEOT W-WO LNGTH SHRT-CORRJ METAR XCP 1ST EA,28308,HCPCS,,,LT,Outpatient,,,6032.16,1508.04,742.5,5127.34,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3957.1,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4222.51,Percent of Total Billed Charges, ,,85,,5127.34,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4101.87,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3378.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3619.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28309 - OSTEOT W-WO LNGTH SHRT-ANGULAR CORRJ METAR MLT,28309,HCPCS,,,XS,Outpatient,,,9110.4,2277.6,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5976.42,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6377.28,Percent of Total Billed Charges, ,,85,,7743.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6195.07,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5101.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5466.24,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28309 - OSTEOT W-WO LNGTH SHRT-ANGULAR CORRJ METAR MLT,28309,HCPCS,,,RT,Outpatient,,,4188.36,1047.09,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2747.56,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2931.85,Percent of Total Billed Charges, ,,85,,3560.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2848.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2345.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2513.02,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28309 - OSTEOT W-WO LNGTH SHRT-ANGULAR CORRJ METAR MLT,28309,HCPCS,,,LT,Outpatient,,,3807.84,951.96,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2497.94,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2665.49,Percent of Total Billed Charges, ,,85,,3236.66,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2589.33,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2132.39,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2284.7,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28313 - RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY,28313,HCPCS,,,XU,Outpatient,,,3709.4,927.35,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2433.37,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2596.58,Percent of Total Billed Charges, ,,85,,3152.99,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2522.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2077.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2225.64,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28313 - RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY,28313,HCPCS,,,XS,Outpatient,,,5474.66,1368.665,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3591.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3832.26,Percent of Total Billed Charges, ,,85,,4653.46,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3722.77,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3065.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3284.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28313 - RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY,28313,HCPCS,,,LT,Outpatient,,,9041,2260.25,742.5,7684.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5930.9,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6328.7,Percent of Total Billed Charges, ,,85,,7684.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6147.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5062.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5424.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28315 - SESAMOIDECTOMY FIRST TOE SPX,28315,HCPCS,,,XU,Outpatient,,,7181,1795.25,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4710.74,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5026.7,Percent of Total Billed Charges, ,,85,,6103.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4883.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4021.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4308.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28315 - SESAMOIDECTOMY FIRST TOE SPX,28315,HCPCS,,,XS,Outpatient,,,16016,4004,950.4,13613.6,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10506.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11211.2,Percent of Total Billed Charges, ,,85,,13613.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10890.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8968.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9609.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28315 - SESAMOIDECTOMY FIRST TOE SPX,28315,HCPCS,,,TA,Outpatient,,,6449.05,1612.2625,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4230.58,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4514.34,Percent of Total Billed Charges, ,,85,,5481.69,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4385.35,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3611.47,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3869.43,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28315 - SESAMOIDECTOMY FIRST TOE SPX,28315,HCPCS,,,LT,Outpatient,,,9004.23,2251.0575,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5906.77,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6302.96,Percent of Total Billed Charges, ,,85,,7653.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6122.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5042.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5402.54,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28320 - REPAIR NONUNION-MALUNION TARSAL BONES,28320,HCPCS,,,RT,Outpatient,,,7557.34,1889.335,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4957.62,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5290.14,Percent of Total Billed Charges, ,,85,,6423.74,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5138.99,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4232.11,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4534.4,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28322 - RPR NON-MALUNION METARSAL W-WO BONE GRAFT,28322,HCPCS,,,T9,Outpatient,,,23662,5915.5,1078.11,20112.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15522.27,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16563.4,Percent of Total Billed Charges, ,,85,,20112.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16090.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13250.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14197.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28322 - RPR NON-MALUNION METARSAL W-WO BONE GRAFT,28322,HCPCS,,,T4,Outpatient,,,15137,3784.25,1078.11,12866.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9929.87,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10595.9,Percent of Total Billed Charges, ,,85,,12866.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10293.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8476.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9082.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28322 - RPR NON-MALUNION METARSAL W-WO BONE GRAFT,28322,HCPCS,,,RT,Outpatient,,,12337.48,3084.37,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8093.39,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8636.24,Percent of Total Billed Charges, ,,85,,10486.86,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8389.49,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6908.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7402.49,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28322 - RPR NON-MALUNION METARSAL W-WO BONE GRAFT,28322,HCPCS,,,LT,Outpatient,,,13310.5,3327.625,1078.11,11313.93,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8731.69,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9317.35,Percent of Total Billed Charges, ,,85,,11313.93,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9051.14,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7453.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7986.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28406 - PRQ SKELETAL FIXJ CALCANEAL FRACTURE W-MANJ,28406,HCPCS,,,LT,Outpatient,,,20252,5063,882.09,17214.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13285.31,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14176.4,Percent of Total Billed Charges, ,,85,,17214.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13771.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11341.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12151.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28415 - OPEN TREATMENT CALCANEAL FRACTURE,28415,HCPCS,,,RT,Outpatient,,,14032.65,3508.1625,1078.11,11927.75,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9205.42,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9822.86,Percent of Total Billed Charges, ,,85,,11927.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9542.2,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7858.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8419.59,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28415 - OPEN TREATMENT CALCANEAL FRACTURE,28415,HCPCS,,,LT,Outpatient,,,12000.25,3000.0625,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7872.16,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8400.18,Percent of Total Billed Charges, ,,85,,10200.21,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8160.17,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6720.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7200.15,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28415 - OPEN TREATMENT CALCANEAL FRACTURE,28415,HCPCS,,,80,Outpatient,,,15008.5,3752.125,1078.11,12757.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9845.58,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10505.95,Percent of Total Billed Charges, ,,85,,12757.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10205.78,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8404.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9005.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28415 - OPEN TREATMENT CALCANEAL FRACTURE,28415,HCPCS,,,50,Outpatient,,,21239.64,5309.91,1078.11,18053.69,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13933.2,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14867.75,Percent of Total Billed Charges, ,,85,,18053.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14442.96,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11894.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12743.78,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28420 - OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT,28420,HCPCS,,,RT,Outpatient,,,23662,5915.5,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15522.27,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16563.4,Percent of Total Billed Charges, ,,85,,20112.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16090.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13250.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14197.2,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28445 - OPEN TREATMENT TALUS FRACTURE,28445,HCPCS,,,RT,Outpatient,,,12005.63,3001.4075,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7875.69,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8403.94,Percent of Total Billed Charges, ,,85,,10204.79,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8163.83,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6723.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7203.38,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28445 - OPEN TREATMENT TALUS FRACTURE,28445,HCPCS,,,LT,Outpatient,,,11896.73,2974.1825,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7804.25,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8327.71,Percent of Total Billed Charges, ,,85,,10112.22,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8089.78,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6662.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7138.04,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28445 - OPEN TREATMENT TALUS FRACTURE,28445,HCPCS,,,50,Outpatient,,,16960.66,4240.165,882.09,14416.56,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11126.19,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11872.46,Percent of Total Billed Charges, ,,85,,14416.56,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11533.25,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9497.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10176.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28450 - TX TARSAL BONE FX XCP TALUSANDCALCN W-O MANJ,28450,HCPCS,,,LT,Outpatient,,,13432,3358,0.01,11417.2,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8811.39,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9402.4,Percent of Total Billed Charges, ,,85,,11417.2,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9133.76,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7521.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8059.2,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28465 - OPEN TX TARSAL FRACTURE XCP TALUS AND CALCANEUS EA,28465,HCPCS,,,RT,Outpatient,,,6372.11,1593.0275,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4180.1,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4460.48,Percent of Total Billed Charges, ,,85,,5416.29,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4333.03,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3568.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3823.27,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28465 - OPEN TX TARSAL FRACTURE XCP TALUS AND CALCANEUS EA,28465,HCPCS,,,LT,Outpatient,,,9799,2449.75,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6428.14,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6859.3,Percent of Total Billed Charges, ,,85,,8329.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6663.32,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5487.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5879.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28470 - CLOSED TX METATARSAL FRACTURE W-O MANIPULATION,28470,HCPCS,,,XU,Outpatient,,,4734.5,1183.625,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3105.83,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3314.15,Percent of Total Billed Charges, ,,85,,4024.33,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3219.46,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2651.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2840.7,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28470 - CLOSED TX METATARSAL FRACTURE W-O MANIPULATION,28470,HCPCS,,,XS,Outpatient,,,10437.78,2609.445,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6847.18,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7306.45,Percent of Total Billed Charges, ,,85,,8872.11,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7097.69,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5845.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6262.67,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28475 - CLTX METAR FX W-MANJ,28475,HCPCS,,,XU,Outpatient,,,4907.75,1226.9375,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3219.48,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3435.43,Percent of Total Billed Charges, ,,85,,4171.59,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3337.27,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2748.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2944.65,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28476 - PRQ SKEL FIXJ METAR FX W-MANJ,28476,HCPCS,,,LT,Outpatient,,,16997,4249.25,742.5,14447.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11150.03,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11897.9,Percent of Total Billed Charges, ,,85,,14447.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11557.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9518.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10198.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,XU,Outpatient,,,7569.02,1892.255,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4965.28,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5298.31,Percent of Total Billed Charges, ,,85,,6433.67,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5146.93,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4238.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4541.41,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,XS,Outpatient,,,9293.92,2323.48,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6096.81,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6505.74,Percent of Total Billed Charges, ,,85,,7899.83,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6319.87,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5204.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5576.35,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,T8,Outpatient,,,4503.4,1125.85,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2954.23,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3152.38,Percent of Total Billed Charges, ,,85,,3827.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3062.31,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2521.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2702.04,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,T7,Outpatient,,,4503.4,1125.85,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2954.23,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3152.38,Percent of Total Billed Charges, ,,85,,3827.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3062.31,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2521.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2702.04,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,T6,Outpatient,,,4503.4,1125.85,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2954.23,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3152.38,Percent of Total Billed Charges, ,,85,,3827.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3062.31,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2521.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2702.04,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,T4,Outpatient,,,8338.09,2084.5225,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5469.79,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5836.66,Percent of Total Billed Charges, ,,85,,7087.38,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5669.9,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4669.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5002.85,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,T2,Outpatient,,,3150.28,787.57,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2066.58,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2205.2,Percent of Total Billed Charges, ,,85,,2677.74,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2142.19,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1764.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1890.17,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,T1,Outpatient,,,11553.59,2888.3975,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7579.16,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8087.51,Percent of Total Billed Charges, ,,85,,9820.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7856.44,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6470.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6932.15,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,RT,Outpatient,,,11680.04,2920.01,1078.11,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7662.11,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8176.03,Percent of Total Billed Charges, ,,85,,9928.03,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7942.43,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6540.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7008.02,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28485 - OPEN TREATMENT METATARSAL FRACTURE EACH,28485,HCPCS,,,LT,Outpatient,,,14054.42,3513.605,1078.11,11946.26,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9219.7,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9838.09,Percent of Total Billed Charges, ,,85,,11946.26,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9557.01,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7870.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8432.65,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28496 - PRQ SKEL FIXJ FX GRT TOE PHLX-PHLG W-MANJ,28496,HCPCS,,,RT,Outpatient,,,13951,3487.75,742.5,11858.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9151.86,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9765.7,Percent of Total Billed Charges, ,,85,,11858.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9486.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7812.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8370.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28505 - OPEN TX FRACTURE GREAT TOE-PHALANX-PHALANGES,28505,HCPCS,,,TA,Outpatient,,,15955.89,3988.9725,950.4,13562.51,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10467.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11169.12,Percent of Total Billed Charges, ,,85,,13562.51,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10850.01,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8935.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9573.53,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28505 - OPEN TX FRACTURE GREAT TOE-PHALANX-PHALANGES,28505,HCPCS,,,T5,Outpatient,,,8976.67,2244.1675,950.4,7630.17,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5888.7,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6283.67,Percent of Total Billed Charges, ,,85,,7630.17,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6104.14,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5026.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5386,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28505 - OPEN TX FRACTURE GREAT TOE-PHALANX-PHALANGES,28505,HCPCS,,,LT,Outpatient,,,12812,3203,950.4,10890.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8404.67,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8968.4,Percent of Total Billed Charges, ,,85,,10890.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8712.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7174.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7687.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28515 - CLTX FX PHLX-PHLG OTH-THN GRT TOE W-MANJ,28515,HCPCS,,,T8,Outpatient,,,4967,1241.75,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3258.35,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3476.9,Percent of Total Billed Charges, ,,85,,4221.95,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3377.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2781.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2980.2,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28515 - CLTX FX PHLX-PHLG OTH-THN GRT TOE W-MANJ,28515,HCPCS,,,T7,Outpatient,,,4967,1241.75,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3258.35,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3476.9,Percent of Total Billed Charges, ,,85,,4221.95,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3377.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2781.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2980.2,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28525 - OPEN TX FRACTURE PHALANX-PHALANGES NOT GREAT TOE,28525,HCPCS,,,T8,Outpatient,,,15475.5,3868.875,950.4,13154.18,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10151.93,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10832.85,Percent of Total Billed Charges, ,,85,,13154.18,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10523.34,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8666.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9285.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28525 - OPEN TX FRACTURE PHALANX-PHALANGES NOT GREAT TOE,28525,HCPCS,,,T7,Outpatient,,,7026,1756.5,950.4,5972.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4609.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4918.2,Percent of Total Billed Charges, ,,85,,5972.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4777.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3934.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4215.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28525 - OPEN TX FRACTURE PHALANX-PHALANGES NOT GREAT TOE,28525,HCPCS,,,T6,Outpatient,,,6362.5,1590.625,950.4,5408.13,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4173.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4453.75,Percent of Total Billed Charges, ,,85,,5408.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4326.5,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3563,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3817.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28525 - OPEN TX FRACTURE PHALANX-PHALANGES NOT GREAT TOE,28525,HCPCS,,,T4,Outpatient,,,6793.5,1698.375,950.4,5774.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4456.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4755.45,Percent of Total Billed Charges, ,,85,,5774.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4619.58,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3804.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4076.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28525 - OPEN TX FRACTURE PHALANX-PHALANGES NOT GREAT TOE,28525,HCPCS,,,RT,Outpatient,,,6952.4,1738.1,950.4,5909.54,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4560.77,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4866.68,Percent of Total Billed Charges, ,,85,,5909.54,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4727.63,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3893.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4171.44,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28555 - OPEN TREATMENT TARSAL BONE DISLOCATION,28555,HCPCS,,,LT,Outpatient,,,9799,2449.75,1078.11,10730.04,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6428.14,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6859.3,Percent of Total Billed Charges, ,,85,,8329.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6663.32,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5487.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5879.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28585 - OPEN TREATMENT TALOTARSAL JOINT DISLOCATION,28585,HCPCS,,,RT,Outpatient,,,8389.57,2097.3925,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5503.56,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5872.7,Percent of Total Billed Charges, ,,85,,7131.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5704.91,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4698.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5033.74,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28585 - OPEN TREATMENT TALOTARSAL JOINT DISLOCATION,28585,HCPCS,,,LT,Outpatient,,,7248.6,1812.15,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4755.08,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5074.02,Percent of Total Billed Charges, ,,85,,6161.31,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4929.05,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4059.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4349.16,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28606 - PRQ SKEL FIXJ TARS JT DISLC W-MANJ,28606,HCPCS,,,RT,Outpatient,,,18547,4636.75,882.09,15764.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12166.83,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12982.9,Percent of Total Billed Charges, ,,85,,15764.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12611.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10386.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11128.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,XU,Outpatient,,,4670.5,1167.625,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3063.85,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3269.35,Percent of Total Billed Charges, ,,85,,3969.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3175.94,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2615.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2802.3,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,XS,Outpatient,,,9024.25,2256.0625,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5919.91,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6316.98,Percent of Total Billed Charges, ,,85,,7670.61,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6136.49,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5053.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5414.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,TA,Outpatient,,,2938.03,734.5075,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1927.35,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2056.62,Percent of Total Billed Charges, ,,85,,2497.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1997.86,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1645.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1762.82,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,T6,Outpatient,,,3654.4,913.6,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2397.29,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2558.08,Percent of Total Billed Charges, ,,85,,3106.24,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2484.99,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2046.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2192.64,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,T4,Outpatient,,,2725.77,681.4425,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1788.11,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1908.04,Percent of Total Billed Charges, ,,85,,2316.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1853.52,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1526.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1635.46,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,T3,Outpatient,,,2938.03,734.5075,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1927.35,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2056.62,Percent of Total Billed Charges, ,,85,,2497.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1997.86,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1645.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1762.82,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,T2,Outpatient,,,2725.77,681.4425,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1788.11,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1908.04,Percent of Total Billed Charges, ,,85,,2316.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1853.52,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1526.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1635.46,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,T1,Outpatient,,,2725.77,681.4425,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1788.11,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1908.04,Percent of Total Billed Charges, ,,85,,2316.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1853.52,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1526.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1635.46,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,RT,Outpatient,,,6963.03,1740.7575,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4567.75,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4874.12,Percent of Total Billed Charges, ,,85,,5918.58,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4734.86,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3899.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4177.82,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,28615,HCPCS,,,LT,Outpatient,,,12847.97,3211.9925,1078.11,10920.77,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8428.27,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8993.58,Percent of Total Billed Charges, ,,85,,10920.77,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8736.62,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7194.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7708.78,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28645 - OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION,28645,HCPCS,,,XU,Outpatient,,,2670.39,667.5975,1078.11,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1751.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1869.27,Percent of Total Billed Charges, ,,85,,2269.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1815.87,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1495.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1602.23,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28645 - OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION,28645,HCPCS,,,LT,Outpatient,,,7413.5,1853.375,1078.11,6301.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4863.26,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5189.45,Percent of Total Billed Charges, ,,85,,6301.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5041.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4151.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4448.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28705 - ARTHRODESIS PANTALAR,28705,HCPCS,,,RT,Outpatient,,,23584.5,5896.125,0.01,35521.64,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27159.44,,,27159.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15471.43,Percent of Total Billed Charges, ,35521.64,,,35521.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16509.15,Percent of Total Billed Charges, ,,85,,20046.83,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16037.46,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13207.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14150.7,Percent of Total Billed Charges, ,26881.9,,,26881.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34408.11,,,34408.11,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18096.11,,,18096.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18270.95,,,18270.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17484.16,,,17484.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17659,,,17659,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18008.68,,,18008.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18314.66,,,18314.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28715 - ARTHRODESIS TRIPLE,28715,HCPCS,,,RT,Outpatient,,,7896.75,1974.1875,950.4,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5180.27,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5527.73,Percent of Total Billed Charges, ,,85,,6712.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5369.79,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4422.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4738.05,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28715 - ARTHRODESIS TRIPLE,28715,HCPCS,,,LT,Outpatient,,,7896.73,1974.1825,950.4,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5180.25,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5527.71,Percent of Total Billed Charges, ,,85,,6712.22,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5369.78,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4422.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4738.04,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28725 - ARTHRODESIS SUBTALAR,28725,HCPCS,,,RT,Outpatient,,,9024.44,2256.11,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5920.03,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6317.11,Percent of Total Billed Charges, ,,85,,7670.77,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6136.62,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5053.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5414.66,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28725 - ARTHRODESIS SUBTALAR,28725,HCPCS,,,LT,Outpatient,,,11501.75,2875.4375,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7545.15,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8051.23,Percent of Total Billed Charges, ,,85,,9776.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7821.19,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6440.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6901.05,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28725 - ARTHRODESIS SUBTALAR,28725,HCPCS,,,50,Outpatient,,,16960.66,4240.165,1078.11,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11126.19,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11872.46,Percent of Total Billed Charges, ,,85,,14416.56,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11533.25,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9497.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10176.4,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28730 - ARTHRD MIDTARSL-TARSOMETATARSAL MULT-TRANSVRS,28730,HCPCS,,,XS,Outpatient,,,7631.5,1907.875,882.09,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5006.26,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5342.05,Percent of Total Billed Charges, ,,85,,6486.78,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5189.42,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4273.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4578.9,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28730 - ARTHRD MIDTARSL-TARSOMETATARSAL MULT-TRANSVRS,28730,HCPCS,,,RT,Outpatient,,,6826.87,1706.7175,882.09,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4478.43,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4778.81,Percent of Total Billed Charges, ,,85,,5802.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4642.27,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3823.05,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4096.12,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28730 - ARTHRD MIDTARSL-TARSOMETATARSAL MULT-TRANSVRS,28730,HCPCS,,,LT,Outpatient,,,6825.09,1706.2725,882.09,21166.19,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4477.26,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4777.56,Percent of Total Billed Charges, ,,85,,5801.33,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4641.06,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3822.05,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4095.05,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28735 - ARTHRD MIDTARSL-TARS MLT-TRANSVRS W-OSTEOT,28735,HCPCS,,,RT,Outpatient,,,5769.41,1442.3525,0.01,19002.44,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3784.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4038.59,Percent of Total Billed Charges, ,,85,,4904,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3923.2,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3230.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3461.65,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28740 - ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,28740,HCPCS,,,XU,Outpatient,,,7678.6,1919.65,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5037.16,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5375.02,Percent of Total Billed Charges, ,,85,,6526.81,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5221.45,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4300.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4607.16,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28740 - ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,28740,HCPCS,,,XS,Outpatient,,,9668.4,2417.1,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6342.47,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6767.88,Percent of Total Billed Charges, ,,85,,8218.14,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6574.51,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5414.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5801.04,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28740 - ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,28740,HCPCS,,,RT,Outpatient,,,10685.28,2671.32,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7009.54,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7479.7,Percent of Total Billed Charges, ,,85,,9082.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7265.99,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5983.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6411.17,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28740 - ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,28740,HCPCS,,,LT,Outpatient,,,9894.12,2473.53,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6490.54,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6925.88,Percent of Total Billed Charges, ,,85,,8410,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6728,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5540.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5936.47,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28750 - ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT,28750,HCPCS,,,TA,Outpatient,,,9082.91,2270.7275,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5958.39,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6358.04,Percent of Total Billed Charges, ,,85,,7720.47,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6176.38,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5086.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5449.75,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28750 - ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT,28750,HCPCS,,,T5,Outpatient,,,9589.36,2397.34,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6290.62,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6712.55,Percent of Total Billed Charges, ,,85,,8150.96,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6520.76,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5370.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5753.62,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28750 - ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT,28750,HCPCS,,,RT,Outpatient,,,9299.49,2324.8725,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6100.47,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6509.64,Percent of Total Billed Charges, ,,85,,7904.57,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6323.65,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5207.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5579.69,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28750 - ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT,28750,HCPCS,,,LT,Outpatient,,,9904.03,2476.0075,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6497.04,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6932.82,Percent of Total Billed Charges, ,,85,,8418.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6734.74,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5546.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5942.42,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28755 - ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT,28755,HCPCS,,,TA,Outpatient,,,6333.6,1583.4,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4154.84,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4433.52,Percent of Total Billed Charges, ,,85,,5383.56,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4306.85,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3546.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3800.16,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28755 - ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT,28755,HCPCS,,,T5,Outpatient,,,9295.8,2323.95,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6098.04,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6507.06,Percent of Total Billed Charges, ,,85,,7901.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6321.14,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5205.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5577.48,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28755 - ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT,28755,HCPCS,,,RT,Outpatient,,,8329.69,2082.4225,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5464.28,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5830.78,Percent of Total Billed Charges, ,,85,,7080.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5664.19,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4664.63,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4997.81,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28805 - AMPUTATION FOOT TRANSMETARSAL,28805,HCPCS,,,RT,Outpatient,,,11613.51,2903.3775,882.09,9871.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7618.46,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8129.46,Percent of Total Billed Charges, ,,85,,9871.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7897.19,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6503.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6968.11,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28805 - AMPUTATION FOOT TRANSMETARSAL,28805,HCPCS,,,LT,Outpatient,,,14038.21,3509.5525,882.09,11932.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9209.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9826.75,Percent of Total Billed Charges, ,,85,,11932.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9545.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7861.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8422.93,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28810 - AMPUTATION METATARSAL W-TOE SINGLE,28810,HCPCS,,,T9,Outpatient,,,10665.11,2666.2775,742.5,9065.34,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6996.31,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7465.58,Percent of Total Billed Charges, ,,85,,9065.34,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7252.27,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5972.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6399.07,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28810 - AMPUTATION METATARSAL W-TOE SINGLE,28810,HCPCS,,,T8,Outpatient,,,9661,2415.25,742.5,8211.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6337.62,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6762.7,Percent of Total Billed Charges, ,,85,,8211.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6569.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5410.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5796.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28810 - AMPUTATION METATARSAL W-TOE SINGLE,28810,HCPCS,,,T5,Outpatient,,,10355.5,2588.875,742.5,8802.18,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6793.21,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7248.85,Percent of Total Billed Charges, ,,85,,8802.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7041.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5799.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6213.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28810 - AMPUTATION METATARSAL W-TOE SINGLE,28810,HCPCS,,,T4,Outpatient,,,12035,3008.75,742.5,10229.75,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7894.96,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8424.5,Percent of Total Billed Charges, ,,85,,10229.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8183.8,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6739.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7221,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28810 - AMPUTATION METATARSAL W-TOE SINGLE,28810,HCPCS,,,T3,Outpatient,,,8714,2178.5,742.5,7406.9,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5716.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6099.8,Percent of Total Billed Charges, ,,85,,7406.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5925.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4879.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5228.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28810 - AMPUTATION METATARSAL W-TOE SINGLE,28810,HCPCS,,,RT,Outpatient,,,15483.75,3870.9375,742.5,13161.19,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10157.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10838.63,Percent of Total Billed Charges, ,,85,,13161.19,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10528.95,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8670.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9290.25,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28810 - AMPUTATION METATARSAL W-TOE SINGLE,28810,HCPCS,,,LT,Outpatient,,,15499,3874.75,742.5,13174.15,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10167.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10849.3,Percent of Total Billed Charges, ,,85,,13174.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10539.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8679.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9299.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,TA,Outpatient,,,12087.08,3021.77,742.5,10274.02,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7929.12,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8460.96,Percent of Total Billed Charges, ,,85,,10274.02,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8219.21,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6768.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7252.25,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,T9,Outpatient,,,8679.5,2169.875,742.5,7377.58,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5693.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6075.65,Percent of Total Billed Charges, ,,85,,7377.58,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5902.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4860.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5207.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,T8,Outpatient,,,9662.1,2415.525,742.5,8212.79,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6338.34,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6763.47,Percent of Total Billed Charges, ,,85,,8212.79,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6570.23,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5410.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5797.26,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,T7,Outpatient,,,11440.11,2860.0275,742.5,9724.09,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7504.71,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8008.08,Percent of Total Billed Charges, ,,85,,9724.09,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7779.27,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6406.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6864.07,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,T6,Outpatient,,,10021.68,2505.42,742.5,8518.43,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6574.22,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7015.18,Percent of Total Billed Charges, ,,85,,8518.43,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6814.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5612.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6013.01,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,T5,Outpatient,,,9704.24,2426.06,742.5,8248.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6365.98,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6792.97,Percent of Total Billed Charges, ,,85,,8248.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6598.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5434.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5822.54,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,T4,Outpatient,,,7170.25,1792.5625,742.5,6094.71,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4703.68,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5019.18,Percent of Total Billed Charges, ,,85,,6094.71,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4875.77,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4015.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4302.15,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,T3,Outpatient,,,5427.88,1356.97,742.5,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3560.69,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3799.52,Percent of Total Billed Charges, ,,85,,4613.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3690.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3039.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3256.73,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,T2,Outpatient,,,8734.35,2183.5875,742.5,7424.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5729.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6114.05,Percent of Total Billed Charges, ,,85,,7424.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5939.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4891.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5240.61,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,T1,Outpatient,,,10593.18,2648.295,742.5,9004.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6949.13,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7415.23,Percent of Total Billed Charges, ,,85,,9004.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7203.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5932.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6355.91,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,RT,Outpatient,,,11471.11,2867.7775,742.5,9750.44,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7525.05,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8029.78,Percent of Total Billed Charges, ,,85,,9750.44,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7800.35,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6423.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6882.67,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,LT,Outpatient,,,9295.7,2323.925,742.5,7901.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6097.98,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6506.99,Percent of Total Billed Charges, ,,85,,7901.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6321.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5205.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5577.42,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,HCPCS,,,50,Outpatient,,,15757,3939.25,742.5,13393.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10336.59,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11029.9,Percent of Total Billed Charges, ,,85,,13393.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10714.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8823.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9454.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,XU,Outpatient,,,4775.5,1193.875,882.09,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3132.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3342.85,Percent of Total Billed Charges, ,,85,,4059.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3247.34,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2674.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2865.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,XS,Outpatient,,,4942.33,1235.5825,882.09,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3242.17,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3459.63,Percent of Total Billed Charges, ,,85,,4200.98,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3360.78,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2767.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2965.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,TA,Outpatient,,,11031.68,2757.92,882.09,9376.93,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7236.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7722.18,Percent of Total Billed Charges, ,,85,,9376.93,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7501.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6177.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6619.01,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,T8,Outpatient,,,4839,1209.75,882.09,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3174.38,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3387.3,Percent of Total Billed Charges, ,,85,,4113.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3290.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2709.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2903.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,T7,Outpatient,,,8603.86,2150.965,882.09,7313.28,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5644.13,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6022.7,Percent of Total Billed Charges, ,,85,,7313.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5850.62,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4818.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5162.32,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,T6,Outpatient,,,9234.34,2308.585,882.09,7849.19,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6057.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6464.04,Percent of Total Billed Charges, ,,85,,7849.19,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6279.35,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5171.23,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5540.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,T5,Outpatient,,,15351.75,3837.9375,882.09,13048.99,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10070.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10746.23,Percent of Total Billed Charges, ,,85,,13048.99,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10439.19,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8596.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9211.05,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,T4,Outpatient,,,14207,3551.75,882.09,12075.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9319.79,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9944.9,Percent of Total Billed Charges, ,,85,,12075.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9660.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7955.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8524.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,T2,Outpatient,,,10137.11,2534.2775,882.09,8616.54,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6649.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7095.98,Percent of Total Billed Charges, ,,85,,8616.54,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6893.23,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5676.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6082.27,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,T1,Outpatient,,,11339.18,2834.795,882.09,9638.3,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7438.5,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7937.43,Percent of Total Billed Charges, ,,85,,9638.3,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7710.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6349.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6803.51,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,RT,Outpatient,,,11345,2836.25,882.09,9643.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7442.32,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7941.5,Percent of Total Billed Charges, ,,85,,9643.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7714.6,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6353.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6807,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28825 - AMPUTATION TOE INTERPHALANGEAL JOINT,28825,HCPCS,,,LT,Outpatient,,,12347,3086.75,882.09,10494.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8099.63,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8642.9,Percent of Total Billed Charges, ,,85,,10494.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8395.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6914.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7408.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28899 - UNLISTED PROCEDURE FOOT-TOES,28899,HCPCS,,,LT,Outpatient,,,9301.66,2325.415,0.01,7906.41,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6101.89,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6511.16,Percent of Total Billed Charges, ,,85,,7906.41,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6325.13,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5208.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5581,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29345 - APPLICATION LONG LEG CAST THIGH-TOE,29345,HCPCS,,,LT,Outpatient,,,6867,1716.75,252.5,5836.95,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4504.75,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4806.9,Percent of Total Billed Charges, ,,85,,5836.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4669.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3845.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4120.2,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29515 - APPLICATION SHORT LEG SPLINT CALF FOOT,29515,HCPCS,,,RT,Outpatient,,,15327.33,3831.8325,150.02,13028.23,,,,,,,Service Paid at Rev Code level,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10054.73,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10729.13,Percent of Total Billed Charges, ,,85,,13028.23,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10422.58,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8583.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9196.4,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29806 - SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY,29806,HCPCS,,,XU,Outpatient,,,7206.43,1801.6075,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4727.42,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5044.5,Percent of Total Billed Charges, ,,85,,6125.47,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4900.37,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4035.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4323.86,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29806 - SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY,29806,HCPCS,,,RT,Outpatient,,,12442.39,3110.5975,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8162.21,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8709.67,Percent of Total Billed Charges, ,,85,,10576.03,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8460.83,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6967.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7465.43,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29806 - SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY,29806,HCPCS,,,LT,Outpatient,,,10180.14,2545.035,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6678.17,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7126.1,Percent of Total Billed Charges, ,,85,,8653.12,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6922.5,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5700.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6108.08,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29806 - SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY,29806,HCPCS,,,22,Outpatient,,,17520.17,4380.0425,1078.11,14892.14,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11493.23,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12264.12,Percent of Total Billed Charges, ,,85,,14892.14,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11913.72,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9811.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10512.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29807 - SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION,29807,HCPCS,,,XU,Outpatient,,,10828.38,2707.095,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7103.42,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7579.87,Percent of Total Billed Charges, ,,85,,9204.12,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7363.3,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6063.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6497.03,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29807 - SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION,29807,HCPCS,,,RT,Outpatient,,,9639.06,2409.765,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6323.22,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6747.34,Percent of Total Billed Charges, ,,85,,8193.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6554.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5397.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5783.44,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29807 - SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION,29807,HCPCS,,,LT,Outpatient,,,7476.7,1869.175,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4904.72,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5233.69,Percent of Total Billed Charges, ,,85,,6355.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5084.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4186.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4486.02,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29819 - SURGICAL ARTHROSCOPY SHOULDER REMOVAL LOOSE-FB,29819,HCPCS,,,XU,Outpatient,,,6575.68,1643.92,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4313.65,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4602.98,Percent of Total Billed Charges, ,,85,,5589.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4471.46,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3682.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3945.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29819 - SURGICAL ARTHROSCOPY SHOULDER REMOVAL LOOSE-FB,29819,HCPCS,,,XS,Outpatient,,,4009.25,1002.3125,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2630.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2806.48,Percent of Total Billed Charges, ,,85,,3407.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2726.29,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2245.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2405.55,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29820 - SURGICAL ARTHROSCOPY SHOULDER PRTL SYNOVECTOMY,29820,HCPCS,,,XU,Outpatient,,,2765.85,691.4625,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1814.4,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1936.1,Percent of Total Billed Charges, ,,85,,2350.97,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1880.78,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1548.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1659.51,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29822 - SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1-2,29822,HCPCS,,,XU,Outpatient,,,6342.67,1585.6675,1078.11,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4160.79,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4439.87,Percent of Total Billed Charges, ,,85,,5391.27,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4313.02,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3551.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3805.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29822 - SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1-2,29822,HCPCS,,,XS,Outpatient,,,7568.77,1892.1925,1078.11,6433.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4965.11,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5298.14,Percent of Total Billed Charges, ,,85,,6433.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5146.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4238.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4541.26,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29822 - SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1-2,29822,HCPCS,,,RT,Outpatient,,,7374.45,1843.6125,1078.11,6268.28,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4837.64,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5162.12,Percent of Total Billed Charges, ,,85,,6268.28,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5014.63,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4129.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4424.67,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29822 - SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1-2,29822,HCPCS,,,LT,Outpatient,,,7530.52,1882.63,1078.11,6400.94,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4940.02,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5271.36,Percent of Total Billed Charges, ,,85,,6400.94,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5120.75,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4217.09,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4518.31,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29823 - SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+,29823,HCPCS,,,XU,Outpatient,,,6608.51,1652.1275,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4335.18,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4625.96,Percent of Total Billed Charges, ,,85,,5617.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4493.79,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3700.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3965.11,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29823 - SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+,29823,HCPCS,,,RT,Outpatient,,,6380.03,1595.0075,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4185.3,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4466.02,Percent of Total Billed Charges, ,,85,,5423.03,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4338.42,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3572.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3828.02,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29823 - SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+,29823,HCPCS,,,LT,Outpatient,,,6606.19,1651.5475,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4333.66,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4624.33,Percent of Total Billed Charges, ,,85,,5615.26,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4492.21,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3699.47,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3963.71,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29823 - SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+,29823,HCPCS,,,59,Outpatient,,,7683,1920.75,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5040.05,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5378.1,Percent of Total Billed Charges, ,,85,,6530.55,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5224.44,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4302.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4609.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29824 - SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC,29824,HCPCS,,,RT,Outpatient,,,5792.37,1448.0925,882.09,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3799.79,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4054.66,Percent of Total Billed Charges, ,,85,,4923.51,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3938.81,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3243.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3475.42,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29824 - SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC,29824,HCPCS,,,LT,Outpatient,,,6178.24,1544.56,882.09,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4052.93,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4324.77,Percent of Total Billed Charges, ,,85,,5251.5,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4201.2,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3459.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3706.94,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29825 - SURGICAL ARTHROSCOPY SHOULDER W-LSSANDRESCJ ADS,29825,HCPCS,,,XS,Outpatient,,,7688.5,1922.125,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5043.66,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5381.95,Percent of Total Billed Charges, ,,85,,6535.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5228.18,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4305.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4613.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29825 - SURGICAL ARTHROSCOPY SHOULDER W-LSSANDRESCJ ADS,29825,HCPCS,,,RT,Outpatient,,,9942.52,2485.63,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6522.29,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6959.76,Percent of Total Billed Charges, ,,85,,8451.14,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6760.91,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5567.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5965.51,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29825 - SURGICAL ARTHROSCOPY SHOULDER W-LSSANDRESCJ ADS,29825,HCPCS,,,LT,Outpatient,,,10185.5,2546.375,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6681.69,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7129.85,Percent of Total Billed Charges, ,,85,,8657.68,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6926.14,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5703.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6111.3,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29826 - SURGICAL ARTHROSCOPY SHO W-CORACOACRM LIGM RLS,29826,HCPCS,,,XU,Outpatient,,,5396.75,1349.1875,0.01,4587.24,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3540.27,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3777.73,Percent of Total Billed Charges, ,,85,,4587.24,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3669.79,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3022.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3238.05,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
29826 - SURGICAL ARTHROSCOPY SHO W-CORACOACRM LIGM RLS,29826,HCPCS,,,XS,Outpatient,,,5230.53,1307.6325,0.01,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3431.23,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3661.37,Percent of Total Billed Charges, ,,85,,4445.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3556.76,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2929.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3138.32,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
29826 - SURGICAL ARTHROSCOPY SHO W-CORACOACRM LIGM RLS,29826,HCPCS,,,RT,Outpatient,,,5935.79,1483.9475,0.01,5045.42,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3893.88,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4155.05,Percent of Total Billed Charges, ,,85,,5045.42,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4036.34,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3324.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3561.47,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
29826 - SURGICAL ARTHROSCOPY SHO W-CORACOACRM LIGM RLS,29826,HCPCS,,,LT,Outpatient,,,6301.9,1575.475,0.01,5356.62,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4134.05,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4411.33,Percent of Total Billed Charges, ,,85,,5356.62,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4285.29,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3529.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3781.14,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
29827 - SURGICAL ARTHROSCOPY SHOULDER W-ROTATOR CUFF RPR,29827,HCPCS,,,RT,Outpatient,,,6699.33,1674.8325,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4394.76,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4689.53,Percent of Total Billed Charges, ,,85,,5694.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4555.54,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3751.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4019.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29827 - SURGICAL ARTHROSCOPY SHOULDER W-ROTATOR CUFF RPR,29827,HCPCS,,,LT,Outpatient,,,6863.09,1715.7725,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4502.19,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4804.16,Percent of Total Billed Charges, ,,85,,5833.63,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4666.9,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3843.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4117.85,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29827 - SURGICAL ARTHROSCOPY SHOULDER W-ROTATOR CUFF RPR,29827,HCPCS,,,22,Outpatient,,,8791.07,2197.7675,1078.11,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5766.94,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6153.75,Percent of Total Billed Charges, ,,85,,7472.41,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5977.93,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4923,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5274.64,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29828 - SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS,29828,HCPCS,,,RT,Outpatient,,,6865.01,1716.2525,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4503.45,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4805.51,Percent of Total Billed Charges, ,,85,,5835.26,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4668.21,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3844.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4119.01,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29828 - SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS,29828,HCPCS,,,LT,Outpatient,,,7045.84,1761.46,1078.11,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4622.07,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4932.09,Percent of Total Billed Charges, ,,85,,5988.96,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4791.17,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3945.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4227.5,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29834 - ARTHROSCOPY ELBOW SURGICAL W-REMOVAL LOOSE-FB,29834,HCPCS,,,RT,Outpatient,,,11054.5,2763.625,742.5,9396.33,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7251.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7738.15,Percent of Total Billed Charges, ,,85,,9396.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7517.06,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6190.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6632.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29835 - ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL,29835,HCPCS,,,RT,Outpatient,,,11054.5,2763.625,742.5,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7251.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7738.15,Percent of Total Billed Charges, ,,85,,9396.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7517.06,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6190.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6632.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29836 - ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE,29836,HCPCS,,,LT,Outpatient,,,23817,5954.25,882.09,20244.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15623.95,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16671.9,Percent of Total Billed Charges, ,,85,,20244.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16195.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13337.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14290.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29844 - ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL,29844,HCPCS,,,XU,Outpatient,,,8145.3,2036.325,882.09,6923.51,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5343.32,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5701.71,Percent of Total Billed Charges, ,,85,,6923.51,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5538.8,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4561.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4887.18,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29845 - ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE,29845,HCPCS,,,LT,Outpatient,,,11174,2793.5,742.5,9497.9,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7330.14,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7821.8,Percent of Total Billed Charges, ,,85,,9497.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7598.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6257.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6704.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29846 - ARTHRS WRST EXCAND-RPR TRIANG FIBROCARTAND-JOINT,29846,HCPCS,,,RT,Outpatient,,,9781.5,2445.375,950.4,8314.28,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6416.66,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6847.05,Percent of Total Billed Charges, ,,85,,8314.28,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6651.42,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5477.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5868.9,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29846 - ARTHRS WRST EXCAND-RPR TRIANG FIBROCARTAND-JOINT,29846,HCPCS,,,LT,Outpatient,,,10478.48,2619.62,950.4,8906.71,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6873.88,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7334.94,Percent of Total Billed Charges, ,,85,,8906.71,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7125.37,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5867.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6287.09,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29848 - NDSC WRST SURG W-RLS TRANSVRS CARPL LIGM,29848,HCPCS,,,RT,Outpatient,,,10602.51,2650.6275,950.4,13976,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6955.25,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7421.76,Percent of Total Billed Charges, ,,85,,9012.13,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7209.71,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5937.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6361.51,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29848 - NDSC WRST SURG W-RLS TRANSVRS CARPL LIGM,29848,HCPCS,,,LT,Outpatient,,,10179.51,2544.8775,950.4,13976,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6677.76,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7125.66,Percent of Total Billed Charges, ,,85,,8652.58,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6922.07,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5700.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6107.71,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29848 - NDSC WRST SURG W-RLS TRANSVRS CARPL LIGM,29848,HCPCS,,,79,Outpatient,,,11727,2931.75,950.4,13976,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7692.91,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8208.9,Percent of Total Billed Charges, ,,85,,9967.95,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7974.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6567.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7036.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29848 - NDSC WRST SURG W-RLS TRANSVRS CARPL LIGM,29848,HCPCS,,,50,Outpatient,,,8266,2066.5,950.4,13976,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5422.5,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5786.2,Percent of Total Billed Charges, ,,85,,7026.1,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5620.88,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4628.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4959.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29850 - ARTHROSCOPY AID TX SPINEAND-FX KNEE W-O FIXJ,29850,HCPCS,,,LT,Outpatient,,,12761,3190.25,950.4,10846.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8371.22,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8932.7,Percent of Total Billed Charges, ,,85,,10846.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8677.48,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7146.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7656.6,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29851 - ARTHROSCOPY AID TX SPINEAND-FX KNEE W-FIXJ,29851,HCPCS,,,LT,Outpatient,,,8022.34,2005.585,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5262.66,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5615.64,Percent of Total Billed Charges, ,,85,,6818.99,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5455.19,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4492.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4813.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29855 - ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR,29855,HCPCS,,,RT,Outpatient,,,7867.34,1966.835,950.4,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5160.98,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5507.14,Percent of Total Billed Charges, ,,85,,6687.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5349.79,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4405.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4720.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29862 - ARTHRS HIP DEBRIDEMENT-SHAVING ARTICULAR CRTLG,29862,HCPCS,,,RT,Outpatient,,,8638.88,2159.72,950.4,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5667.11,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6047.22,Percent of Total Billed Charges, ,,85,,7343.05,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5874.44,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4837.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5183.33,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29863 - ARTHROSCOPY HIP SURGICAL W-SYNOVECTOMY,29863,HCPCS,,,RT,Outpatient,,,13381,3345.25,950.4,11373.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8777.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9366.7,Percent of Total Billed Charges, ,,85,,11373.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9099.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7493.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8028.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29863 - ARTHROSCOPY HIP SURGICAL W-SYNOVECTOMY,29863,HCPCS,,,LT,Outpatient,,,17152,4288,950.4,14579.2,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11251.71,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12006.4,Percent of Total Billed Charges, ,,85,,14579.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11663.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9605.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10291.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29868 - ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED-LAT,29868,HCPCS,,,RT,Outpatient,,,16451,4112.75,1078.11,13983.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10791.86,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11515.7,Percent of Total Billed Charges, ,,85,,13983.35,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11186.68,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9212.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9870.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29870 - ARTHROSCOPY KNEE DIAGNOSTIC W-WO SYNOVIAL BX SPX,29870,HCPCS,,,XS,Outpatient,,,8952.33,2238.0825,742.5,7609.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5872.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6266.63,Percent of Total Billed Charges, ,,85,,7609.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6087.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5013.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5371.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29870 - ARTHROSCOPY KNEE DIAGNOSTIC W-WO SYNOVIAL BX SPX,29870,HCPCS,,,LT,Outpatient,,,8909.25,2227.3125,742.5,7572.86,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5844.47,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6236.48,Percent of Total Billed Charges, ,,85,,7572.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6058.29,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4989.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5345.55,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29870 - ARTHROSCOPY KNEE DIAGNOSTIC W-WO SYNOVIAL BX SPX,29870,HCPCS,,,59,Outpatient,,,8952.33,2238.0825,742.5,7609.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5872.73,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6266.63,Percent of Total Billed Charges, ,,85,,7609.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6087.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5013.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5371.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29873 - ARTHROSCOPY KNEE LATERAL RELEASE,29873,HCPCS,,,XU,Outpatient,,,8984.5,2246.125,882.09,7636.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5893.83,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6289.15,Percent of Total Billed Charges, ,,85,,7636.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6109.46,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5031.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5390.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29873 - ARTHROSCOPY KNEE LATERAL RELEASE,29873,HCPCS,,,RT,Outpatient,,,9319.02,2329.755,882.09,7921.17,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6113.28,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6523.31,Percent of Total Billed Charges, ,,85,,7921.17,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6336.93,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5218.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5591.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29873 - ARTHROSCOPY KNEE LATERAL RELEASE,29873,HCPCS,,,LT,Outpatient,,,11773.59,2943.3975,882.09,10007.55,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7723.48,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8241.51,Percent of Total Billed Charges, ,,85,,10007.55,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8006.04,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6593.21,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7064.15,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29874 - ARTHROSCOPY KNEE REMOVAL LOOSE-FOREIGN BODY,29874,HCPCS,,,RT,Outpatient,,,11983.23,2995.8075,742.5,10185.75,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7861,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8388.26,Percent of Total Billed Charges, ,,85,,10185.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8148.6,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6710.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7189.94,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29874 - ARTHROSCOPY KNEE REMOVAL LOOSE-FOREIGN BODY,29874,HCPCS,,,LT,Outpatient,,,11558.22,2889.555,742.5,9824.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7582.19,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8090.75,Percent of Total Billed Charges, ,,85,,9824.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7859.59,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6472.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6934.93,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29875 - ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,29875,HCPCS,,,XU,Outpatient,,,7650.75,1912.6875,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5018.89,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5355.53,Percent of Total Billed Charges, ,,85,,6503.14,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5202.51,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4284.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4590.45,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29875 - ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,29875,HCPCS,,,XS,Outpatient,,,7748.75,1937.1875,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5083.18,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5424.13,Percent of Total Billed Charges, ,,85,,6586.44,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5269.15,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4339.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4649.25,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29875 - ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,29875,HCPCS,,,RT,Outpatient,,,13142.25,3285.5625,882.09,11170.91,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8621.32,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9199.58,Percent of Total Billed Charges, ,,85,,11170.91,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8936.73,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7359.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7885.35,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29875 - ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,29875,HCPCS,,,LT,Outpatient,,,8665.69,2166.4225,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5684.69,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6065.98,Percent of Total Billed Charges, ,,85,,7365.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5892.67,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4852.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5199.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29875 - ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,29875,HCPCS,,,59,Outpatient,,,7646,1911.5,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5015.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5352.2,Percent of Total Billed Charges, ,,85,,6499.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5199.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4281.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4587.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29876 - ARTHROSCOPY KNEE SYNOVECTOMY 2-GREATER THAN COMPARTMENTS,29876,HCPCS,,,RT,Outpatient,,,10199.08,2549.77,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6690.6,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7139.36,Percent of Total Billed Charges, ,,85,,8669.22,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6935.37,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5711.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6119.45,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29876 - ARTHROSCOPY KNEE SYNOVECTOMY 2-GREATER THAN COMPARTMENTS,29876,HCPCS,,,LT,Outpatient,,,8490.27,2122.5675,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5569.62,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5943.19,Percent of Total Billed Charges, ,,85,,7216.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5773.38,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4754.55,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5094.16,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29877 - ARTHRS KNEE DEBRIDEMENT-SHAVING ARTCLR CRTLG,29877,HCPCS,,,RT,Outpatient,,,10650.82,2662.705,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6986.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7455.57,Percent of Total Billed Charges, ,,85,,9053.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7242.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5964.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6390.49,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29877 - ARTHRS KNEE DEBRIDEMENT-SHAVING ARTCLR CRTLG,29877,HCPCS,,,LT,Outpatient,,,12067.07,3016.7675,882.09,10257.01,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7916,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8446.95,Percent of Total Billed Charges, ,,85,,10257.01,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8205.61,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6757.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7240.24,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29877 - ARTHRS KNEE DEBRIDEMENT-SHAVING ARTCLR CRTLG,29877,HCPCS,,,50,Outpatient,,,18082,4520.5,882.09,15369.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11861.79,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12657.4,Percent of Total Billed Charges, ,,85,,15369.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12295.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10125.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10849.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29879 - ARTHRS KNEE ABRASION ARTHRP-MLT DRLG-MICROFX,29879,HCPCS,,,RT,Outpatient,,,8781.38,2195.345,882.09,7464.17,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5760.59,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6146.97,Percent of Total Billed Charges, ,,85,,7464.17,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5971.34,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4917.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5268.83,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29879 - ARTHRS KNEE ABRASION ARTHRP-MLT DRLG-MICROFX,29879,HCPCS,,,LT,Outpatient,,,9445.94,2361.485,882.09,8029.05,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6196.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6612.16,Percent of Total Billed Charges, ,,85,,8029.05,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6423.24,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5289.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5667.56,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29880 - ARTHRS KNEE W-MENISCECTOMY MEDANDLAT W-SHAVING,29880,HCPCS,,,RT,Outpatient,,,13347.61,3336.9025,882.09,11345.47,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8756.03,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9343.33,Percent of Total Billed Charges, ,,85,,11345.47,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9076.37,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7474.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8008.57,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29880 - ARTHRS KNEE W-MENISCECTOMY MEDANDLAT W-SHAVING,29880,HCPCS,,,LT,Outpatient,,,12761.47,3190.3675,882.09,10847.25,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8371.52,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8933.03,Percent of Total Billed Charges, ,,85,,10847.25,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8677.8,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7146.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7656.88,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29880 - ARTHRS KNEE W-MENISCECTOMY MEDANDLAT W-SHAVING,29880,HCPCS,,,50,Outpatient,,,25367,6341.75,882.09,21561.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16640.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17756.9,Percent of Total Billed Charges, ,,85,,21561.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17249.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14205.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15220.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29881 - ARTHRS KNE SURG W-MENISCECTOMY MED-LAT W-SHVG,29881,HCPCS,,,XU,Outpatient,,,7445.94,1861.485,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4884.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5212.16,Percent of Total Billed Charges, ,,85,,6329.05,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5063.24,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4169.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4467.56,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29881 - ARTHRS KNE SURG W-MENISCECTOMY MED-LAT W-SHVG,29881,HCPCS,,,XS,Outpatient,,,8309.86,2077.465,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5451.27,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5816.9,Percent of Total Billed Charges, ,,85,,7063.38,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5650.7,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4653.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4985.92,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29881 - ARTHRS KNE SURG W-MENISCECTOMY MED-LAT W-SHVG,29881,HCPCS,,,RT,Outpatient,,,12317.49,3079.3725,882.09,10469.87,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8080.27,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8622.24,Percent of Total Billed Charges, ,,85,,10469.87,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8375.89,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6897.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7390.49,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29881 - ARTHRS KNE SURG W-MENISCECTOMY MED-LAT W-SHVG,29881,HCPCS,,,LT,Outpatient,,,12677.57,3169.3925,882.09,10775.93,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8316.49,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8874.3,Percent of Total Billed Charges, ,,85,,10775.93,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8620.75,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7099.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7606.54,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29881 - ARTHRS KNE SURG W-MENISCECTOMY MED-LAT W-SHVG,29881,HCPCS,,,50,Outpatient,,,18237,4559.25,882.09,15501.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11963.47,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12765.9,Percent of Total Billed Charges, ,,85,,15501.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12401.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10212.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10942.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29882 - ARTHROSCOPY KNEE W-MENISCUS RPR MEDIAL-LATERAL,29882,HCPCS,,,RT,Outpatient,,,10629.72,2657.43,742.5,9035.26,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6973.1,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7440.8,Percent of Total Billed Charges, ,,85,,9035.26,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7228.21,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5952.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6377.83,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29882 - ARTHROSCOPY KNEE W-MENISCUS RPR MEDIAL-LATERAL,29882,HCPCS,,,LT,Outpatient,,,11199.48,2799.87,742.5,9519.56,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7346.86,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7839.64,Percent of Total Billed Charges, ,,85,,9519.56,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7615.65,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6271.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6719.69,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29882 - ARTHROSCOPY KNEE W-MENISCUS RPR MEDIAL-LATERAL,29882,HCPCS,,,22,Outpatient,,,23972,5993,742.5,20376.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15725.63,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16780.4,Percent of Total Billed Charges, ,,85,,20376.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16300.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13424.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14383.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29883 - ARTHROSCOPY KNEE W-MENISCUS RPR MEDIALANDLATERAL,29883,HCPCS,,,RT,Outpatient,,,10923.13,2730.7825,882.09,9284.66,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7165.57,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7646.19,Percent of Total Billed Charges, ,,85,,9284.66,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7427.73,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6116.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6553.88,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29883 - ARTHROSCOPY KNEE W-MENISCUS RPR MEDIALANDLATERAL,29883,HCPCS,,,LT,Outpatient,,,8830.34,2207.585,882.09,7505.79,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5792.7,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6181.24,Percent of Total Billed Charges, ,,85,,7505.79,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6004.63,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4944.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5298.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29884 - ARTHROSCOPY KNEE W-LYSIS ADHESIONS W-WO MANJ SPX,29884,HCPCS,,,XS,Outpatient,,,10793.5,2698.375,882.09,9174.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7080.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7555.45,Percent of Total Billed Charges, ,,85,,9174.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7339.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6044.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6476.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29884 - ARTHROSCOPY KNEE W-LYSIS ADHESIONS W-WO MANJ SPX,29884,HCPCS,,,RT,Outpatient,,,9702.75,2425.6875,882.09,8247.34,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6365,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6791.93,Percent of Total Billed Charges, ,,85,,8247.34,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6597.87,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5433.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5821.65,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29884 - ARTHROSCOPY KNEE W-LYSIS ADHESIONS W-WO MANJ SPX,29884,HCPCS,,,LT,Outpatient,,,14083.75,3520.9375,882.09,11971.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9238.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9858.63,Percent of Total Billed Charges, ,,85,,11971.19,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9576.95,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7886.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8450.25,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29885 - ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG,29885,HCPCS,,,RT,Outpatient,,,15611.5,3902.875,882.09,13269.78,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10241.14,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10928.05,Percent of Total Billed Charges, ,,85,,13269.78,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10615.82,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8742.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9366.9,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29886 - ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION,29886,HCPCS,,,RT,Outpatient,,,15292,3823,882.09,12998.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10031.55,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10704.4,Percent of Total Billed Charges, ,,85,,12998.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10398.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8563.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9175.2,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29886 - ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION,29886,HCPCS,,,LT,Outpatient,,,7646,1911.5,882.09,6499.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5015.78,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5352.2,Percent of Total Billed Charges, ,,85,,6499.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5199.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4281.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4587.6,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29887 - ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ,29887,HCPCS,,,RT,Outpatient,,,11069,2767.25,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7261.26,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7748.3,Percent of Total Billed Charges, ,,85,,9408.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7526.92,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6198.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6641.4,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29888 - ARTHRS AIDED ANT CRUCIATE LIGM RPR-AGMNTJ-RCNSTJ,29888,HCPCS,,,XU,Outpatient,,,11610.22,2902.555,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7616.3,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8127.15,Percent of Total Billed Charges, ,,85,,9868.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7894.95,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6501.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6966.13,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29888 - ARTHRS AIDED ANT CRUCIATE LIGM RPR-AGMNTJ-RCNSTJ,29888,HCPCS,,,XS,Outpatient,,,10682.73,2670.6825,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7007.87,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7477.91,Percent of Total Billed Charges, ,,85,,9080.32,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7264.26,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5982.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6409.64,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29888 - ARTHRS AIDED ANT CRUCIATE LIGM RPR-AGMNTJ-RCNSTJ,29888,HCPCS,,,RT,Outpatient,,,12532.71,3133.1775,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8221.46,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8772.9,Percent of Total Billed Charges, ,,85,,10652.8,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8522.24,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7018.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7519.63,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29888 - ARTHRS AIDED ANT CRUCIATE LIGM RPR-AGMNTJ-RCNSTJ,29888,HCPCS,,,LT,Outpatient,,,11343.17,2835.7925,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7441.12,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7940.22,Percent of Total Billed Charges, ,,85,,9641.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7713.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6352.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6805.9,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29888 - ARTHRS AIDED ANT CRUCIATE LIGM RPR-AGMNTJ-RCNSTJ,29888,HCPCS,,,59,Outpatient,,,8254.25,2063.5625,882.09,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5414.79,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5777.98,Percent of Total Billed Charges, ,,85,,7016.11,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5612.89,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4622.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4952.55,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29889 - ARTHRS AIDED PST CRUCIATE LIGM RPR-AGMNTJ-RCNSTJ,29889,HCPCS,,,XU,Outpatient,,,9406.96,2351.74,882.09,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6170.97,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6584.87,Percent of Total Billed Charges, ,,85,,7995.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6396.73,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5267.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5644.18,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29889 - ARTHRS AIDED PST CRUCIATE LIGM RPR-AGMNTJ-RCNSTJ,29889,HCPCS,,,XS,Outpatient,,,9327.4,2331.85,882.09,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6118.77,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6529.18,Percent of Total Billed Charges, ,,85,,7928.29,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6342.63,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5223.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5596.44,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29889 - ARTHRS AIDED PST CRUCIATE LIGM RPR-AGMNTJ-RCNSTJ,29889,HCPCS,,,RT,Outpatient,,,13602.33,3400.5825,882.09,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8923.13,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9521.63,Percent of Total Billed Charges, ,,85,,11561.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9249.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7617.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8161.4,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29889 - ARTHRS AIDED PST CRUCIATE LIGM RPR-AGMNTJ-RCNSTJ,29889,HCPCS,,,LT,Outpatient,,,9876.66,2469.165,882.09,21166.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6479.09,Percent of Total Billed Charges, ,21166.19,,,21166.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6913.66,Percent of Total Billed Charges, ,,85,,8395.16,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6716.13,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5530.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5926,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20502.68,,,20502.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29891 - ARTHRS ANKLE EXC OSTCHNDRL DFCT W-DRLG DFCT,29891,HCPCS,,,RT,Outpatient,,,7935.35,1983.8375,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5205.59,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5554.75,Percent of Total Billed Charges, ,,85,,6745.05,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5396.04,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4443.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4761.21,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29891 - ARTHRS ANKLE EXC OSTCHNDRL DFCT W-DRLG DFCT,29891,HCPCS,,,LT,Outpatient,,,9772.63,2443.1575,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6410.85,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6840.84,Percent of Total Billed Charges, ,,85,,8306.74,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6645.39,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5472.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5863.58,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29892 - ARTHRS AID RPR LES-TALAR DOME FX-TIBL PLAFOND FX,29892,HCPCS,,,LT,Outpatient,,,8651.75,2162.9375,950.4,10730.04,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5675.55,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6056.23,Percent of Total Billed Charges, ,,85,,7353.99,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5883.19,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4844.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5191.05,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29893 - ENDOSCOPIC PLANTAR FASCIOTOMY,29893,HCPCS,,,RT,Outpatient,,,9284.75,2321.1875,882.09,13976,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6090.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6499.33,Percent of Total Billed Charges, ,,85,,7892.04,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6313.63,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5199.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5570.85,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29893 - ENDOSCOPIC PLANTAR FASCIOTOMY,29893,HCPCS,,,LT,Outpatient,,,8331.8,2082.95,882.09,13976,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5465.66,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5832.26,Percent of Total Billed Charges, ,,85,,7082.03,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5665.62,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4665.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4999.08,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29894 - ARTHROSCOPY ANKLE W-REMOVAL LOOSE-FOREIGN BODY,29894,HCPCS,,,XS,Outpatient,,,19193.5,4798.375,882.09,16314.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12590.94,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13435.45,Percent of Total Billed Charges, ,,85,,16314.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13051.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10748.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11516.1,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29894 - ARTHROSCOPY ANKLE W-REMOVAL LOOSE-FOREIGN BODY,29894,HCPCS,,,RT,Outpatient,,,7817.73,1954.4325,882.09,6645.07,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5128.43,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5472.41,Percent of Total Billed Charges, ,,85,,6645.07,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5316.06,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4377.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4690.64,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29894 - ARTHROSCOPY ANKLE W-REMOVAL LOOSE-FOREIGN BODY,29894,HCPCS,,,LT,Outpatient,,,6376.05,1594.0125,882.09,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4182.69,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4463.24,Percent of Total Billed Charges, ,,85,,5419.64,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4335.71,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3570.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3825.63,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29897 - ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED,29897,HCPCS,,,XS,Outpatient,,,14190.66,3547.665,950.4,12062.06,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9309.07,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9933.46,Percent of Total Billed Charges, ,,85,,12062.06,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9649.65,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7946.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8514.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29897 - ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED,29897,HCPCS,,,RT,Outpatient,,,11002.35,2750.5875,950.4,9352,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7217.54,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7701.65,Percent of Total Billed Charges, ,,85,,9352,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7481.6,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6161.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6601.41,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29897 - ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED,29897,HCPCS,,,LT,Outpatient,,,16784.35,4196.0875,950.4,14266.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11010.53,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11749.05,Percent of Total Billed Charges, ,,85,,14266.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11413.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9399.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10070.61,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29898 - ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE,29898,HCPCS,,,XU,Outpatient,,,4691.71,1172.9275,1078.11,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3077.76,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3284.2,Percent of Total Billed Charges, ,,85,,3987.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3190.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2627.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2815.03,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29898 - ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE,29898,HCPCS,,,RT,Outpatient,,,6725.79,1681.4475,1078.11,5716.92,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4412.12,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4708.05,Percent of Total Billed Charges, ,,85,,5716.92,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4573.54,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3766.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4035.47,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29898 - ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE,29898,HCPCS,,,LT,Outpatient,,,7303.23,1825.8075,1078.11,6207.75,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4790.92,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5112.26,Percent of Total Billed Charges, ,,85,,6207.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4966.2,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4089.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4381.94,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29906 - ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT,29906,HCPCS,,,RT,Outpatient,,,7184.54,1796.135,882.09,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4713.06,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5029.18,Percent of Total Billed Charges, ,,85,,6106.86,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4885.49,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4023.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4310.72,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29906 - ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT,29906,HCPCS,,,LT,Outpatient,,,4885.66,1221.415,882.09,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3204.99,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3419.96,Percent of Total Billed Charges, ,,85,,4152.81,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3322.25,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2735.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2931.4,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29914 - ARTHROSCOPY HIP W-FEMOROPLASTY,29914,HCPCS,,,RT,Outpatient,,,11557.06,2889.265,882.09,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7581.43,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8089.94,Percent of Total Billed Charges, ,,85,,9823.5,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7858.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6471.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6934.24,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29914 - ARTHROSCOPY HIP W-FEMOROPLASTY,29914,HCPCS,,,LT,Outpatient,,,9992.76,2498.19,882.09,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6555.25,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6994.93,Percent of Total Billed Charges, ,,85,,8493.85,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6795.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5595.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5995.66,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29914 - ARTHROSCOPY HIP W-FEMOROPLASTY,29914,HCPCS,,,1P,Outpatient,,,14621,3655.25,882.09,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9591.38,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10234.7,Percent of Total Billed Charges, ,,85,,12427.85,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9942.28,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8187.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8772.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29915 - ARTHROSCOPY HIP W-ACETABULOPLASTY,29915,HCPCS,,,RT,Outpatient,,,12232.92,3058.23,882.09,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8024.8,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8563.04,Percent of Total Billed Charges, ,,85,,10397.98,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8318.39,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6850.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7339.75,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29915 - ARTHROSCOPY HIP W-ACETABULOPLASTY,29915,HCPCS,,,LT,Outpatient,,,15659.8,3914.95,882.09,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10272.83,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10961.86,Percent of Total Billed Charges, ,,85,,13310.83,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10648.66,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8769.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9395.88,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29916 - ARTHROSCOPY HIP W-LABRAL REPAIR,29916,HCPCS,,,RT,Outpatient,,,9690.73,2422.6825,882.09,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6357.12,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6783.51,Percent of Total Billed Charges, ,,85,,8237.12,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6589.7,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5426.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5814.44,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29916 - ARTHROSCOPY HIP W-LABRAL REPAIR,29916,HCPCS,,,LT,Outpatient,,,10027.41,2506.8525,882.09,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6577.98,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7019.19,Percent of Total Billed Charges, ,,85,,8523.3,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6818.64,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5615.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6016.45,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29999 - UNLISTED PROCEDURE ARTHROSCOPY,29999,HCPCS,,,RT,Outpatient,,,8266,2066.5,0.01,7026.1,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5422.5,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5786.2,Percent of Total Billed Charges, ,,85,,7026.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5620.88,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4628.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4959.6,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29999 - UNLISTED PROCEDURE ARTHROSCOPY,29999,HCPCS,,,LT,Outpatient,,,6513.44,1628.36,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4272.82,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4559.41,Percent of Total Billed Charges, ,,85,,5536.42,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4429.14,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3647.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3908.06,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30100 - BIOPSY INTRANASAL,30100,HCPCS,,,RT,Outpatient,,,7397.5,1849.375,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2187.63,,,2187.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4852.76,Percent of Total Billed Charges, ,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5178.25,Percent of Total Billed Charges, ,,85,,6287.88,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5030.3,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4142.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4438.5,Percent of Total Billed Charges, ,2165.28,,,2165.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2181.22,,,2181.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1457.6,,,1457.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1471.68,,,1471.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1408.31,,,1408.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1450.56,,,1450.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1475.2,,,1475.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30117 - EXCISION-DESTRUCTION INTRANASAL LESION INT APPR,30117,HCPCS,,,RT,Outpatient,,,11831,2957.75,882.09,10056.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7761.14,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8281.7,Percent of Total Billed Charges, ,,85,,10056.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8045.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6625.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7098.6,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30130 - EXCISION INFERIOR TURBINATE PARTIAL-COMPLETE,30130,HCPCS,,,LT,Outpatient,,,7259.5,1814.875,742.5,6170.58,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4762.23,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5081.65,Percent of Total Billed Charges, ,,85,,6170.58,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4936.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4065.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4355.7,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30130 - EXCISION INFERIOR TURBINATE PARTIAL-COMPLETE,30130,HCPCS,,,50,Outpatient,,,8497.7,2124.425,742.5,7223.05,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5574.49,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5948.39,Percent of Total Billed Charges, ,,85,,7223.05,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5778.44,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4758.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5098.62,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30140 - SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL-COMPL,30140,HCPCS,,,XU,Outpatient,,,11555.66,2888.915,1078.11,9822.31,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7580.51,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8088.96,Percent of Total Billed Charges, ,,85,,9822.31,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7857.85,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6471.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6933.4,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30140 - SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL-COMPL,30140,HCPCS,,,RT,Outpatient,,,10023,2505.75,1078.11,8519.55,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6575.09,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7016.1,Percent of Total Billed Charges, ,,85,,8519.55,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6815.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5612.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6013.8,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30140 - SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL-COMPL,30140,HCPCS,,,LT,Outpatient,,,9248,2312,1078.11,7860.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6066.69,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6473.6,Percent of Total Billed Charges, ,,85,,7860.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6288.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5178.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5548.8,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30140 - SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL-COMPL,30140,HCPCS,,,50,Outpatient,,,7582.19,1895.5475,1078.11,6444.86,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4973.92,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5307.53,Percent of Total Billed Charges, ,,85,,6444.86,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5155.89,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4246.03,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4549.31,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30465 - REPAIR NASAL VESTIBULAR STENOSIS,30465,HCPCS,,,50,Outpatient,,,7262.12,1815.53,1078.11,13976,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4763.95,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5083.48,Percent of Total Billed Charges, ,,85,,6172.8,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4938.24,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4066.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4357.27,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30520 - SEPTOPLASTY-SUBMUCOUS RESECJ W-WO CARTILAGE GRF,30520,HCPCS,,,50,Outpatient,,,5935.75,1483.9375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3893.85,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4155.03,Percent of Total Billed Charges, ,,85,,5045.39,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4036.31,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3324.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3561.45,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,30901,HCPCS,,,RT,Outpatient,,,3342.5,835.625,122.55,2841.13,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2192.68,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2339.75,Percent of Total Billed Charges, ,,85,,2841.13,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2272.9,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1871.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2005.5,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,30901,HCPCS,,,LT,Outpatient,,,6439.83,1609.9575,122.55,5473.86,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4224.53,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4507.88,Percent of Total Billed Charges, ,,85,,5473.86,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4379.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3606.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3863.9,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30930 - FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC,30930,HCPCS,,,50,Outpatient,,,8294.5,2073.625,3083.32,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5441.19,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5806.15,Percent of Total Billed Charges, ,,85,,7050.33,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5640.26,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4644.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4976.7,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
31032 - SINUSOT MAX ANTRT RAD W-RMVL ANTROCH POLYPS,31032,HCPCS,,,50,Outpatient,,,17540.5,4385.125,1078.11,14909.43,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11506.57,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12278.35,Percent of Total Billed Charges, ,,85,,14909.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11927.54,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9822.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10524.3,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31237 - NASAL-SINUS NDSC SURG W-BX POLYPC-DBRDMT SPX,31237,HCPCS,,,XU,Outpatient,,,10359.68,2589.92,882.09,8805.73,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6795.95,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7251.78,Percent of Total Billed Charges, ,,85,,8805.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7044.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5801.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6215.81,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31237 - NASAL-SINUS NDSC SURG W-BX POLYPC-DBRDMT SPX,31237,HCPCS,,,RT,Outpatient,,,9966,2491.5,882.09,8471.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6537.7,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6976.2,Percent of Total Billed Charges, ,,85,,8471.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6776.88,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5580.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5979.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31237 - NASAL-SINUS NDSC SURG W-BX POLYPC-DBRDMT SPX,31237,HCPCS,,,LT,Outpatient,,,11751,2937.75,882.09,9988.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7708.66,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8225.7,Percent of Total Billed Charges, ,,85,,9988.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7990.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6580.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7050.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31237 - NASAL-SINUS NDSC SURG W-BX POLYPC-DBRDMT SPX,31237,HCPCS,,,50,Outpatient,,,4014,1003.5,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2633.18,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2809.8,Percent of Total Billed Charges, ,,85,,3411.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2729.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2247.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2408.4,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31238 - NASAL-SINUS NDSC SURG W-CONTROL NASAL HEMORRHAGE,31238,HCPCS,,,RT,Outpatient,,,18711,4677.75,882.09,15904.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12274.42,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13097.7,Percent of Total Billed Charges, ,,85,,15904.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12723.48,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10478.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11226.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31238 - NASAL-SINUS NDSC SURG W-CONTROL NASAL HEMORRHAGE,31238,HCPCS,,,LT,Outpatient,,,7722,1930.5,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5065.63,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5405.4,Percent of Total Billed Charges, ,,85,,6563.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5250.96,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4324.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4633.2,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31238 - NASAL-SINUS NDSC SURG W-CONTROL NASAL HEMORRHAGE,31238,HCPCS,,,50,Outpatient,,,8742,2185.5,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5734.75,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6119.4,Percent of Total Billed Charges, ,,85,,7430.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5944.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4895.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5245.2,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31239 - NASAL-SINUS NDSC SURG W-DACRYOCYSTORHINOSTOMY,31239,HCPCS,,,RT,Outpatient,,,14706,3676.5,882.09,12500.1,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9647.14,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10294.2,Percent of Total Billed Charges, ,,85,,12500.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10000.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8235.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8823.6,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31240 - NASAL-SINUS NDSC SURG W-CONCHA BULLOSA RESECTION,31240,HCPCS,,,RT,Outpatient,,,5551.75,1387.9375,882.09,4718.99,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3641.95,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3886.23,Percent of Total Billed Charges, ,,85,,4718.99,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3775.19,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3108.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3331.05,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31240 - NASAL-SINUS NDSC SURG W-CONCHA BULLOSA RESECTION,31240,HCPCS,,,LT,Outpatient,,,5742.55,1435.6375,882.09,4881.17,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3767.11,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4019.79,Percent of Total Billed Charges, ,,85,,4881.17,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3904.93,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3215.83,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3445.53,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31240 - NASAL-SINUS NDSC SURG W-CONCHA BULLOSA RESECTION,31240,HCPCS,,,50,Outpatient,,,6025.17,1506.2925,882.09,5121.39,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3952.51,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4217.62,Percent of Total Billed Charges, ,,85,,5121.39,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4097.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3374.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3615.1,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31253 - NASAL-SINUS NDSC TOT W-FRNT SINS EXPL TISS RMVL,31253,HCPCS,,,50,Outpatient,,,6893.83,1723.4575,950.4,10223.49,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4522.35,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4825.68,Percent of Total Billed Charges, ,,85,,5859.76,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4687.8,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3860.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4136.3,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31254 - NASAL-SINUS NDSC W-PARTIAL ETHMOIDECTOMY,31254,HCPCS,,,RT,Outpatient,,,5291.17,1322.7925,882.09,10223.49,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3471.01,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3703.82,Percent of Total Billed Charges, ,,85,,4497.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3598,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2963.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3174.7,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31254 - NASAL-SINUS NDSC W-PARTIAL ETHMOIDECTOMY,31254,HCPCS,,,LT,Outpatient,,,6473.78,1618.445,882.09,10223.49,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4246.8,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4531.65,Percent of Total Billed Charges, ,,85,,5502.71,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4402.17,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3625.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3884.27,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31254 - NASAL-SINUS NDSC W-PARTIAL ETHMOIDECTOMY,31254,HCPCS,,,50,Outpatient,,,7309.83,1827.4575,882.09,10223.49,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4795.25,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5116.88,Percent of Total Billed Charges, ,,85,,6213.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4970.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4093.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4385.9,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31255 - NASAL-SINUS NDSC W-TOTAL ETHOIDECTOMY,31255,HCPCS,,,XU,Outpatient,,,3178.83,794.7075,950.4,10223.49,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2085.31,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2225.18,Percent of Total Billed Charges, ,,85,,2702.01,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2161.6,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1780.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1907.3,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31255 - NASAL-SINUS NDSC W-TOTAL ETHOIDECTOMY,31255,HCPCS,,,LT,Outpatient,,,8343.47,2085.8675,950.4,10223.49,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5473.32,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5840.43,Percent of Total Billed Charges, ,,85,,7091.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5673.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4672.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5006.08,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31255 - NASAL-SINUS NDSC W-TOTAL ETHOIDECTOMY,31255,HCPCS,,,50,Outpatient,,,8208.96,2052.24,950.4,10223.49,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5385.08,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5746.27,Percent of Total Billed Charges, ,,85,,6977.62,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5582.09,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4597.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4925.38,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31256 - NASAL-SINUS ENDOSCOPY W-MAXILLARY ANTROSTOMY,31256,HCPCS,,,RT,Outpatient,,,5980.89,1495.2225,882.09,5445.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3923.46,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4186.62,Percent of Total Billed Charges, ,,85,,5083.76,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4067.01,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3349.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3588.53,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31256 - NASAL-SINUS ENDOSCOPY W-MAXILLARY ANTROSTOMY,31256,HCPCS,,,50,Outpatient,,,6033.46,1508.365,882.09,5445.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3957.95,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4223.42,Percent of Total Billed Charges, ,,85,,5128.44,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4102.75,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3378.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3620.08,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31257 - NASAL-SINUS NDSC TOTAL WITH SPHENOIDOTOMY,31257,HCPCS,,,RT,Outpatient,,,6060.79,1515.1975,950.4,10223.49,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3975.88,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4242.55,Percent of Total Billed Charges, ,,85,,5151.67,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4121.34,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3394.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3636.47,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31257 - NASAL-SINUS NDSC TOTAL WITH SPHENOIDOTOMY,31257,HCPCS,,,50,Outpatient,,,6873.85,1718.4625,950.4,10223.49,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4509.25,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4811.7,Percent of Total Billed Charges, ,,85,,5842.77,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4674.22,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3849.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4124.31,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31259 - NASAL-SINUS NDSC TOT W-SPHENDT W-SPHEN TISS RMVL,31259,HCPCS,,,50,Outpatient,,,8588.02,2147.005,950.4,10223.49,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5633.74,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6011.61,Percent of Total Billed Charges, ,,85,,7299.82,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5839.85,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4809.29,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5152.81,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31267 - NSL-SINUS NDSC MAX ANTROST W-RMVL TISS MAX SINUS,31267,HCPCS,,,RT,Outpatient,,,7882.59,1970.6475,882.09,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5170.98,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5517.81,Percent of Total Billed Charges, ,,85,,6700.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5360.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4414.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4729.55,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31267 - NSL-SINUS NDSC MAX ANTROST W-RMVL TISS MAX SINUS,31267,HCPCS,,,LT,Outpatient,,,7706.86,1926.715,882.09,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5055.7,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5394.8,Percent of Total Billed Charges, ,,85,,6550.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5240.66,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4315.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4624.12,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31267 - NSL-SINUS NDSC MAX ANTROST W-RMVL TISS MAX SINUS,31267,HCPCS,,,50,Outpatient,,,7234.18,1808.545,882.09,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4745.62,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5063.93,Percent of Total Billed Charges, ,,85,,6149.05,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4919.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4051.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4340.51,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31276 - NASAL-SINUS NDSC W-RMVL TISS FROM FRONTAL SINUS,31276,HCPCS,,,RT,Outpatient,,,4856.02,1214.005,882.09,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3185.55,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3399.21,Percent of Total Billed Charges, ,,85,,4127.62,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3302.09,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2719.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2913.61,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31276 - NASAL-SINUS NDSC W-RMVL TISS FROM FRONTAL SINUS,31276,HCPCS,,,LT,Outpatient,,,3733.25,933.3125,882.09,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2449.01,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2613.28,Percent of Total Billed Charges, ,,85,,3173.26,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2538.61,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2090.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2239.95,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31276 - NASAL-SINUS NDSC W-RMVL TISS FROM FRONTAL SINUS,31276,HCPCS,,,50,Outpatient,,,6142.37,1535.5925,882.09,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4029.39,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4299.66,Percent of Total Billed Charges, ,,85,,5221.01,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4176.81,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3439.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3685.42,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31287 - NASAL-SINUS ENDOSCOPY W-SPHENOIDOTOMY,31287,HCPCS,,,RT,Outpatient,,,4425.66,1106.415,950.4,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2903.23,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3097.96,Percent of Total Billed Charges, ,,85,,3761.81,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3009.45,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2478.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2655.4,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31295 - NASAL-SINUS NDSC SURG W-DILATION MAXILLARY SINUS,31295,HCPCS,,,RT,Outpatient,,,6012,1503,950.4,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3943.87,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4208.4,Percent of Total Billed Charges, ,,85,,5110.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4088.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3366.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3607.2,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31295 - NASAL-SINUS NDSC SURG W-DILATION MAXILLARY SINUS,31295,HCPCS,,,50,Outpatient,,,7634.83,1908.7075,950.4,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5008.45,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5344.38,Percent of Total Billed Charges, ,,85,,6489.61,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5191.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4275.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4580.9,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31296 - NASAL-SINUS NDSC SURG W-DILATION FRONTAL SINUS,31296,HCPCS,,,RT,Outpatient,,,3178.83,794.7075,950.4,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2085.31,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2225.18,Percent of Total Billed Charges, ,,85,,2702.01,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2161.6,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1780.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1907.3,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31296 - NASAL-SINUS NDSC SURG W-DILATION FRONTAL SINUS,31296,HCPCS,,,LT,Outpatient,,,5836.14,1459.035,950.4,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3828.51,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4085.3,Percent of Total Billed Charges, ,,85,,4960.72,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3968.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3268.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3501.68,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31296 - NASAL-SINUS NDSC SURG W-DILATION FRONTAL SINUS,31296,HCPCS,,,50,Outpatient,,,7303.44,1825.86,950.4,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4791.06,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5112.41,Percent of Total Billed Charges, ,,85,,6207.92,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4966.34,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4089.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4382.06,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31297 - NASAL-SINUS NDSC SURG W-DILATION SPHENOID SINUS,31297,HCPCS,,,LT,Outpatient,,,7286.75,1821.6875,950.4,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4780.11,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5100.73,Percent of Total Billed Charges, ,,85,,6193.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4954.99,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4080.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4372.05,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31297 - NASAL-SINUS NDSC SURG W-DILATION SPHENOID SINUS,31297,HCPCS,,,50,Outpatient,,,6673.11,1668.2775,950.4,10223.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4377.56,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4671.18,Percent of Total Billed Charges, ,,85,,5672.14,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4537.71,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3736.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4003.87,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31298 - NASAL-SINUS NDSC SURG W-DILATION FRNTANDSPHN SINUS,31298,HCPCS,,,50,Outpatient,,,10359.66,2589.915,950.4,10223.49,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10223.49,,,10223.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6795.94,Percent of Total Billed Charges, ,10036.47,,,10036.47,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7251.76,Percent of Total Billed Charges, ,,85,,8805.71,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7044.57,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5801.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6215.8,Percent of Total Billed Charges, ,10119.01,,,10119.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9721.85,,,9721.85,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6811.82,,,6811.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6877.64,,,6877.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6581.47,,,6581.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6647.28,,,6647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6778.91,,,6778.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6894.09,,,6894.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31525 - LARYNGOSCOPY W-WO TRACHEOSCOPY DX EXCEPT NEWBORN,31525,HCPCS,,,XU,Outpatient,,,4241.68,1060.42,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2782.54,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2969.18,Percent of Total Billed Charges, ,,85,,3605.43,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2884.34,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2375.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2545.01,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31526 - LARYNGOSCOPY W-WO TRACHEOSCOPY W-MICRO-TELESCOPE,31526,HCPCS,,,XU,Outpatient,,,6909.68,1727.42,742.5,5873.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4532.75,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4836.78,Percent of Total Billed Charges, ,,85,,5873.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4698.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3869.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4145.81,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31535 - LARYNGOSCOPY DIRECT OPERATIVE W-BIOPSY,31535,HCPCS,,,XU,Outpatient,,,5445.54,1361.385,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3572.27,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3811.88,Percent of Total Billed Charges, ,,85,,4628.71,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3702.97,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3049.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3267.32,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31536 - LARYNGOSCOPY W-BIOPSY MICROSCOPE-TELESCOPE,31536,HCPCS,,,XU,Outpatient,,,8790.5,2197.625,742.5,7471.93,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5766.57,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6153.35,Percent of Total Billed Charges, ,,85,,7471.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5977.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4922.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5274.3,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31540 - LARYNGOSCOPY EXC TUMAND-STRIPPING CORDS-EPIGLOTT,31540,HCPCS,,,XP,Outpatient,,,17430.5,4357.625,742.5,14815.93,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11434.41,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12201.35,Percent of Total Billed Charges, ,,85,,14815.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11852.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9761.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10458.3,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31541 - LARGSC EXC TUMAND-STRPG CORDS-EPIGL MCRSCP-TLSCP,31541,HCPCS,,,XU,Outpatient,,,10968.33,2742.0825,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7195.22,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7677.83,Percent of Total Billed Charges, ,,85,,9323.08,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7458.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6142.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6581,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31541 - LARGSC EXC TUMAND-STRPG CORDS-EPIGL MCRSCP-TLSCP,31541,HCPCS,,,RT,Outpatient,,,12781.25,3195.3125,742.5,10864.06,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8384.5,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8946.88,Percent of Total Billed Charges, ,,85,,10864.06,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8691.25,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7157.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7668.75,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31541 - LARGSC EXC TUMAND-STRPG CORDS-EPIGL MCRSCP-TLSCP,31541,HCPCS,,,LT,Outpatient,,,17625.22,4406.305,742.5,14981.44,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11562.14,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12337.65,Percent of Total Billed Charges, ,,85,,14981.44,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11985.15,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9870.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10575.13,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31541 - LARGSC EXC TUMAND-STRPG CORDS-EPIGL MCRSCP-TLSCP,31541,HCPCS,,,50,Outpatient,,,18401,4600.25,742.5,15640.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12071.06,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12880.7,Percent of Total Billed Charges, ,,85,,15640.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12512.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10304.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11040.6,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31545 - LARGSC MICRO-TELESCOPE RMVL LES VOCAL CORD FLAP,31545,HCPCS,,,RT,Outpatient,,,7824,1956,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5132.54,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5476.8,Percent of Total Billed Charges, ,,85,,6650.4,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5320.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4381.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4694.4,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31571 - LARGSC W-NJX VOCAL CORD THER W-MICRO-TELESCOPE,31571,HCPCS,,,LT,Outpatient,,,7896.5,1974.125,742.5,6712.03,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5180.1,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5527.55,Percent of Total Billed Charges, ,,85,,6712.03,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5369.62,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4422.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4737.9,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31623 - BRNCHSC BRUSHING-PROTECTED BRUSHINGS,31623,HCPCS,,,RT,Outpatient,,,3077.5,769.375,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2018.84,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2154.25,Percent of Total Billed Charges, ,,85,,2615.88,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2092.7,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1723.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1846.5,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31623 - BRNCHSC BRUSHING-PROTECTED BRUSHINGS,31623,HCPCS,,,LT,Outpatient,,,2624.63,656.1575,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1721.76,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1837.24,Percent of Total Billed Charges, ,,85,,2230.94,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1784.75,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1469.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1574.78,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,RT,Outpatient,,,3617.39,904.3475,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2373.01,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2532.17,Percent of Total Billed Charges, ,,85,,3074.78,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2459.83,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2025.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2170.43,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,LT,Outpatient,,,3837.21,959.3025,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2517.21,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2686.05,Percent of Total Billed Charges, ,,85,,3261.63,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2609.3,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2148.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2302.33,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31625 - BRONCHOSCOPY BRONCHIAL-ENDOBRNCL BX 1+ SITES,31625,HCPCS,,,XU,Outpatient,,,2566.95,641.7375,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1683.92,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1796.87,Percent of Total Billed Charges, ,,85,,2181.91,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1745.53,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1437.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1540.17,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31625 - BRONCHOSCOPY BRONCHIAL-ENDOBRNCL BX 1+ SITES,31625,HCPCS,,,RT,Outpatient,,,2780.33,695.0825,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1823.9,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1946.23,Percent of Total Billed Charges, ,,85,,2363.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1890.62,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1556.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1668.2,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31625 - BRONCHOSCOPY BRONCHIAL-ENDOBRNCL BX 1+ SITES,31625,HCPCS,,,LT,Outpatient,,,3973.3,993.325,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2606.48,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2781.31,Percent of Total Billed Charges, ,,85,,3377.31,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2701.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2225.05,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2383.98,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31627 - BRONCHOSCOPY W-CPTR-ASST IMAGE-GUIDED NAVIGATION,31627,HCPCS,,,LT,Outpatient,,,2978.25,744.5625,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1953.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2084.78,Percent of Total Billed Charges, ,,85,,2531.51,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2025.21,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1667.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1786.95,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
31628 - BRONCHOSCOPY W-TRANSBRONCHIAL LUNG BX 1 LOBE,31628,HCPCS,,,RT,Outpatient,,,3484.39,871.0975,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2285.76,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2439.07,Percent of Total Billed Charges, ,,85,,2961.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2369.39,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1951.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2090.63,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31628 - BRONCHOSCOPY W-TRANSBRONCHIAL LUNG BX 1 LOBE,31628,HCPCS,,,LT,Outpatient,,,3076.65,769.1625,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2018.28,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2153.66,Percent of Total Billed Charges, ,,85,,2615.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2092.12,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1722.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1845.99,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31630 - BRNCHSC W-TRACHEAL-BRONCHIAL DILAT-CLSD RDCTJ FX,31630,HCPCS,,,XU,Outpatient,,,14710.5,3677.625,742.5,12503.93,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9650.09,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10297.35,Percent of Total Billed Charges, ,,85,,12503.93,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10003.14,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8237.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8826.3,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31640 - BRONCHOSCOPY W-EXCISION TUMOR,31640,HCPCS,,,XU,Outpatient,,,7604.5,1901.125,742.5,6463.83,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4988.55,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5323.15,Percent of Total Billed Charges, ,,85,,6463.83,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5171.06,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4258.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4562.7,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31640 - BRONCHOSCOPY W-EXCISION TUMOR,31640,HCPCS,,,RT,Outpatient,,,8946,2236.5,742.5,7604.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5868.58,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6262.2,Percent of Total Billed Charges, ,,85,,7604.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6083.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5009.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5367.6,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31641 - BRNCHSC W-DSTRJ TUM RELIEF STENOSIS OTH-THN EXC,31641,HCPCS,,,RT,Outpatient,,,3606,901.5,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2365.54,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2524.2,Percent of Total Billed Charges, ,,85,,3065.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2452.08,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2019.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2163.6,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31641 - BRNCHSC W-DSTRJ TUM RELIEF STENOSIS OTH-THN EXC,31641,HCPCS,,,74,Outpatient,,,6105,1526.25,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4004.88,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4273.5,Percent of Total Billed Charges, ,,85,,5189.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4151.4,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3418.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3663,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31645 - BRONCHOSCOPY W-THER ASPIR TRACHBRNCL TREE 1ST,31645,HCPCS,,,RT,Outpatient,,,4908.5,1227.125,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3219.98,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3435.95,Percent of Total Billed Charges, ,,85,,4172.23,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3337.78,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2748.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2945.1,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31652 - BRNCHSC EBUS GUIDED SAMPL 1-2 NODE STATION-STRUX,31652,HCPCS,,,RT,Outpatient,,,3728.08,932.02,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2445.62,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2609.66,Percent of Total Billed Charges, ,,85,,3168.87,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2535.09,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2087.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2236.85,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31652 - BRNCHSC EBUS GUIDED SAMPL 1-2 NODE STATION-STRUX,31652,HCPCS,,,LT,Outpatient,,,3285.31,821.3275,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2155.16,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2299.72,Percent of Total Billed Charges, ,,85,,2792.51,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2234.01,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1839.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1971.19,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31653 - BRNCHSC EBUS GUIDED SAMPL 3-GREATER THAN NODE STATION-STRUX,31653,HCPCS,,,RT,Outpatient,,,3616.38,904.095,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2372.35,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2531.47,Percent of Total Billed Charges, ,,85,,3073.92,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2459.14,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2025.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2169.83,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31653 - BRNCHSC EBUS GUIDED SAMPL 3-GREATER THAN NODE STATION-STRUX,31653,HCPCS,,,LT,Outpatient,,,2913.42,728.355,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1911.2,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2039.39,Percent of Total Billed Charges, ,,85,,2476.41,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1981.13,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1631.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1748.05,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31654 - BRNSCHSC TNDSC EBUS DX-TX INTERVENTION PERPH LES,31654,HCPCS,,,RT,Outpatient,,,2230.88,557.72,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1463.46,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1561.62,Percent of Total Billed Charges, ,,85,,1896.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1517,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1249.29,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1338.53,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31654 - BRNSCHSC TNDSC EBUS DX-TX INTERVENTION PERPH LES,31654,HCPCS,,,LT,Outpatient,,,3883.5,970.875,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2547.58,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2718.45,Percent of Total Billed Charges, ,,85,,3300.98,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2640.78,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2174.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2330.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32550 - INSERTION INDWELLING TUNNELED PLEURAL CATHETER,32550,HCPCS,,,RT,Outpatient,,,10931,2732.75,742.5,9291.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7170.74,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7651.7,Percent of Total Billed Charges, ,,85,,9291.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7433.08,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6121.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6558.6,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32550 - INSERTION INDWELLING TUNNELED PLEURAL CATHETER,32550,HCPCS,,,LT,Outpatient,,,10493.75,2623.4375,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6883.9,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7345.63,Percent of Total Billed Charges, ,,85,,8919.69,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7135.75,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5876.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6296.25,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32552 - RMVL NDWELLG TUNNELED PLEURAL CATHETER W-CUFF,32552,HCPCS,,,50,Outpatient,,,2575.5,643.875,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1689.53,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1802.85,Percent of Total Billed Charges, ,,85,,2189.18,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1751.34,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1442.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1545.3,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,RT,Outpatient,,,3433.5,858.375,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2252.38,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2403.45,Percent of Total Billed Charges, ,,85,,2918.48,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2334.78,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1922.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2060.1,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32607 - THORACOSCOPY W-DX BX OF LUNG INFILTRATE UNILATRL,32607,HCPCS,,,LT,Outpatient,,,19089.5,4772.375,950.4,16226.08,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12522.71,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13362.65,Percent of Total Billed Charges, ,,85,,16226.08,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12980.86,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10690.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11453.7,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32609 - THORACOSCOPY WITH BIOPSYIES OF PLEURA,32609,HCPCS,,,LT,Outpatient,,,8846.5,2211.625,950.4,8616.51,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5803.3,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6192.55,Percent of Total Billed Charges, ,,85,,7519.53,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6015.62,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4954.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5307.9,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33206 - INS NEW-RPLCMT PRM PACEMAKR W-TRANS ELTRD ATRIAL,33206,HCPCS,,,XU,Outpatient,,,18318,4579.5,1078.11,16755.01,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15455.79,,,15455.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12016.61,Percent of Total Billed Charges, ,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12822.6,Percent of Total Billed Charges, ,,85,,15570.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12456.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10258.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10990.8,Percent of Total Billed Charges, ,15297.83,,,15297.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16229.78,,,16229.78,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10298.05,,,10298.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10397.55,,,10397.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9949.81,,,9949.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10248.3,,,10248.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10422.43,,,10422.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33206 - INS NEW-RPLCMT PRM PACEMAKR W-TRANS ELTRD ATRIAL,33206,HCPCS,,,KX,Outpatient,,,14633.5,3658.375,1078.11,16755.01,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15455.79,,,15455.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9599.58,Percent of Total Billed Charges, ,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10243.45,Percent of Total Billed Charges, ,,85,,12438.48,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9950.78,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8194.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8780.1,Percent of Total Billed Charges, ,15297.83,,,15297.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16229.78,,,16229.78,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10298.05,,,10298.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10397.55,,,10397.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9949.81,,,9949.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10248.3,,,10248.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10422.43,,,10422.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33207 - INS NEW-RPLC PRM PACEMAKER W-TRANSV ELTRD VENTR,33207,HCPCS,,,KX,Outpatient,,,17124.88,4281.22,950.4,16755.01,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15455.79,,,15455.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11233.92,Percent of Total Billed Charges, ,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11987.42,Percent of Total Billed Charges, ,,85,,14556.15,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11644.92,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9589.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10274.93,Percent of Total Billed Charges, ,15297.83,,,15297.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16229.78,,,16229.78,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10298.05,,,10298.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10397.55,,,10397.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9949.81,,,9949.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10248.3,,,10248.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10422.43,,,10422.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33208 - INS NEW-RPLCMT PRM PM W-TRANSV ELTRD ATRIALANDVENT,33208,HCPCS,,,SC,Outpatient,,,18318,4579.5,882.09,16755.01,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15455.79,,,15455.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12016.61,Percent of Total Billed Charges, ,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12822.6,Percent of Total Billed Charges, ,,85,,15570.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12456.24,Percent of Total Billed Charges,0,12266,,,12266,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10258.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10990.8,Percent of Total Billed Charges, ,15297.83,,,15297.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16229.78,,,16229.78,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10298.05,,,10298.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10397.55,,,10397.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9949.81,,,9949.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10248.3,,,10248.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10422.43,,,10422.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33208 - INS NEW-RPLCMT PRM PM W-TRANSV ELTRD ATRIALANDVENT,33208,HCPCS,,,KX,Outpatient,,,18276.42,4569.105,882.09,16755.01,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15455.79,,,15455.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11989.33,Percent of Total Billed Charges, ,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12793.49,Percent of Total Billed Charges, ,,85,,15534.96,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12427.97,Percent of Total Billed Charges,0,12266,,,12266,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10234.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10965.85,Percent of Total Billed Charges, ,15297.83,,,15297.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16229.78,,,16229.78,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10298.05,,,10298.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10397.55,,,10397.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9949.81,,,9949.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10248.3,,,10248.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10422.43,,,10422.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33210 - INSJ-RPLCMT TEMP TRANSVNS 1CHMBR ELTRD-PM CATH,33210,HCPCS,,,XU,Outpatient,,,15359.25,3839.8125,950.4,13241.39,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12222.43,,,12222.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10075.67,Percent of Total Billed Charges, ,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10751.48,Percent of Total Billed Charges, ,,85,,13055.36,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10444.29,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8601.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9215.55,Percent of Total Billed Charges, ,12097.53,,,12097.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12826.3,,,12826.3,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8143.7,,,8143.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8222.38,,,8222.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7868.31,,,7868.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8104.36,,,8104.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8242.05,,,8242.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33215 - RPSG PREV IMPLTED PM-DFB R ATR-R VENTR ELECTRODE,33215,HCPCS,,,XU,Outpatient,,,10007.17,2501.7925,742.5,8506.09,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6564.7,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7005.02,Percent of Total Billed Charges, ,,85,,8506.09,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6804.88,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5604.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6004.3,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33216 - INSJ 1 TRANSVNS ELTRD PERM PACEMAKER-IMPLTBL DFB,33216,HCPCS,,,74,Outpatient,,,14373,3593.25,882.09,13241.39,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12222.43,,,12222.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9428.69,Percent of Total Billed Charges, ,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10061.1,Percent of Total Billed Charges, ,,85,,12217.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9773.64,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8048.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8623.8,Percent of Total Billed Charges, ,12097.53,,,12097.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12826.3,,,12826.3,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8143.7,,,8143.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8222.38,,,8222.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7868.31,,,7868.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8104.36,,,8104.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8242.05,,,8242.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33225 - INSJ ELTRD CAR VEN SYS TM INSJ DFB-PM PLS GEN,33225,HCPCS,,,KX,Outpatient,,,30275.25,7568.8125,0.01,25733.96,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19860.56,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21192.68,Percent of Total Billed Charges, ,,85,,25733.96,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,20587.17,Percent of Total Billed Charges,0,12266,,,12266,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16954.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18165.15,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
33225 - INSJ ELTRD CAR VEN SYS TM INSJ DFB-PM PLS GEN,33225,HCPCS,,,74,Outpatient,,,18015,4503.75,0.01,15312.75,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11817.84,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12610.5,Percent of Total Billed Charges, ,,85,,15312.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12250.2,Percent of Total Billed Charges,0,12266,,,12266,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10088.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10809,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
33227 - REMVL PERM PM PLSE GEN W-REPL PLSE GEN SNGL LEAD,33227,HCPCS,,,SC,Outpatient,,,14373,3593.25,1078.11,13241.39,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12222.43,,,12222.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9428.69,Percent of Total Billed Charges, ,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10061.1,Percent of Total Billed Charges, ,,85,,12217.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9773.64,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8048.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8623.8,Percent of Total Billed Charges, ,12097.53,,,12097.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12826.3,,,12826.3,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8143.7,,,8143.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8222.38,,,8222.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7868.31,,,7868.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8104.36,,,8104.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8242.05,,,8242.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33227 - REMVL PERM PM PLSE GEN W-REPL PLSE GEN SNGL LEAD,33227,HCPCS,,,KX,Outpatient,,,14373,3593.25,1078.11,13241.39,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12222.43,,,12222.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9428.69,Percent of Total Billed Charges, ,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10061.1,Percent of Total Billed Charges, ,,85,,12217.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9773.64,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8048.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8623.8,Percent of Total Billed Charges, ,12097.53,,,12097.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12826.3,,,12826.3,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8143.7,,,8143.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8222.38,,,8222.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7868.31,,,7868.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8104.36,,,8104.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8242.05,,,8242.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33228 - REMVL PERM PM PLS GEN W-REPL PLSE GEN 2 LEAD SYS,33228,HCPCS,,,SC,Outpatient,,,18318,4579.5,1078.11,16755.01,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15455.79,,,15455.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12016.61,Percent of Total Billed Charges, ,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12822.6,Percent of Total Billed Charges, ,,85,,15570.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12456.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10258.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10990.8,Percent of Total Billed Charges, ,15297.83,,,15297.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16229.78,,,16229.78,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10298.05,,,10298.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10397.55,,,10397.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9949.81,,,9949.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10248.3,,,10248.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10422.43,,,10422.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33228 - REMVL PERM PM PLS GEN W-REPL PLSE GEN 2 LEAD SYS,33228,HCPCS,,,KX,Outpatient,,,18249.65,4562.4125,1078.11,16755.01,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15455.79,,,15455.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11971.77,Percent of Total Billed Charges, ,16755.01,,,16755.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12774.76,Percent of Total Billed Charges, ,,85,,15512.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12409.76,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10219.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10949.79,Percent of Total Billed Charges, ,15297.83,,,15297.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16229.78,,,16229.78,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10298.05,,,10298.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10397.55,,,10397.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9949.81,,,9949.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10049.31,,,10049.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10248.3,,,10248.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10422.43,,,10422.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33229 - REMVL PERM PM PLS GEN W-REPL PLSE GEN MULT LEAD,33229,HCPCS,,,SC,Outpatient,,,31331.4,7832.85,1078.11,30289.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30289.15,,,30289.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28165.36,,,28165.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20553.4,Percent of Total Billed Charges, ,30289.15,,,30289.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21931.98,Percent of Total Billed Charges, ,,85,,26631.69,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21305.35,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17545.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18798.84,Percent of Total Billed Charges, ,27877.5,,,27877.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29339.64,,,29339.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18766.32,,,18766.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18947.64,,,18947.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18313.03,,,18313.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18131.71,,,18131.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18313.03,,,18313.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18675.66,,,18675.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18992.97,,,18992.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33229 - REMVL PERM PM PLS GEN W-REPL PLSE GEN MULT LEAD,33229,HCPCS,,,KX,Outpatient,,,17286,4321.5,1078.11,30289.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30289.15,,,30289.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28165.36,,,28165.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11339.62,Percent of Total Billed Charges, ,30289.15,,,30289.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12100.2,Percent of Total Billed Charges, ,,85,,14693.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11754.48,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9680.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10371.6,Percent of Total Billed Charges, ,27877.5,,,27877.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29339.64,,,29339.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18766.32,,,18766.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18947.64,,,18947.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18313.03,,,18313.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18131.71,,,18131.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18313.03,,,18313.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18675.66,,,18675.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18992.97,,,18992.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33233 - REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY,33233,HCPCS,,,KX,Outpatient,,,26742.25,6685.5625,742.5,22730.91,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12222.43,,,12222.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17542.92,Percent of Total Billed Charges, ,13241.39,,,13241.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18719.58,Percent of Total Billed Charges, ,,85,,22730.91,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18184.73,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14975.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16045.35,Percent of Total Billed Charges, ,12097.53,,,12097.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12826.3,,,12826.3,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8143.7,,,8143.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8222.38,,,8222.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7868.31,,,7868.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7946.99,,,7946.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8104.36,,,8104.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8242.05,,,8242.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33234 - RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR-VENTR,33234,HCPCS,,,CG,Outpatient,,,12587,3146.75,742.5,10698.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5435.78,,,5435.78,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5374.72,,,5374.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8257.07,Percent of Total Billed Charges, ,5435.78,,,5435.78,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8810.9,Percent of Total Billed Charges, ,,85,,10698.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8559.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7048.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7552.2,Percent of Total Billed Charges, ,5319.8,,,5319.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5265.38,,,5265.38,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3581.13,,,3581.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3615.73,,,3615.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3494.63,,,3494.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3460.03,,,3460.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3494.63,,,3494.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3563.83,,,3563.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3624.38,,,3624.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33249 - INSJ-RPLCMT PERM DFB W-TRNSVNS LDS 1-DUAL CHMBR,33249,HCPCS,,,KX,Outpatient,,,40416,10104,882.09,52033.19,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52033.19,,,52033.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47350.33,,,47350.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26512.9,Percent of Total Billed Charges, ,52033.19,,,52033.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28291.2,Percent of Total Billed Charges, ,,85,,34353.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,27482.88,Percent of Total Billed Charges,0,21967,,,21967,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,22632.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,24249.6,Percent of Total Billed Charges, ,46866.43,,,46866.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50402.06,,,50402.06,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31549.11,,,31549.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31853.93,,,31853.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30787.05,,,30787.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30482.23,,,30482.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30787.05,,,30787.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31396.7,,,31396.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31930.14,,,31930.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33264 - RMVL IMPLTBL DFB PLS GEN W-RPLCMT PLS GEN MLT LD,33264,HCPCS,,,XU,Outpatient,,,57869,14467.25,1078.11,52033.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52033.19,,,52033.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47350.33,,,47350.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,37962.06,Percent of Total Billed Charges, ,52033.19,,,52033.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,40508.3,Percent of Total Billed Charges, ,,85,,49188.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,39350.92,Percent of Total Billed Charges,0,21967,,,21967,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,32406.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,34721.4,Percent of Total Billed Charges, ,46866.43,,,46866.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50402.06,,,50402.06,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31549.11,,,31549.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31853.93,,,31853.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30787.05,,,30787.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30482.23,,,30482.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30787.05,,,30787.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31396.7,,,31396.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31930.14,,,31930.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33264 - RMVL IMPLTBL DFB PLS GEN W-RPLCMT PLS GEN MLT LD,33264,HCPCS,,,74,Outpatient,,,57869,14467.25,1078.11,52033.19,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52033.19,,,52033.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47350.33,,,47350.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,37962.06,Percent of Total Billed Charges, ,52033.19,,,52033.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,40508.3,Percent of Total Billed Charges, ,,85,,49188.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,39350.92,Percent of Total Billed Charges,0,21967,,,21967,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,32406.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,34721.4,Percent of Total Billed Charges, ,46866.43,,,46866.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50402.06,,,50402.06,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31549.11,,,31549.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31853.93,,,31853.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30787.05,,,30787.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30482.23,,,30482.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30787.05,,,30787.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31396.7,,,31396.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31930.14,,,31930.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33990 - INSJ PERQ VAD W-RSANDI L HRT ARTERIAL ACCESS ONLY,33990,HCPCS,,,53,Outpatient,,,20624,5156,0.01,17530.4,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13529.34,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14436.8,Percent of Total Billed Charges, ,,85,,17530.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,14024.32,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11549.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12374.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
34201 - EMBLC-THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART,34201,HCPCS,,,LT,Outpatient,,,39782,9945.5,0.01,33814.7,,,,,,,Service Paid at Rev Code level,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26096.99,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,27847.4,Percent of Total Billed Charges, ,,85,,33814.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,27051.76,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,22277.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,23869.2,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
34713 - PERQ ACCESS AND CLOSURE FEM ART FOR DELIVERY NDGFT,34713,HCPCS,,,RT,Outpatient,,,3327.66,831.915,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2182.94,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2329.36,Percent of Total Billed Charges, ,,85,,2828.51,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2262.81,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1863.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1996.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
34713 - PERQ ACCESS AND CLOSURE FEM ART FOR DELIVERY NDGFT,34713,HCPCS,,,LT,Outpatient,,,3327.66,831.915,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2182.94,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2329.36,Percent of Total Billed Charges, ,,85,,2828.51,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2262.81,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1863.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1996.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
35011 - DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION,35011,HCPCS,,,RT,Outpatient,,,15615.25,3903.8125,0.01,13272.96,,,,,,,Service Paid at Rev Code level,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10243.6,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10930.68,Percent of Total Billed Charges, ,,85,,13272.96,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10618.37,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8744.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9369.15,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
35011 - DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION,35011,HCPCS,,,LT,Outpatient,,,18638.38,4659.595,0.01,15842.62,,,,,,,Service Paid at Rev Code level,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12226.78,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13046.87,Percent of Total Billed Charges, ,,85,,15842.62,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12674.1,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10437.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11183.03,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
35206 - REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY,35206,HCPCS,,,XU,Outpatient,,,11676,2919,1078.11,9924.6,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7659.46,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8173.2,Percent of Total Billed Charges, ,,85,,9924.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7939.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6538.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7005.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
35206 - REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY,35206,HCPCS,,,RT,Outpatient,,,10419.75,2604.9375,1078.11,9034,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6835.36,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7293.83,Percent of Total Billed Charges, ,,85,,8856.79,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7085.43,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5835.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6251.85,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
35226 - REPAIR BLOOD VESSEL DIRECT LOWER EXTREMITY,35226,HCPCS,,,RT,Outpatient,,,9902.33,2475.5825,668.93,9034,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6495.93,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6931.63,Percent of Total Billed Charges, ,,85,,8416.98,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6733.58,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5545.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5941.4,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
35321 - TEAEC W-WO PATCH GRF AXILLARY-BRACHIAL,35321,HCPCS,,,RT,Outpatient,,,13398.34,3349.585,0.01,11388.59,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8789.31,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9378.84,Percent of Total Billed Charges, ,,85,,11388.59,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9110.87,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7503.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8039,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
35321 - TEAEC W-WO PATCH GRF AXILLARY-BRACHIAL,35321,HCPCS,,,LT,Outpatient,,,12162.59,3040.6475,0.01,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7978.66,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8513.81,Percent of Total Billed Charges, ,,85,,10338.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8270.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6811.05,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7297.55,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
35903 - EXCISION INFECTED GRAFT EXTREMITY,35903,HCPCS,,,RT,Outpatient,,,14517,3629.25,882.09,12339.45,,,,,,,Service Paid at Rev Code level,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9523.15,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10161.9,Percent of Total Billed Charges, ,,85,,12339.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9871.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8129.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8710.2,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
35903 - EXCISION INFECTED GRAFT EXTREMITY,35903,HCPCS,,,LT,Outpatient,,,16215.88,4053.97,882.09,13783.5,,,,,,,Service Paid at Rev Code level,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10637.62,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11351.12,Percent of Total Billed Charges, ,,85,,13783.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11026.8,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9080.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9729.53,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36011 - SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH,36011,HCPCS,,,RT,Outpatient,,,3328.13,832.0325,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2183.25,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2329.69,Percent of Total Billed Charges, ,,85,,2828.91,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2263.13,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1863.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1996.88,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36011 - SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH,36011,HCPCS,,,LT,Outpatient,,,4067,1016.75,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2667.95,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2846.9,Percent of Total Billed Charges, ,,85,,3456.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2765.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2277.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2440.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36011 - SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH,36011,HCPCS,,,50,Outpatient,,,1632,408,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1070.59,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1142.4,Percent of Total Billed Charges, ,,85,,1387.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1109.76,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,913.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,979.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36012 - SLCTV CATH PLMT VEN SYS 2ND ORDER-GREATER THAN SLCTV BRANC,36012,HCPCS,,,RT,Outpatient,,,1134,283.5,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,743.9,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,793.8,Percent of Total Billed Charges, ,,85,,963.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,771.12,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,635.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,680.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36012 - SLCTV CATH PLMT VEN SYS 2ND ORDER-GREATER THAN SLCTV BRANC,36012,HCPCS,,,LT,Outpatient,,,1134,283.5,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,743.9,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,793.8,Percent of Total Billed Charges, ,,85,,963.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,771.12,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,635.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,680.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36012 - SLCTV CATH PLMT VEN SYS 2ND ORDER-GREATER THAN SLCTV BRANC,36012,HCPCS,,,50,Outpatient,,,1700,425,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1115.2,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1190,Percent of Total Billed Charges, ,,85,,1445,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1156,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,952,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1020,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36215 - SLCTV CATHJ EA 1ST ORD THRC-BRCH-CPHLC BRNCH,36215,HCPCS,,,XU,Outpatient,,,9184.4,2296.1,0.01,7806.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6024.97,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6429.08,Percent of Total Billed Charges, ,,85,,7806.74,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6245.39,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5143.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5510.64,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36215 - SLCTV CATHJ EA 1ST ORD THRC-BRCH-CPHLC BRNCH,36215,HCPCS,,,LT,Outpatient,,,30017,7504.25,0.01,25514.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19691.15,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21011.9,Percent of Total Billed Charges, ,,85,,25514.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,20411.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16809.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18010.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36217 - SLCTV CATHJ 3RD+ ORD SLCTV THRC-BRCH-CPHLC BRNCH,36217,HCPCS,,,LT,Outpatient,,,3640,910,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2387.84,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2548,Percent of Total Billed Charges, ,,85,,3094,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2475.2,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2038.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2184,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36221 - NONSLCTV CATH THOR AORTA ANGIO INTR-XTRCRANL ART,36221,HCPCS,,,LT,Outpatient,,,9184.4,2296.1,1078.11,7806.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6024.97,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6429.08,Percent of Total Billed Charges, ,,85,,7806.74,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6245.39,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5143.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5510.64,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36222 - SLCTV CATH CAROTID-INNOM ART ANGIO XTRCRANL ART,36222,HCPCS,,,XU,Outpatient,,,6741.75,1685.4375,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4422.59,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4719.23,Percent of Total Billed Charges, ,,85,,5730.49,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4584.39,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3775.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4045.05,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36222 - SLCTV CATH CAROTID-INNOM ART ANGIO XTRCRANL ART,36222,HCPCS,,,RT,Outpatient,,,6260,1565,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4106.56,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4382,Percent of Total Billed Charges, ,,85,,5321,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4256.8,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3505.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3756,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36222 - SLCTV CATH CAROTID-INNOM ART ANGIO XTRCRANL ART,36222,HCPCS,,,LT,Outpatient,,,5151,1287.75,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36222 - SLCTV CATH CAROTID-INNOM ART ANGIO XTRCRANL ART,36222,HCPCS,,,50,Outpatient,,,5151,1287.75,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36223 - SLCTV CATH CAROTID-INNOM ART ANGIO INTRCRANL ART,36223,HCPCS,,,XU,Outpatient,,,9768.96,2442.24,1078.11,10452,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6408.44,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6838.27,Percent of Total Billed Charges, ,,85,,8303.62,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6642.89,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5470.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5861.38,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36223 - SLCTV CATH CAROTID-INNOM ART ANGIO INTRCRANL ART,36223,HCPCS,,,RT,Outpatient,,,9634.21,2408.5525,1078.11,10452,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6320.04,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6743.95,Percent of Total Billed Charges, ,,85,,8189.08,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6551.26,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5395.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5780.53,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36223 - SLCTV CATH CAROTID-INNOM ART ANGIO INTRCRANL ART,36223,HCPCS,,,LT,Outpatient,,,9905.16,2476.29,1078.11,10452,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6497.78,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6933.61,Percent of Total Billed Charges, ,,85,,8419.39,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6735.51,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5546.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5943.1,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36223 - SLCTV CATH CAROTID-INNOM ART ANGIO INTRCRANL ART,36223,HCPCS,,,50,Outpatient,,,9597.3,2399.325,1078.11,10452,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6295.83,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6718.11,Percent of Total Billed Charges, ,,85,,8157.71,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6526.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5374.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5758.38,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36224 - SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART,36224,HCPCS,,,XU,Outpatient,,,11278.5,2819.625,1078.11,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7398.7,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7894.95,Percent of Total Billed Charges, ,,85,,9586.73,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7669.38,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6315.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6767.1,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36224 - SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART,36224,HCPCS,,,RT,Outpatient,,,10843.62,2710.905,1078.11,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7113.41,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7590.53,Percent of Total Billed Charges, ,,85,,9217.08,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7373.66,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6072.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6506.17,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36224 - SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART,36224,HCPCS,,,LT,Outpatient,,,10565.64,2641.41,1078.11,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6931.06,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7395.95,Percent of Total Billed Charges, ,,85,,8980.79,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7184.64,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5916.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6339.38,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36224 - SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART,36224,HCPCS,,,50,Outpatient,,,15398.19,3849.5475,1078.11,13088.46,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10101.21,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10778.73,Percent of Total Billed Charges, ,,85,,13088.46,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10470.77,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8622.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9238.91,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36225 - SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY,36225,HCPCS,,,XU,Outpatient,,,4917.92,1229.48,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3226.16,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3442.54,Percent of Total Billed Charges, ,,85,,4180.23,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3344.19,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2754.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2950.75,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36225 - SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY,36225,HCPCS,,,RT,Outpatient,,,5328.71,1332.1775,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3495.63,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3730.1,Percent of Total Billed Charges, ,,85,,4529.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3623.52,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2984.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3197.23,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36225 - SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY,36225,HCPCS,,,LT,Outpatient,,,5151,1287.75,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36225 - SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY,36225,HCPCS,,,50,Outpatient,,,7576,1894,1078.11,6439.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4969.86,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5303.2,Percent of Total Billed Charges, ,,85,,6439.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5151.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4242.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4545.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36226 - SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY,36226,HCPCS,,,RT,Outpatient,,,9513.07,2378.2675,1078.11,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6240.57,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6659.15,Percent of Total Billed Charges, ,,85,,8086.11,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6468.89,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5327.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5707.84,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36226 - SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY,36226,HCPCS,,,LT,Outpatient,,,9859,2464.75,1078.11,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6467.5,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6901.3,Percent of Total Billed Charges, ,,85,,8380.15,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6704.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5521.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5915.4,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36226 - SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY,36226,HCPCS,,,50,Outpatient,,,12467.69,3116.9225,1078.11,10597.54,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8178.8,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8727.38,Percent of Total Billed Charges, ,,85,,10597.54,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8478.03,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6981.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7480.61,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36227 - SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC,36227,HCPCS,,,XU,Outpatient,,,7650.75,1912.6875,0.01,6503.14,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5018.89,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5355.53,Percent of Total Billed Charges, ,,85,,6503.14,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5202.51,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4284.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4590.45,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36227 - SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC,36227,HCPCS,,,RT,Outpatient,,,2971.79,742.9475,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1949.49,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2080.25,Percent of Total Billed Charges, ,,85,,2526.02,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2020.82,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1664.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1783.07,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36227 - SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC,36227,HCPCS,,,LT,Outpatient,,,2866.78,716.695,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1880.61,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2006.75,Percent of Total Billed Charges, ,,85,,2436.76,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1949.41,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1605.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1720.07,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36227 - SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC,36227,HCPCS,,,50,Outpatient,,,4682.89,1170.7225,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3071.98,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3278.02,Percent of Total Billed Charges, ,,85,,3980.46,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3184.37,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2622.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2809.73,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36228 - SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT-VERT,36228,HCPCS,,,RT,Outpatient,,,8416.33,2104.0825,0.01,7153.88,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5521.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5891.43,Percent of Total Billed Charges, ,,85,,7153.88,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5723.1,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4713.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5049.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36245 - SLCTV CATHJ EA 1ST ORD ABDL PEL-LXTR ART BRNCH,36245,HCPCS,,,RT,Outpatient,,,17181,4295.25,0.01,14603.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11270.74,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12026.7,Percent of Total Billed Charges, ,,85,,14603.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11683.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9621.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10308.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36246 - SLCTV CATHJ 2ND ORDER ABDL PEL-LXTR ART BRNCH,36246,HCPCS,,,XU,Outpatient,,,7706,1926.5,0.01,6550.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5055.14,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5394.2,Percent of Total Billed Charges, ,,85,,6550.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5240.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4315.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4623.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36246 - SLCTV CATHJ 2ND ORDER ABDL PEL-LXTR ART BRNCH,36246,HCPCS,,,RT,Outpatient,,,2123.75,530.9375,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1393.18,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1486.63,Percent of Total Billed Charges, ,,85,,1805.19,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1444.15,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1189.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1274.25,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36246 - SLCTV CATHJ 2ND ORDER ABDL PEL-LXTR ART BRNCH,36246,HCPCS,,,LT,Outpatient,,,1691,422.75,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1109.3,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1183.7,Percent of Total Billed Charges, ,,85,,1437.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1149.88,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,946.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1014.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36246 - SLCTV CATHJ 2ND ORDER ABDL PEL-LXTR ART BRNCH,36246,HCPCS,,,50,Outpatient,,,2537,634.25,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1664.27,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1775.9,Percent of Total Billed Charges, ,,85,,2156.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1725.16,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1420.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1522.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36247 - SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL-LXTR BRNCH,36247,HCPCS,,,XU,Outpatient,,,6242.55,1560.6375,0.01,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4095.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4369.79,Percent of Total Billed Charges, ,,85,,5306.17,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4244.93,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3495.83,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3745.53,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36247 - SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL-LXTR BRNCH,36247,HCPCS,,,RT,Outpatient,,,2093.45,523.3625,0.01,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1373.3,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1465.42,Percent of Total Billed Charges, ,,85,,1779.43,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1423.55,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1172.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1256.07,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36247 - SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL-LXTR BRNCH,36247,HCPCS,,,LT,Outpatient,,,1864,466,0.01,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1222.78,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1304.8,Percent of Total Billed Charges, ,,85,,1584.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1267.52,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1043.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1118.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36247 - SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL-LXTR BRNCH,36247,HCPCS,,,50,Outpatient,,,3602.56,900.64,0.01,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2363.28,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2521.79,Percent of Total Billed Charges, ,,85,,3062.18,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2449.74,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2017.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2161.54,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36470 - INJECTION SCLEROSANT SINGLE INCMPTNT VEIN,36470,HCPCS,,,RT,Outpatient,,,775,193.75,0.01,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36470 - INJECTION SCLEROSANT SINGLE INCMPTNT VEIN,36470,HCPCS,,,LT,Outpatient,,,775,193.75,0.01,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36470 - INJECTION SCLEROSANT SINGLE INCMPTNT VEIN,36470,HCPCS,,,50,Outpatient,,,775,193.75,0.01,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36471 - INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS,36471,HCPCS,,,RT,Outpatient,,,775,193.75,379.85,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36471 - INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS,36471,HCPCS,,,LT,Outpatient,,,801,200.25,379.85,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,525.46,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,560.7,Percent of Total Billed Charges, ,,85,,680.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,544.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,448.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,480.6,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36500 - VEN CATHJ SLCTV ORGAN BLD SAMPLING,36500,HCPCS,,,XU,Outpatient,,,2024.88,506.22,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1328.32,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1417.42,Percent of Total Billed Charges, ,,85,,1721.15,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1376.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1133.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1214.93,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36558 - INSJ TUNNELED CVC W-O SUBQ PORT-PMP AGE 5 YR-GREATER THAN,36558,HCPCS,,,RT,Outpatient,,,15485.94,3871.485,742.5,13163.05,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10158.78,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10840.16,Percent of Total Billed Charges, ,,85,,13163.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10530.44,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8672.13,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9291.56,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36558 - INSJ TUNNELED CVC W-O SUBQ PORT-PMP AGE 5 YR-GREATER THAN,36558,HCPCS,,,LT,Outpatient,,,4611.34,1152.835,742.5,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3025.04,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3227.94,Percent of Total Billed Charges, ,,85,,3919.64,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3135.71,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2582.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2766.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36558 - INSJ TUNNELED CVC W-O SUBQ PORT-PMP AGE 5 YR-GREATER THAN,36558,HCPCS,,,74,Outpatient,,,7397.5,1849.375,742.5,6287.88,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4852.76,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5178.25,Percent of Total Billed Charges, ,,85,,6287.88,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5030.3,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4142.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4438.5,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36561 - INSJ TUNNELED CTR VAD W-SUBQ PORT AGE 5 YR-GREATER THAN,36561,HCPCS,,,RT,Outpatient,,,14436.33,3609.0825,882.09,12270.88,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9470.23,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10105.43,Percent of Total Billed Charges, ,,85,,12270.88,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9816.7,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8084.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8661.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36561 - INSJ TUNNELED CTR VAD W-SUBQ PORT AGE 5 YR-GREATER THAN,36561,HCPCS,,,LT,Outpatient,,,16047.5,4011.875,882.09,13640.38,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10527.16,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11233.25,Percent of Total Billed Charges, ,,85,,13640.38,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10912.3,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8986.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9628.5,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36561 - INSJ TUNNELED CTR VAD W-SUBQ PORT AGE 5 YR-GREATER THAN,36561,HCPCS,,,74,Outpatient,,,13897,3474.25,882.09,11812.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9116.43,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9727.9,Percent of Total Billed Charges, ,,85,,11812.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9449.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7782.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8338.2,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36581 - RPLCMT COMPL TUN CVC W-O SUBQ PORT-PMP,36581,HCPCS,,,RT,Outpatient,,,12424.5,3106.125,882.09,10560.83,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8150.47,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8697.15,Percent of Total Billed Charges, ,,85,,10560.83,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8448.66,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6957.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7454.7,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36581 - RPLCMT COMPL TUN CVC W-O SUBQ PORT-PMP,36581,HCPCS,,,LT,Outpatient,,,17152,4288,882.09,14579.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11251.71,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12006.4,Percent of Total Billed Charges, ,,85,,14579.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11663.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9605.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10291.2,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36589 - RMVL TUN CVC W-O SUBQ PORT-PMP,36589,HCPCS,,,RT,Outpatient,,,8145.66,2036.415,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5343.55,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5701.96,Percent of Total Billed Charges, ,,85,,6923.81,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5539.05,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4561.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4887.4,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36590 - RMVL TUN CTR VAD W-SUBQ PORT-PMP CTR-PRPH INSJ,36590,HCPCS,,,RT,Outpatient,,,4167.33,1041.8325,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2733.77,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2917.13,Percent of Total Billed Charges, ,,85,,3542.23,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2833.78,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2333.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2500.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36818 - ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS,36818,HCPCS,,,RT,Outpatient,,,13643.17,3410.7925,882.09,11596.69,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8949.92,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9550.22,Percent of Total Billed Charges, ,,85,,11596.69,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9277.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7640.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8185.9,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36818 - ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS,36818,HCPCS,,,LT,Outpatient,,,21907.32,5476.83,882.09,18621.22,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14371.2,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15335.12,Percent of Total Billed Charges, ,,85,,18621.22,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14896.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12268.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13144.39,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36819 - ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS,36819,HCPCS,,,RT,Outpatient,,,23094.9,5773.725,882.09,19630.67,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15150.25,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16166.43,Percent of Total Billed Charges, ,,85,,19630.67,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15704.53,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12933.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13856.94,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36819 - ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS,36819,HCPCS,,,LT,Outpatient,,,27855.89,6963.9725,882.09,23677.51,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18273.46,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19499.12,Percent of Total Billed Charges, ,,85,,23677.51,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18942.01,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15599.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16713.53,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36819 - ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS,36819,HCPCS,,,74,Outpatient,,,15757,3939.25,882.09,13393.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10336.59,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11029.9,Percent of Total Billed Charges, ,,85,,13393.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10714.76,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8823.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9454.2,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36820 - ARVEN ANAST OPN F-ARM VEIN TRPOS,36820,HCPCS,,,RT,Outpatient,,,19477,4869.25,882.09,16555.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12776.91,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13633.9,Percent of Total Billed Charges, ,,85,,16555.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13244.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10907.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11686.2,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36820 - ARVEN ANAST OPN F-ARM VEIN TRPOS,36820,HCPCS,,,LT,Outpatient,,,17107.63,4276.9075,882.09,14541.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11222.61,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11975.34,Percent of Total Billed Charges, ,,85,,14541.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11633.19,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9580.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10264.58,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36821 - ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT,36821,HCPCS,,,XU,Outpatient,,,12330.66,3082.665,950.4,10481.06,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8088.91,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8631.46,Percent of Total Billed Charges, ,,85,,10481.06,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8384.85,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6905.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7398.4,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36821 - ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT,36821,HCPCS,,,RT,Outpatient,,,18230.57,4557.6425,950.4,15495.98,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11959.25,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12761.4,Percent of Total Billed Charges, ,,85,,15495.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12396.79,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10209.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10938.34,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36821 - ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT,36821,HCPCS,,,LT,Outpatient,,,19490.65,4872.6625,950.4,16567.05,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12785.87,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13643.46,Percent of Total Billed Charges, ,,85,,16567.05,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13253.64,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10914.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11694.39,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36821 - ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT,36821,HCPCS,,,74,Outpatient,,,20602.86,5150.715,950.4,17512.43,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13515.48,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14422,Percent of Total Billed Charges, ,,85,,17512.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14009.94,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11537.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12361.72,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36825 - CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF,36825,HCPCS,,,LT,Outpatient,,,18541,4635.25,950.4,15759.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12162.9,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12978.7,Percent of Total Billed Charges, ,,85,,15759.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12607.88,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10382.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11124.6,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36825 - CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF,36825,HCPCS,,,74,Outpatient,,,17691,4422.75,950.4,15037.35,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11605.3,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12383.7,Percent of Total Billed Charges, ,,85,,15037.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12029.88,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9906.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10614.6,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36830 - CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF,36830,HCPCS,,,XU,Outpatient,,,14948.17,3737.0425,742.5,12705.94,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9806,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10463.72,Percent of Total Billed Charges, ,,85,,12705.94,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10164.76,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8370.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8968.9,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36830 - CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF,36830,HCPCS,,,RT,Outpatient,,,22195.78,5548.945,742.5,18866.41,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14560.43,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15537.05,Percent of Total Billed Charges, ,,85,,18866.41,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15093.13,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12429.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13317.47,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36830 - CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF,36830,HCPCS,,,LT,Outpatient,,,22374.8,5593.7,742.5,19018.58,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14677.87,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15662.36,Percent of Total Billed Charges, ,,85,,19018.58,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15214.86,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12529.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13424.88,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36831 - THRMBC OPN ARVEN FSTL W-O REVJ DIAL GRF,36831,HCPCS,,,LT,Outpatient,,,16119,4029.75,742.5,13976,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10574.06,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11283.3,Percent of Total Billed Charges, ,,85,,13701.15,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10960.92,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9026.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9671.4,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36832 - REVJ OPN ARVEN FSTL W-O THRMBC DIAL GRF,36832,HCPCS,,,XU,Outpatient,,,8984.5,2246.125,882.09,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5893.83,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6289.15,Percent of Total Billed Charges, ,,85,,7636.83,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6109.46,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5031.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5390.7,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36832 - REVJ OPN ARVEN FSTL W-O THRMBC DIAL GRF,36832,HCPCS,,,RT,Outpatient,,,22005,5501.25,882.09,18704.25,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14435.28,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15403.5,Percent of Total Billed Charges, ,,85,,18704.25,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14963.4,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12322.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13203,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36832 - REVJ OPN ARVEN FSTL W-O THRMBC DIAL GRF,36832,HCPCS,,,LT,Outpatient,,,19679.18,4919.795,882.09,16727.3,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12909.54,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13775.43,Percent of Total Billed Charges, ,,85,,16727.3,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13381.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11020.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11807.51,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36833 - REVJ OPN ARVEN FSTL W-THRMBC DIAL GRF,36833,HCPCS,,,RT,Outpatient,,,27847,6961.75,742.5,23669.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18267.63,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19492.9,Percent of Total Billed Charges, ,,85,,23669.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18935.96,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15594.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16708.2,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36833 - REVJ OPN ARVEN FSTL W-THRMBC DIAL GRF,36833,HCPCS,,,LT,Outpatient,,,32411,8102.75,742.5,27549.35,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21261.62,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22687.7,Percent of Total Billed Charges, ,,85,,27549.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22039.48,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18150.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19446.6,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36837 - PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,HCPCS,,,LT,Outpatient,,,38303,9575.75,0.01,32557.55,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,25126.77,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26812.1,Percent of Total Billed Charges, ,,85,,32557.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,26046.04,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,21449.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,22981.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36838 - DSTL REVSCANDINTERVAL LIG UXTR HEMO ACCESS,36838,HCPCS,,,LT,Outpatient,,,36992,9248,950.4,31443.2,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24266.75,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25894.4,Percent of Total Billed Charges, ,,85,,31443.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25154.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20715.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,22195.2,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36901 - INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR SANDI,36901,HCPCS,,,XU,Outpatient,,,5329.13,1332.2825,775,4529.76,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3495.91,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3730.39,Percent of Total Billed Charges, ,,85,,4529.76,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3623.81,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2984.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3197.48,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36901 - INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR SANDI,36901,HCPCS,,,RT,Outpatient,,,4764.1,1191.025,775,4049.49,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3125.25,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3334.87,Percent of Total Billed Charges, ,,85,,4049.49,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3239.59,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2667.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2858.46,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36901 - INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR SANDI,36901,HCPCS,,,LT,Outpatient,,,2196,549,775,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1440.58,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1537.2,Percent of Total Billed Charges, ,,85,,1866.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1493.28,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1229.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1317.6,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36901 - INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR SANDI,36901,HCPCS,,,74,Outpatient,,,2154,538.5,775,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1413.02,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1507.8,Percent of Total Billed Charges, ,,85,,1830.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1464.72,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1206.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1292.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36901 - INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR SANDI,36901,HCPCS,,,73,Outpatient,,,2154,538.5,775,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1413.02,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1507.8,Percent of Total Billed Charges, ,,85,,1830.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1464.72,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1206.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1292.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36902 - INTRO CATH DIALYSIS CIRCUIT W-TRLUML BALO ANGIOP,36902,HCPCS,,,XU,Outpatient,,,11334.95,2833.7375,882.09,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7435.73,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7934.47,Percent of Total Billed Charges, ,,85,,9634.71,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7707.77,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6347.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6800.97,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36902 - INTRO CATH DIALYSIS CIRCUIT W-TRLUML BALO ANGIOP,36902,HCPCS,,,XS,Outpatient,,,20921,5230.25,882.09,17782.85,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13724.18,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14644.7,Percent of Total Billed Charges, ,,85,,17782.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,14226.28,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11715.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12552.6,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36902 - INTRO CATH DIALYSIS CIRCUIT W-TRLUML BALO ANGIOP,36902,HCPCS,,,RT,Outpatient,,,9644.46,2411.115,882.09,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6326.77,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6751.12,Percent of Total Billed Charges, ,,85,,8197.79,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6558.23,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5400.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5786.68,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36902 - INTRO CATH DIALYSIS CIRCUIT W-TRLUML BALO ANGIOP,36902,HCPCS,,,LT,Outpatient,,,11008.74,2752.185,882.09,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7221.73,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7706.12,Percent of Total Billed Charges, ,,85,,9357.43,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7485.94,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6164.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6605.24,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36903 - INTRO CATH DIALYSIS CIRCUIT W-TCAT PLMT IV STENT,36903,HCPCS,,,RT,Outpatient,,,17893,4473.25,882.09,17219.83,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11737.81,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12525.1,Percent of Total Billed Charges, ,,85,,15209.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12167.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10020.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10735.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36903 - INTRO CATH DIALYSIS CIRCUIT W-TCAT PLMT IV STENT,36903,HCPCS,,,LT,Outpatient,,,17893,4473.25,882.09,17219.83,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11737.81,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12525.1,Percent of Total Billed Charges, ,,85,,15209.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12167.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10020.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10735.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36904 - PERQ THRMBC-NFS DIALYSIS CIRCUIT IMG DX ANGRPH,36904,HCPCS,,,RT,Outpatient,,,9859,2464.75,742.5,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6467.5,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6901.3,Percent of Total Billed Charges, ,,85,,8380.15,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6704.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5521.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5915.4,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36905 - PERQ THRMBC-NFS DIAL CIRCUIT TRLUML BALO ANGIOP,36905,HCPCS,,,XU,Outpatient,,,19701.28,4925.32,742.5,17219.83,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12924.04,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13790.9,Percent of Total Billed Charges, ,,85,,16746.09,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13396.87,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11032.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11820.77,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36905 - PERQ THRMBC-NFS DIAL CIRCUIT TRLUML BALO ANGIOP,36905,HCPCS,,,RT,Outpatient,,,16659.14,4164.785,742.5,17219.83,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10928.4,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11661.4,Percent of Total Billed Charges, ,,85,,14160.27,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11328.22,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9329.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9995.48,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36905 - PERQ THRMBC-NFS DIAL CIRCUIT TRLUML BALO ANGIOP,36905,HCPCS,,,LT,Outpatient,,,18895.67,4723.9175,742.5,17219.83,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12395.56,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13226.97,Percent of Total Billed Charges, ,,85,,16061.32,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12849.06,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10581.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11337.4,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36906 - PERQ THRMBC-NFS DIAL CIRCUIT TCAT PLMT IV STENT,36906,HCPCS,,,XU,Outpatient,,,30211.67,7552.9175,742.5,27864.95,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19818.86,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21148.17,Percent of Total Billed Charges, ,,85,,25679.92,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,20543.94,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16918.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18127,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36906 - PERQ THRMBC-NFS DIAL CIRCUIT TCAT PLMT IV STENT,36906,HCPCS,,,RT,Outpatient,,,28294,7073.5,742.5,27864.95,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19239.92,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36906 - PERQ THRMBC-NFS DIAL CIRCUIT TCAT PLMT IV STENT,36906,HCPCS,,,LT,Outpatient,,,28294,7073.5,742.5,27864.95,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19239.92,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36907 - TRLUML BALO ANGIOP CTR DIALYSIS SEG W-IMG SANDI,36907,HCPCS,,,XU,Outpatient,,,10337.3,2584.325,0.01,8786.71,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6781.27,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7236.11,Percent of Total Billed Charges, ,,85,,8786.71,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7029.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5788.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6202.38,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36907 - TRLUML BALO ANGIOP CTR DIALYSIS SEG W-IMG SANDI,36907,HCPCS,,,RT,Outpatient,,,7689.63,1922.4075,0.01,6536.19,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5044.4,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5382.74,Percent of Total Billed Charges, ,,85,,6536.19,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5228.95,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4306.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4613.78,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36907 - TRLUML BALO ANGIOP CTR DIALYSIS SEG W-IMG SANDI,36907,HCPCS,,,LT,Outpatient,,,9546.1,2386.525,0.01,8114.19,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6262.24,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6682.27,Percent of Total Billed Charges, ,,85,,8114.19,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6491.35,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5345.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5727.66,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36908 - STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR,36908,HCPCS,,,RT,Outpatient,,,5148,1287,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3377.09,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3603.6,Percent of Total Billed Charges, ,,85,,4375.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3500.64,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2882.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3088.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36909 - DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG SANDI,36909,HCPCS,,,RT,Outpatient,,,3651,912.75,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2395.06,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2555.7,Percent of Total Billed Charges, ,,85,,3103.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2482.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2044.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2190.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36909 - DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG SANDI,36909,HCPCS,,,LT,Outpatient,,,3651,912.75,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2395.06,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2555.7,Percent of Total Billed Charges, ,,85,,3103.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2482.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2044.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2190.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37184 - PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST,37184,HCPCS,,,RT,Outpatient,,,16173.5,4043.375,1078.11,26519.48,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10609.82,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11321.45,Percent of Total Billed Charges, ,,85,,13747.48,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10997.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9057.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9704.1,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37184 - PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST,37184,HCPCS,,,LT,Outpatient,,,17696,4424,1078.11,26519.48,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11608.58,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12387.2,Percent of Total Billed Charges, ,,85,,15041.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12033.28,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9909.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10617.6,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37184 - PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST,37184,HCPCS,,,50,Outpatient,,,17696,4424,1078.11,26519.48,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11608.58,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12387.2,Percent of Total Billed Charges, ,,85,,15041.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12033.28,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9909.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10617.6,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37185 - PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ,37185,HCPCS,,,LT,Outpatient,,,5061,1265.25,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3320.02,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3542.7,Percent of Total Billed Charges, ,,85,,4301.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3441.48,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2834.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3036.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN,37187,HCPCS,,,RT,Outpatient,,,13629.5,3407.375,1078.11,17219.83,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8940.95,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9540.65,Percent of Total Billed Charges, ,,85,,11585.08,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9268.06,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7632.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8177.7,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37187 - PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN,37187,HCPCS,,,LT,Outpatient,,,17696,4424,1078.11,17219.83,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11608.58,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12387.2,Percent of Total Billed Charges, ,,85,,15041.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12033.28,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9909.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10617.6,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37193 - RTRVL INTRVAS VC FILTR W-WO ACS VSL SELXN RSANDI,37193,HCPCS,,,RT,Outpatient,,,9462,2365.5,1078.11,8042.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37193 - RTRVL INTRVAS VC FILTR W-WO ACS VSL SELXN RSANDI,37193,HCPCS,,,74,Outpatient,,,9462,2365.5,1078.11,8042.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37193 - RTRVL INTRVAS VC FILTR W-WO ACS VSL SELXN RSANDI,37193,HCPCS,,,52,Outpatient,,,9462,2365.5,1078.11,8042.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37215 - TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ,37215,HCPCS,,,RT,Outpatient,,,12631,3157.75,0.01,10736.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8285.94,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8841.7,Percent of Total Billed Charges, ,,85,,10736.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8589.08,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7073.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7578.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37215 - TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ,37215,HCPCS,,,LT,Outpatient,,,12631,3157.75,0.01,10736.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8285.94,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8841.7,Percent of Total Billed Charges, ,,85,,10736.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8589.08,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7073.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7578.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37220 - REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL,37220,HCPCS,,,RT,Outpatient,,,10347.71,2586.9275,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6788.1,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7243.4,Percent of Total Billed Charges, ,,85,,8795.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7036.44,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5794.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6208.63,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37220 - REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL,37220,HCPCS,,,LT,Outpatient,,,12266,3066.5,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8046.5,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8586.2,Percent of Total Billed Charges, ,,85,,10426.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8340.88,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6868.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7359.6,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37220 - REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL,37220,HCPCS,,,50,Outpatient,,,12823,3205.75,1078.11,10899.55,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8411.89,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8976.1,Percent of Total Billed Charges, ,,85,,10899.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8719.64,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7180.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7693.8,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37221 - REVSC OPN-PRQ ILIAC ART W-STNT PLMT AND ANGIOPLSTY,37221,HCPCS,,,XU,Outpatient,,,15844.58,3961.145,1078.11,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10394.04,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11091.21,Percent of Total Billed Charges, ,,85,,13467.89,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10774.31,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8872.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9506.75,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37221 - REVSC OPN-PRQ ILIAC ART W-STNT PLMT AND ANGIOPLSTY,37221,HCPCS,,,RT,Outpatient,,,18146.03,4536.5075,1078.11,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11903.8,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12702.22,Percent of Total Billed Charges, ,,85,,15424.13,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12339.3,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10161.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10887.62,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37221 - REVSC OPN-PRQ ILIAC ART W-STNT PLMT AND ANGIOPLSTY,37221,HCPCS,,,LT,Outpatient,,,18312.53,4578.1325,1078.11,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12013.02,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12818.77,Percent of Total Billed Charges, ,,85,,15565.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12452.52,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10255.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10987.52,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37221 - REVSC OPN-PRQ ILIAC ART W-STNT PLMT AND ANGIOPLSTY,37221,HCPCS,,,50,Outpatient,,,30253.71,7563.4275,1078.11,25715.65,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19846.43,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21177.6,Percent of Total Billed Charges, ,,85,,25715.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,20572.52,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16942.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18152.23,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37222 - REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL,37222,HCPCS,,,LT,Outpatient,,,9859,2464.75,0.01,10452,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6467.5,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6901.3,Percent of Total Billed Charges, ,,85,,8380.15,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6704.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5521.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5915.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37223 - REVSC OPN-PRQ ILIAC ART W-STNT AND ANGIOP IPSILATL,37223,HCPCS,,,XU,Outpatient,,,9859,2464.75,0.01,10452,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6467.5,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6901.3,Percent of Total Billed Charges, ,,85,,8380.15,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6704.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5521.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5915.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37223 - REVSC OPN-PRQ ILIAC ART W-STNT AND ANGIOP IPSILATL,37223,HCPCS,,,RT,Outpatient,,,11165.17,2791.2925,0.01,10452,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7324.35,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7815.62,Percent of Total Billed Charges, ,,85,,9490.39,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7592.32,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6252.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6699.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37223 - REVSC OPN-PRQ ILIAC ART W-STNT AND ANGIOP IPSILATL,37223,HCPCS,,,LT,Outpatient,,,12165.75,3041.4375,0.01,10452,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7980.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8516.03,Percent of Total Billed Charges, ,,85,,10340.89,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8272.71,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6812.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7299.45,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37224 - REVSC OPN-PRG FEM-POP W-ANGIOPLASTY UNI,37224,HCPCS,,,XU,Outpatient,,,4929.5,1232.375,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3233.75,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3450.65,Percent of Total Billed Charges, ,,85,,4190.08,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3352.06,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2760.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2957.7,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37224 - REVSC OPN-PRG FEM-POP W-ANGIOPLASTY UNI,37224,HCPCS,,,RT,Outpatient,,,10807.53,2701.8825,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7089.74,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7565.27,Percent of Total Billed Charges, ,,85,,9186.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7349.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6052.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6484.52,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37224 - REVSC OPN-PRG FEM-POP W-ANGIOPLASTY UNI,37224,HCPCS,,,LT,Outpatient,,,11241.1,2810.275,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7374.16,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7868.77,Percent of Total Billed Charges, ,,85,,9554.94,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7643.95,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6295.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6744.66,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37224 - REVSC OPN-PRG FEM-POP W-ANGIOPLASTY UNI,37224,HCPCS,,,74,Outpatient,,,9757.9,2439.475,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6401.18,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6830.53,Percent of Total Billed Charges, ,,85,,8294.22,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6635.37,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5464.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5854.74,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37225 - REVSC OPN-PRQ FEM-POP W-ATHRC-ANGIOP SM VSL,37225,HCPCS,,,RT,Outpatient,,,17979.77,4494.9425,1078.11,26519.48,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11794.73,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12585.84,Percent of Total Billed Charges, ,,85,,15282.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12226.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10068.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10787.86,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37225 - REVSC OPN-PRQ FEM-POP W-ATHRC-ANGIOP SM VSL,37225,HCPCS,,,LT,Outpatient,,,17696.41,4424.1025,1078.11,26519.48,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11608.84,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12387.49,Percent of Total Billed Charges, ,,85,,15041.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12033.56,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9909.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10617.85,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37226 - REVSC OPN-PRQ FEM-POP W-STNT-ANGIOP SM VSL,37226,HCPCS,,,RT,Outpatient,,,17639.97,4409.9925,1078.11,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11571.82,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12347.98,Percent of Total Billed Charges, ,,85,,14993.97,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11995.18,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9878.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10583.98,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37226 - REVSC OPN-PRQ FEM-POP W-STNT-ANGIOP SM VSL,37226,HCPCS,,,LT,Outpatient,,,18372.58,4593.145,1078.11,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12052.41,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12860.81,Percent of Total Billed Charges, ,,85,,15616.69,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12493.35,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10288.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11023.55,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37227 - REVSC OPN-PRQ FEM-POP W-STNT-ATHRC-ANGIOP SM VSL,37227,HCPCS,,,RT,Outpatient,,,31781.53,7945.3825,1078.11,27864.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20848.68,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22247.07,Percent of Total Billed Charges, ,,85,,27014.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21611.44,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17797.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19068.92,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37227 - REVSC OPN-PRQ FEM-POP W-STNT-ATHRC-ANGIOP SM VSL,37227,HCPCS,,,LT,Outpatient,,,35436.54,8859.135,1078.11,30121.06,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23246.37,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,24805.58,Percent of Total Billed Charges, ,,85,,30121.06,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,24096.85,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,19844.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21261.92,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37228 - REVSC OPN-PRQ TIB-PERO W-ANGIOPLASTY UNI,37228,HCPCS,,,XU,Outpatient,,,11749.5,2937.375,1078.11,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7707.67,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8224.65,Percent of Total Billed Charges, ,,85,,9987.08,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7989.66,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6579.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7049.7,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37228 - REVSC OPN-PRQ TIB-PERO W-ANGIOPLASTY UNI,37228,HCPCS,,,RT,Outpatient,,,17891.91,4472.9775,1078.11,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11737.09,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12524.34,Percent of Total Billed Charges, ,,85,,15208.12,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12166.5,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10019.47,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10735.15,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37228 - REVSC OPN-PRQ TIB-PERO W-ANGIOPLASTY UNI,37228,HCPCS,,,LT,Outpatient,,,17173.82,4293.455,1078.11,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11266.03,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12021.67,Percent of Total Billed Charges, ,,85,,14597.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11678.2,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9617.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10304.29,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37229 - REVSC OPN-PRQ TIB-PERO W-ATHRC-ANGIOP SM VSL,37229,HCPCS,,,RT,Outpatient,,,26390.54,6597.635,1078.11,27864.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17312.19,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18473.38,Percent of Total Billed Charges, ,,85,,22431.96,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,17945.57,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14778.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15834.32,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37229 - REVSC OPN-PRQ TIB-PERO W-ATHRC-ANGIOP SM VSL,37229,HCPCS,,,LT,Outpatient,,,27940.73,6985.1825,1078.11,27864.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18329.12,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19558.51,Percent of Total Billed Charges, ,,85,,23749.62,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,18999.7,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15646.81,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16764.44,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37230 - REVSC OPN-PRQ TIB-PERO W-STNT-ANGIOP SM VSL,37230,HCPCS,,,RT,Outpatient,,,21971,5492.75,1078.11,27864.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14412.98,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15379.7,Percent of Total Billed Charges, ,,85,,18675.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,14940.28,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12303.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13182.6,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37230 - REVSC OPN-PRQ TIB-PERO W-STNT-ANGIOP SM VSL,37230,HCPCS,,,LT,Outpatient,,,28294,7073.5,1078.11,27864.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19239.92,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37232 - REVSC OPN-PRQ TIB-PERO W-ANGIOPLASTY UNI EA VSL,37232,HCPCS,,,XU,Outpatient,,,11606,2901.5,0.01,10452,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7613.54,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8124.2,Percent of Total Billed Charges, ,,85,,9865.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7892.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6499.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6963.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37232 - REVSC OPN-PRQ TIB-PERO W-ANGIOPLASTY UNI EA VSL,37232,HCPCS,,,RT,Outpatient,,,12519.5,3129.875,0.01,10641.58,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8212.79,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8763.65,Percent of Total Billed Charges, ,,85,,10641.58,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8513.26,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7010.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7511.7,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37232 - REVSC OPN-PRQ TIB-PERO W-ANGIOPLASTY UNI EA VSL,37232,HCPCS,,,LT,Outpatient,,,11606,2901.5,0.01,10452,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7613.54,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8124.2,Percent of Total Billed Charges, ,,85,,9865.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7892.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6499.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6963.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37232 - REVSC OPN-PRQ TIB-PERO W-ANGIOPLASTY UNI EA VSL,37232,HCPCS,,,74,Outpatient,,,14651,3662.75,0.01,12453.35,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9611.06,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10255.7,Percent of Total Billed Charges, ,,85,,12453.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9962.68,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8204.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8790.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37233 - REVSC OPN-PRQ TIB-PERO W-ATHRC-ANGIOP UNI EA VSL,37233,HCPCS,,,RT,Outpatient,,,17638,4409.5,0.01,14992.3,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11570.53,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12346.6,Percent of Total Billed Charges, ,,85,,14992.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11993.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9877.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10582.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37236 - OPEN-PERQ PLACEMENT INTRAVASCULAR STENT INITIAL,37236,HCPCS,,,RT,Outpatient,,,17696,4424,1078.11,17219.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11608.58,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12387.2,Percent of Total Billed Charges, ,,85,,15041.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12033.28,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9909.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10617.6,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37236 - OPEN-PERQ PLACEMENT INTRAVASCULAR STENT INITIAL,37236,HCPCS,,,LT,Outpatient,,,17696,4424,1078.11,17219.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11608.58,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12387.2,Percent of Total Billed Charges, ,,85,,15041.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12033.28,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9909.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10617.6,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37236 - OPEN-PERQ PLACEMENT INTRAVASCULAR STENT INITIAL,37236,HCPCS,,,50,Outpatient,,,17696,4424,1078.11,17219.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11608.58,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12387.2,Percent of Total Billed Charges, ,,85,,15041.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12033.28,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9909.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10617.6,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37241 - VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RSANDI,37241,HCPCS,,,LT,Outpatient,,,12160,3040,882.09,17219.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7976.96,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8512,Percent of Total Billed Charges, ,,85,,10336,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8268.8,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6809.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7296,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37242 - VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RSANDI,37242,HCPCS,,,RT,Outpatient,,,9780,2445,882.09,26519.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6415.68,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6846,Percent of Total Billed Charges, ,,85,,8313,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6650.4,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5476.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5868,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37243 - VASCULAR EMBOLIZE-OCCLUDE ORGAN TUMOR INFARCT,37243,HCPCS,,,50,Outpatient,,,12685,3171.25,882.09,17219.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8321.36,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8879.5,Percent of Total Billed Charges, ,,85,,10782.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8625.8,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7103.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7611,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37244 - VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE,37244,HCPCS,,,RT,Outpatient,,,17696,4424,882.09,17219.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11608.58,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12387.2,Percent of Total Billed Charges, ,,85,,15041.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12033.28,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9909.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10617.6,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37246 - TRLML BALO ANGIOP OPEN-PERQ IMG SANDI 1ST ART,37246,HCPCS,,,XU,Outpatient,,,18186,4546.5,1078.11,15458.1,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11930.02,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12730.2,Percent of Total Billed Charges, ,,85,,15458.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12366.48,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10184.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10911.6,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37248 - TRLML BALO ANGIOP OPEN-PERQ W-IMG SANDI 1ST VEIN,37248,HCPCS,,,RT,Outpatient,,,12254.67,3063.6675,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8039.06,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8578.27,Percent of Total Billed Charges, ,,85,,10416.47,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8333.18,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6862.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7352.8,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37249 - TRLML BALO ANGIOP OPEN-PERQ W-IMG SANDI ADDL VEIN,37249,HCPCS,,,RT,Outpatient,,,12254.67,3063.6675,0.01,10416.47,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8039.06,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8578.27,Percent of Total Billed Charges, ,,85,,10416.47,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8333.18,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6862.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7352.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37252 - INTRAVASCULAR US NONCORONARY RSANDI INTIAL VESSEL,37252,HCPCS,,,RT,Outpatient,,,10048.5,2512.125,0.01,8541.23,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6591.82,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7033.95,Percent of Total Billed Charges, ,,85,,8541.23,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6832.98,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5627.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6029.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37607 - LIG-BANDING ANGIOACCESS ARTERIOVENOUS FISTULA,37607,HCPCS,,,RT,Outpatient,,,16545.25,4136.3125,742.5,14063.46,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10853.68,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11581.68,Percent of Total Billed Charges, ,,85,,14063.46,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11250.77,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9265.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9927.15,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37607 - LIG-BANDING ANGIOACCESS ARTERIOVENOUS FISTULA,37607,HCPCS,,,LT,Outpatient,,,15079.58,3769.895,742.5,12817.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9892.2,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10555.71,Percent of Total Billed Charges, ,,85,,12817.64,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10254.11,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8444.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9047.75,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37609 - LIGATION-BIOPSY TEMPORAL ARTERY,37609,HCPCS,,,RT,Outpatient,,,13625.4,3406.35,742.5,11581.59,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8938.26,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9537.78,Percent of Total Billed Charges, ,,85,,11581.59,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9265.27,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7630.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8175.24,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37609 - LIGATION-BIOPSY TEMPORAL ARTERY,37609,HCPCS,,,LT,Outpatient,,,12995.71,3248.9275,742.5,11046.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8525.19,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9097,Percent of Total Billed Charges, ,,85,,11046.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8837.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7277.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7797.43,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37609 - LIGATION-BIOPSY TEMPORAL ARTERY,37609,HCPCS,,,50,Outpatient,,,20485.33,5121.3325,742.5,17412.53,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13438.38,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14339.73,Percent of Total Billed Charges, ,,85,,17412.53,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13930.02,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11471.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12291.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37618 - LIGATION MAJOR ARTERY EXTREMITY,37618,HCPCS,,,LT,Outpatient,,,21147,5286.75,0.01,17974.95,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13872.43,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14802.9,Percent of Total Billed Charges, ,,85,,17974.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,14379.96,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11842.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12688.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37785 - LIGJ DIVJ AND-EXCJ VARICOSE VEIN CLUSTER 1 LEG,37785,HCPCS,,,LT,Outpatient,,,19038.5,4759.625,1078.11,16182.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12489.26,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13326.95,Percent of Total Billed Charges, ,,85,,16182.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12946.18,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10661.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11423.1,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38222 - DIAGNOSTIC BONE MARROW BIOPSIES AND ASPIRATIONS,38222,HCPCS,,,XU,Outpatient,,,4177,1044.25,742.5,4226.84,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2740.11,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2923.9,Percent of Total Billed Charges, ,,85,,3550.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2840.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2339.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2506.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38222 - DIAGNOSTIC BONE MARROW BIOPSIES AND ASPIRATIONS,38222,HCPCS,,,RT,Outpatient,,,4177,1044.25,742.5,4226.84,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2740.11,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2923.9,Percent of Total Billed Charges, ,,85,,3550.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2840.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2339.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2506.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38222 - DIAGNOSTIC BONE MARROW BIOPSIES AND ASPIRATIONS,38222,HCPCS,,,LT,Outpatient,,,4177,1044.25,742.5,4226.84,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2740.11,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2923.9,Percent of Total Billed Charges, ,,85,,3550.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2840.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2339.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2506.2,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38500 - BX-EXC LYMPH NODE OPEN SUPERFICIAL,38500,HCPCS,,,RT,Outpatient,,,11519.29,2879.8225,742.5,9791.4,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7556.65,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8063.5,Percent of Total Billed Charges, ,,85,,9791.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7833.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6450.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6911.57,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38500 - BX-EXC LYMPH NODE OPEN SUPERFICIAL,38500,HCPCS,,,LT,Outpatient,,,10680.55,2670.1375,742.5,9078.47,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7006.44,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7476.39,Percent of Total Billed Charges, ,,85,,9078.47,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7262.77,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5981.11,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6408.33,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38505 - BX-EXC LYMPH NODE NEEDLE SUPERFICIAL,38505,HCPCS,,,RT,Outpatient,,,2420,605,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1587.52,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1694,Percent of Total Billed Charges, ,,85,,2057,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1645.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1355.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1452,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38505 - BX-EXC LYMPH NODE NEEDLE SUPERFICIAL,38505,HCPCS,,,LT,Outpatient,,,2929.2,732.3,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1921.56,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2050.44,Percent of Total Billed Charges, ,,85,,2489.82,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1991.86,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1640.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1757.52,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38505 - BX-EXC LYMPH NODE NEEDLE SUPERFICIAL,38505,HCPCS,,,52,Outpatient,,,2420,605,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1587.52,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1694,Percent of Total Billed Charges, ,,85,,2057,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1645.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1355.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1452,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38505 - BX-EXC LYMPH NODE NEEDLE SUPERFICIAL,38505,HCPCS,,,50,Outpatient,,,2420,605,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1587.52,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1694,Percent of Total Billed Charges, ,,85,,2057,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1645.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1355.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1452,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38510 - BX-EXC LYMPH NODE OPEN DEEP CERVICAL NODE,38510,HCPCS,,,RT,Outpatient,,,15608.44,3902.11,882.09,13267.17,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10239.14,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10925.91,Percent of Total Billed Charges, ,,85,,13267.17,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10613.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8740.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9365.06,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38510 - BX-EXC LYMPH NODE OPEN DEEP CERVICAL NODE,38510,HCPCS,,,LT,Outpatient,,,14148.91,3537.2275,882.09,12026.57,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9281.68,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9904.24,Percent of Total Billed Charges, ,,85,,12026.57,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9621.26,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7923.39,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8489.35,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38520 - BX-EXC LYMPH NODE OPN DP CRV NODE W-EXC FAT PAD,38520,HCPCS,,,LT,Outpatient,,,13435.5,3358.875,742.5,11420.18,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8813.69,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9404.85,Percent of Total Billed Charges, ,,85,,11420.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9136.14,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7523.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8061.3,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38525 - BX-EXC LYMPH NODE OPEN DEEP AXILLARY NODE,38525,HCPCS,,,XU,Outpatient,,,9290.83,2322.7075,742.5,7897.21,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6094.78,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6503.58,Percent of Total Billed Charges, ,,85,,7897.21,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6317.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5202.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5574.5,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38525 - BX-EXC LYMPH NODE OPEN DEEP AXILLARY NODE,38525,HCPCS,,,RT,Outpatient,,,11641.78,2910.445,742.5,9895.51,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7637.01,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8149.25,Percent of Total Billed Charges, ,,85,,9895.51,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7916.41,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6519.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6985.07,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38525 - BX-EXC LYMPH NODE OPEN DEEP AXILLARY NODE,38525,HCPCS,,,LT,Outpatient,,,10283.74,2570.935,742.5,8741.18,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6746.13,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7198.62,Percent of Total Billed Charges, ,,85,,8741.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6992.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5758.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6170.24,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38525 - BX-EXC LYMPH NODE OPEN DEEP AXILLARY NODE,38525,HCPCS,,,50,Outpatient,,,16155.5,4038.875,742.5,13732.18,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10598.01,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11308.85,Percent of Total Billed Charges, ,,85,,13732.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10985.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9047.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9693.3,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38531 - OPEN BIOPSY-EXCISION INGUINOFEMORAL NODES,38531,HCPCS,,,XU,Outpatient,,,7215.66,1803.915,742.5,6133.31,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4733.47,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5050.96,Percent of Total Billed Charges, ,,85,,6133.31,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4906.65,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4040.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4329.4,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38531 - OPEN BIOPSY-EXCISION INGUINOFEMORAL NODES,38531,HCPCS,,,RT,Outpatient,,,16532,4133,742.5,14052.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10844.99,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11572.4,Percent of Total Billed Charges, ,,85,,14052.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11241.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9257.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9919.2,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38531 - OPEN BIOPSY-EXCISION INGUINOFEMORAL NODES,38531,HCPCS,,,LT,Outpatient,,,15912,3978,742.5,13525.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10438.27,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11138.4,Percent of Total Billed Charges, ,,85,,13525.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10820.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8910.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9547.2,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38570 - LAPS SURG RETROPERITONEAL LYMPH NODE BX 1-MLT,38570,HCPCS,,,RT,Outpatient,,,20061.5,5015.375,1078.11,17052.28,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13160.34,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14043.05,Percent of Total Billed Charges, ,,85,,17052.28,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13641.82,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11234.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12036.9,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38570 - LAPS SURG RETROPERITONEAL LYMPH NODE BX 1-MLT,38570,HCPCS,,,LT,Outpatient,,,17373.67,4343.4175,1078.11,14767.62,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11397.13,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12161.57,Percent of Total Billed Charges, ,,85,,14767.62,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11814.1,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9729.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10424.2,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38700 - SUPRAHYOID LYMPHADENECTOMY,38700,HCPCS,,,RT,Outpatient,,,19313.84,4828.46,1078.11,16416.76,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12669.88,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13519.69,Percent of Total Billed Charges, ,,85,,16416.76,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13133.41,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10815.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11588.3,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38700 - SUPRAHYOID LYMPHADENECTOMY,38700,HCPCS,,,LT,Outpatient,,,9575,2393.75,1078.11,9640.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6281.2,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6702.5,Percent of Total Billed Charges, ,,85,,8138.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6511,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5362,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5745,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38724 - CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ,38724,HCPCS,,,RT,Outpatient,,,16199.56,4049.89,0.01,13769.63,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4017.61,,,4017.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10626.91,Percent of Total Billed Charges, ,4017.61,,,4017.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11339.69,Percent of Total Billed Charges, ,,85,,13769.63,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11015.7,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9071.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9719.74,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3891.67,,,3891.67,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
38724 - CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ,38724,HCPCS,,,LT,Outpatient,,,13399.08,3349.77,0.01,11389.22,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4017.61,,,4017.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8789.8,Percent of Total Billed Charges, ,4017.61,,,4017.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9379.36,Percent of Total Billed Charges, ,,85,,11389.22,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9111.37,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7503.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8039.45,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3891.67,,,3891.67,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
38740 - AXILLARY LYMPHADENECTOMY SUPERFICIAL,38740,HCPCS,,,LT,Outpatient,,,15318.5,3829.625,950.4,13020.73,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10048.94,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10722.95,Percent of Total Billed Charges, ,,85,,13020.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10416.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8578.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9191.1,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38760 - INGUINOFEM LMPHADEC SUPFC W-CLOQUETS NODE SPX,38760,HCPCS,,,RT,Outpatient,,,13829,3457.25,950.4,11754.65,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9071.82,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9680.3,Percent of Total Billed Charges, ,,85,,11754.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9403.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7744.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8297.4,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38900 - INTRAOP SENTINEL LYMPH NODE ID W-DYE INJECTION,38900,HCPCS,,,RT,Outpatient,,,7002.77,1750.6925,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4593.82,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4901.94,Percent of Total Billed Charges, ,,85,,5952.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4761.88,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3921.55,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4201.66,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
38900 - INTRAOP SENTINEL LYMPH NODE ID W-DYE INJECTION,38900,HCPCS,,,LT,Outpatient,,,8123.06,2030.765,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5328.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5686.14,Percent of Total Billed Charges, ,,85,,6904.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5523.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4548.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4873.84,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
41120 - GLOSSECTOMY LESS THAN ONE-HALF TONGUE,41120,HCPCS,,,RT,Outpatient,,,13814.5,3453.625,950.4,11742.33,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9062.31,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9670.15,Percent of Total Billed Charges, ,,85,,11742.33,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9393.86,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7736.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8288.7,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
41899 - UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES,41899,HCPCS,,,73,Outpatient,,,5149,1287.25,0.01,10028,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,337.14,,,337.14,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,342.96,,,342.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3377.74,Percent of Total Billed Charges, ,337.14,,,337.14,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3604.3,Percent of Total Billed Charges, ,,85,,4376.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3501.32,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2883.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3089.4,Percent of Total Billed Charges, ,339.45,,,339.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,326.57,,,326.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,228.51,,,228.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.72,,,230.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,222.99,,,222.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,220.78,,,220.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,222.99,,,222.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,227.4,,,227.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,231.27,,,231.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42400 - BIOPSY SALIVARY GLAND NEEDLE,42400,HCPCS,,,LT,Outpatient,,,1301,325.25,668.93,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,853.46,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,910.7,Percent of Total Billed Charges, ,,85,,1105.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,884.68,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,728.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,780.6,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42415 - EXC PRTD TUM-PRTD GLND LAT DSJANDPRSRV FACIAL NR,42415,HCPCS,,,RT,Outpatient,,,20708.84,5177.21,882.09,17602.51,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13585,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14496.19,Percent of Total Billed Charges, ,,85,,17602.51,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14082.01,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11596.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12425.3,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42415 - EXC PRTD TUM-PRTD GLND LAT DSJANDPRSRV FACIAL NR,42415,HCPCS,,,LT,Outpatient,,,24504.13,6126.0325,882.09,20828.51,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16074.71,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17152.89,Percent of Total Billed Charges, ,,85,,20828.51,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16662.81,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13722.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14702.48,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42440 - EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND,42440,HCPCS,,,RT,Outpatient,,,22267,5566.75,882.09,18926.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14607.15,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15586.9,Percent of Total Billed Charges, ,,85,,18926.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15141.56,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12469.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13360.2,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42820 - TONSILLECTOMY AND ADENOIDECTOMY LESS THAN AGE 12,42820,HCPCS,,,50,Outpatient,,,12035,3008.75,1078.11,10229.75,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7894.96,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8424.5,Percent of Total Billed Charges, ,,85,,10229.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8183.8,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6739.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7221,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42826 - TONSILLECTOMY PRIMARY-SECONDARY AGE 12-GREATER THAN,42826,HCPCS,,,50,Outpatient,,,13556.5,3389.125,1078.11,11523.03,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8893.06,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9489.55,Percent of Total Billed Charges, ,,85,,11523.03,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9218.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7591.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8133.9,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42842 - RADICAL RESECTION TONSIL W-O CLOSURE,42842,HCPCS,,,LT,Outpatient,,,11521,2880.25,0.01,9792.85,,,,,,,Service Paid at Rev Code level,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7557.78,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8064.7,Percent of Total Billed Charges, ,,85,,9792.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7834.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6451.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6912.6,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42962 - CTRL OROPHARYNGEAL HEMORRHAGE W-SEC SURG IVNTJ,42962,HCPCS,,,78,Outpatient,,,13271,3317.75,882.09,11280.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8705.78,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9289.7,Percent of Total Billed Charges, ,,85,,11280.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9024.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7431.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7962.6,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43191 - ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH,43191,HCPCS,,,XU,Outpatient,,,3477,869.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2280.91,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2433.9,Percent of Total Billed Charges, ,,85,,2955.45,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2364.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1947.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2086.2,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43202 - ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY,43202,HCPCS,,,XS,Outpatient,,,5045.66,1261.415,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3309.95,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3531.96,Percent of Total Billed Charges, ,,85,,4288.81,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3431.05,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2825.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3027.4,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43235 - ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,43235,HCPCS,,,XU,Outpatient,,,18280.5,4570.125,742.5,15538.43,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11992.01,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12796.35,Percent of Total Billed Charges, ,,85,,15538.43,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12430.74,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10237.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10968.3,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43235 - ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,43235,HCPCS,,,XS,Outpatient,,,24463.5,6115.875,742.5,20793.98,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16048.06,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17124.45,Percent of Total Billed Charges, ,,85,,20793.98,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16635.18,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13699.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14678.1,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43236 - ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION,43236,HCPCS,,,XU,Outpatient,,,4805.2,1201.3,742.5,4084.42,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3152.21,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3363.64,Percent of Total Billed Charges, ,,85,,4084.42,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3267.54,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2690.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2883.12,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43236 - ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION,43236,HCPCS,,,XS,Outpatient,,,5360.34,1340.085,742.5,4556.29,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3516.38,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3752.24,Percent of Total Billed Charges, ,,85,,4556.29,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3645.03,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3001.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3216.2,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43239 - EGD TRANSORAL BIOPSY SINGLE-MULTIPLE,43239,HCPCS,,,XU,Outpatient,,,4258.02,1064.505,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2793.26,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2980.61,Percent of Total Billed Charges, ,,85,,3619.32,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2895.45,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2384.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2554.81,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43239 - EGD TRANSORAL BIOPSY SINGLE-MULTIPLE,43239,HCPCS,,,XS,Outpatient,,,7267.12,1816.78,882.09,6177.05,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4767.23,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5086.98,Percent of Total Billed Charges, ,,85,,6177.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4941.64,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4069.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4360.27,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43239 - EGD TRANSORAL BIOPSY SINGLE-MULTIPLE,43239,HCPCS,,,59,Outpatient,,,5370.88,1342.72,882.09,4565.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3523.3,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3759.62,Percent of Total Billed Charges, ,,85,,4565.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3652.2,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3007.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3222.53,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43255 - EGD TRANSORAL CONTROL BLEEDING ANY METHOD,43255,HCPCS,,,XU,Outpatient,,,3606,901.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2365.54,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2524.2,Percent of Total Billed Charges, ,,85,,3065.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2452.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2019.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2163.6,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43281 - LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W-O MESH,43281,HCPCS,,,XU,Outpatient,,,15097.5,3774.375,1078.11,15375.87,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9903.96,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10568.25,Percent of Total Billed Charges, ,,85,,12832.88,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10266.3,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8454.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9058.5,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43450 - DILATION ESOPH UNGUIDED SOUND-BOUGIE 1-MULT PASS,43450,HCPCS,,,XU,Outpatient,,,5540.5,1385.125,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3634.57,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3878.35,Percent of Total Billed Charges, ,,85,,4709.43,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3767.54,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3102.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3324.3,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44180 - LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE,44180,HCPCS,,,XU,Outpatient,,,6983.5,1745.875,1078.11,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4581.18,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4888.45,Percent of Total Billed Charges, ,,85,,5935.98,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4748.78,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3910.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4190.1,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44380 - ILEOSCOPY THRU STOMA DX W-COLLJ SPEC WHEN PRFMD,44380,HCPCS,,,XU,Outpatient,,,3390,847.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2223.84,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2373,Percent of Total Billed Charges, ,,85,,2881.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2305.2,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1898.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2034,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44388 - COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX,44388,HCPCS,,,52,Outpatient,,,1816,454,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1191.3,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1271.2,Percent of Total Billed Charges, ,,85,,1543.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1234.88,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1016.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1089.6,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44602 - ENTERORRHAPHY SINGLE PERFORATION,44602,HCPCS,,,XU,Outpatient,,,13654,3413.5,0.01,11605.9,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8957.02,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9557.8,Percent of Total Billed Charges, ,,85,,11605.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9284.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7646.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8192.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44970 - LAPAROSCOPIC APPENDECTOMY,44970,HCPCS,,,XU,Outpatient,,,10709.98,2677.495,1078.11,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7025.75,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7496.99,Percent of Total Billed Charges, ,,85,,9103.48,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7282.79,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5997.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6425.99,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44970 - LAPAROSCOPIC APPENDECTOMY,44970,HCPCS,,,XS,Outpatient,,,14194.33,3548.5825,1078.11,12065.18,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9311.48,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9936.03,Percent of Total Billed Charges, ,,85,,12065.18,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9652.14,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7948.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8516.6,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44970 - LAPAROSCOPIC APPENDECTOMY,44970,HCPCS,,,59,Outpatient,,,10281,2570.25,1078.11,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6744.34,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7196.7,Percent of Total Billed Charges, ,,85,,8738.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6991.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5757.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6168.6,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45300 - PROCTOSGMDSC RGD DX W-WO COLLJ SPEC BR-WA SPX,45300,HCPCS,,,XU,Outpatient,,,4693.68,1173.42,742.5,3989.63,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3079.05,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3285.58,Percent of Total Billed Charges, ,,85,,3989.63,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3191.7,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2628.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2816.21,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45378 - COLONOSCOPY FLX DX W-COLLJ SPEC WHEN PFRMD,45378,HCPCS,,,PT,Outpatient,,,3813.25,953.3125,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2501.49,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2669.28,Percent of Total Billed Charges, ,,85,,3241.26,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2593.01,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2135.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2287.95,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45378 - COLONOSCOPY FLX DX W-COLLJ SPEC WHEN PFRMD,45378,HCPCS,,,74,Outpatient,,,4290.5,1072.625,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2814.57,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3003.35,Percent of Total Billed Charges, ,,85,,3646.93,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2917.54,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2402.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2574.3,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45379 - COLONOSCOPY FLX W-REMOVAL OF FOREIGN BODY(S),45379,HCPCS,,,PT,Outpatient,,,3303,825.75,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2166.77,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2312.1,Percent of Total Billed Charges, ,,85,,2807.55,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2246.04,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1849.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1981.8,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,XU,Outpatient,,,3329.88,832.47,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2184.4,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2330.92,Percent of Total Billed Charges, ,,85,,2830.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2264.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1864.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1997.93,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,XS,Outpatient,,,3444.92,861.23,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2259.87,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2411.44,Percent of Total Billed Charges, ,,85,,2928.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2342.55,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1929.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2066.95,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,PT,Outpatient,,,6764.39,1691.0975,742.5,5749.73,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4437.44,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4735.07,Percent of Total Billed Charges, ,,85,,5749.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4599.79,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3788.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4058.63,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45381 - COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST,45381,HCPCS,,,XU,Outpatient,,,2724,681,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1786.94,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1906.8,Percent of Total Billed Charges, ,,85,,2315.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1852.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1525.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1634.4,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45381 - COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST,45381,HCPCS,,,PT,Outpatient,,,3771.17,942.7925,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2473.89,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2639.82,Percent of Total Billed Charges, ,,85,,3205.49,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2564.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2111.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2262.7,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45382 - COLSC FLEXIBLE W-CONTROL BLEEDING ANY METHOD,45382,HCPCS,,,XU,Outpatient,,,5810.5,1452.625,742.5,4938.93,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3811.69,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4067.35,Percent of Total Billed Charges, ,,85,,4938.93,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3951.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3253.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3486.3,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45384 - COLSC FLX W-REMOVAL LESION BY HOT BX FORCEPS,45384,HCPCS,,,XS,Outpatient,,,4030.13,1007.5325,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2643.77,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2821.09,Percent of Total Billed Charges, ,,85,,3425.61,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2740.49,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2256.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2418.08,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45384 - COLSC FLX W-REMOVAL LESION BY HOT BX FORCEPS,45384,HCPCS,,,PT,Outpatient,,,9965,2491.25,742.5,8470.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6537.04,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6975.5,Percent of Total Billed Charges, ,,85,,8470.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6776.2,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5580.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5979,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45385 - COLSC FLX W-RMVL OF TUMOR POLYP LESION SNARE TQ,45385,HCPCS,,,PT,Outpatient,,,5639.93,1409.9825,742.5,4793.94,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3699.79,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3947.95,Percent of Total Billed Charges, ,,85,,4793.94,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3835.15,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3158.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3383.96,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45395 - LAPS PROCTECTOMY ABDOMINOPERINEAL W-COLOSTOMY,45395,HCPCS,,,74,Outpatient,,,33501,8375.25,0.01,28475.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21976.66,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23450.7,Percent of Total Billed Charges, ,,85,,28475.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,22780.68,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18760.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,20100.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
45990 - ANRCT XM SURG REQ ANES GENERAL SPI-EDRL DX,45990,HCPCS,,,78,Outpatient,,,17667,4416.75,742.5,15016.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4050.11,,,4050.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11589.55,Percent of Total Billed Charges, ,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12366.9,Percent of Total Billed Charges, ,,85,,15016.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12013.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9893.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10600.2,Percent of Total Billed Charges, ,4008.72,,,4008.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4037.44,,,4037.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2698.56,,,2698.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2724.63,,,2724.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2607.3,,,2607.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2685.52,,,2685.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2731.15,,,2731.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45990 - ANRCT XM SURG REQ ANES GENERAL SPI-EDRL DX,45990,HCPCS,,,59,Outpatient,,,7801,1950.25,742.5,6630.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4050.11,,,4050.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5117.46,Percent of Total Billed Charges, ,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5460.7,Percent of Total Billed Charges, ,,85,,6630.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5304.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4368.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4680.6,Percent of Total Billed Charges, ,4008.72,,,4008.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4037.44,,,4037.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2698.56,,,2698.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2724.63,,,2724.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2607.3,,,2607.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2685.52,,,2685.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2731.15,,,2731.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
47562 - LAPAROSCOPY SURG CHOLECYSTECTOMY,47562,HCPCS,,,XS,Outpatient,,,13381,3345.25,1078.11,11373.85,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8777.94,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9366.7,Percent of Total Billed Charges, ,,85,,11373.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9099.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7493.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8028.6,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49180 - BX ABDL-RETROPERITONEAL MASS PRQ NEEDLE,49180,HCPCS,,,LT,Outpatient,,,2602,650.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1706.91,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1821.4,Percent of Total Billed Charges, ,,85,,2211.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1769.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1457.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1561.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49180 - BX ABDL-RETROPERITONEAL MASS PRQ NEEDLE,49180,HCPCS,,,74,Outpatient,,,2602,650.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1706.91,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1821.4,Percent of Total Billed Charges, ,,85,,2211.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1769.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1457.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1561.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49180 - BX ABDL-RETROPERITONEAL MASS PRQ NEEDLE,49180,HCPCS,,,73,Outpatient,,,2602,650.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1706.91,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1821.4,Percent of Total Billed Charges, ,,85,,2211.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1769.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1457.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1561.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49320 - LAPS ABD PRTMANDOMENTUM DX W-WO SPEC BR-WA SPX,49320,HCPCS,,,XU,Outpatient,,,8930.17,2232.5425,1078.11,8616.51,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5858.19,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6251.12,Percent of Total Billed Charges, ,,85,,7590.64,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6072.52,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5000.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5358.1,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49320 - LAPS ABD PRTMANDOMENTUM DX W-WO SPEC BR-WA SPX,49320,HCPCS,,,59,Outpatient,,,12400.5,3100.125,1078.11,10540.43,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8134.73,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8680.35,Percent of Total Billed Charges, ,,85,,10540.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8432.34,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6944.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7440.3,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49321 - LAPAROSCOPY SURG W-BX SINGLE-MULTIPLE,49321,HCPCS,,,XU,Outpatient,,,9740.99,2435.2475,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6390.09,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6818.69,Percent of Total Billed Charges, ,,85,,8279.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6623.87,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5454.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5844.59,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49321 - LAPAROSCOPY SURG W-BX SINGLE-MULTIPLE,49321,HCPCS,,,XS,Outpatient,,,3759.4,939.85,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2466.17,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2631.58,Percent of Total Billed Charges, ,,85,,3195.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2556.39,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2105.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2255.64,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49321 - LAPAROSCOPY SURG W-BX SINGLE-MULTIPLE,49321,HCPCS,,,LT,Outpatient,,,8441,2110.25,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5537.3,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5908.7,Percent of Total Billed Charges, ,,85,,7174.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5739.88,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4726.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5064.6,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49321 - LAPAROSCOPY SURG W-BX SINGLE-MULTIPLE,49321,HCPCS,,,74,Outpatient,,,20581,5145.25,1078.11,17493.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13501.14,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14406.7,Percent of Total Billed Charges, ,,85,,17493.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13995.08,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11525.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12348.6,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49321 - LAPAROSCOPY SURG W-BX SINGLE-MULTIPLE,49321,HCPCS,,,59,Outpatient,,,10259,2564.75,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6729.9,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7181.3,Percent of Total Billed Charges, ,,85,,8720.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6976.12,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5745.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6155.4,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49322 - LAPS SURG W-ASPIR CAVITY-CYST SINGLE-MULTIPLE,49322,HCPCS,,,XU,Outpatient,,,5446.65,1361.6625,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3573,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3812.66,Percent of Total Billed Charges, ,,85,,4629.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3703.72,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3050.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3267.99,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49322 - LAPS SURG W-ASPIR CAVITY-CYST SINGLE-MULTIPLE,49322,HCPCS,,,XS,Outpatient,,,4977.68,1244.42,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3265.36,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3484.38,Percent of Total Billed Charges, ,,85,,4231.03,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3384.82,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2787.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2986.61,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49322 - LAPS SURG W-ASPIR CAVITY-CYST SINGLE-MULTIPLE,49322,HCPCS,,,RT,Outpatient,,,9755.13,2438.7825,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6399.37,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6828.59,Percent of Total Billed Charges, ,,85,,8291.86,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6633.49,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5462.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5853.08,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49322 - LAPS SURG W-ASPIR CAVITY-CYST SINGLE-MULTIPLE,49322,HCPCS,,,LT,Outpatient,,,8886,2221.5,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5829.22,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6220.2,Percent of Total Billed Charges, ,,85,,7553.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6042.48,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4976.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5331.6,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49322 - LAPS SURG W-ASPIR CAVITY-CYST SINGLE-MULTIPLE,49322,HCPCS,,,50,Outpatient,,,6389,1597.25,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4191.18,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4472.3,Percent of Total Billed Charges, ,,85,,5430.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4344.52,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3577.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3833.4,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49324 - LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER,49324,HCPCS,,,LT,Outpatient,,,19856.25,4964.0625,1078.11,16877.81,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13025.7,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13899.38,Percent of Total Billed Charges, ,,85,,16877.81,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13502.25,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11119.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11913.75,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49324 - LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER,49324,HCPCS,,,74,Outpatient,,,11443.5,2860.875,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7506.94,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8010.45,Percent of Total Billed Charges, ,,85,,9726.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7781.58,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6408.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6866.1,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ,49405,HCPCS,,,XU,Outpatient,,,9601,2400.25,742.5,8200,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6528.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49405 - IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ,49405,HCPCS,,,LT,Outpatient,,,9601,2400.25,742.5,8200,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6528.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49406 - IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ,49406,HCPCS,,,XU,Outpatient,,,9601,2400.25,742.5,8200,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49422 - REMOVAL TUNNELED INTRAPERITONEAL CATHETER,49422,HCPCS,,,LT,Outpatient,,,8177.33,2044.3325,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5364.33,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5724.13,Percent of Total Billed Charges, ,,85,,6950.73,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5560.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4579.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4906.4,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49422 - REMOVAL TUNNELED INTRAPERITONEAL CATHETER,49422,HCPCS,,,50,Outpatient,,,5151,1287.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49423 - EXCHNG ABSC-CST DRG CATH RAD GID SPX,49423,HCPCS,,,XU,Outpatient,,,4067,1016.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2667.95,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2846.9,Percent of Total Billed Charges, ,,85,,3456.95,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2765.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2277.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2440.2,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49423 - EXCHNG ABSC-CST DRG CATH RAD GID SPX,49423,HCPCS,,,59,Outpatient,,,4067,1016.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2667.95,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2846.9,Percent of Total Billed Charges, ,,85,,3456.95,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2765.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2277.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2440.2,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49450 - REPLACE GASTROSTOMY-CECOSTOMY TUBE PERCUTANEOUS,49450,HCPCS,,,XP,Outpatient,,,1800,450,882.09,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49451 - REPLACE DUODENOSTOMY-JEJUNOSTOMY TUBE PERQ,49451,HCPCS,,,73,Outpatient,,,1800,450,882.09,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49500 - RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE,49500,HCPCS,,,LT,Outpatient,,,20411,5102.75,882.09,17349.35,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9215.21,,,9215.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13389.62,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14287.7,Percent of Total Billed Charges, ,,85,,17349.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13879.48,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11430.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12246.6,Percent of Total Billed Charges, ,9121.03,,,9121.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6140.01,,,6140.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6199.34,,,6199.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5932.38,,,5932.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6110.35,,,6110.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6214.17,,,6214.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49505 - RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN REDUCIBLE,49505,HCPCS,,,RT,Outpatient,,,19590.1,4897.525,1078.11,16651.59,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12851.11,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13713.07,Percent of Total Billed Charges, ,,85,,16651.59,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13321.27,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10970.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11754.06,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49505 - RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN REDUCIBLE,49505,HCPCS,,,LT,Outpatient,,,19297.15,4824.2875,1078.11,16402.58,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12658.93,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13508.01,Percent of Total Billed Charges, ,,85,,16402.58,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13122.06,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10806.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11578.29,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49505 - RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN REDUCIBLE,49505,HCPCS,,,50,Outpatient,,,27473,6868.25,1078.11,23352.05,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18022.29,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19231.1,Percent of Total Billed Charges, ,,85,,23352.05,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18681.64,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15384.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16483.8,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49507 - RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN INCARCERATED,49507,HCPCS,,,XU,Outpatient,,,10065,2516.25,1078.11,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6602.64,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7045.5,Percent of Total Billed Charges, ,,85,,8555.25,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6844.2,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5636.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6039,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49507 - RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN INCARCERATED,49507,HCPCS,,,RT,Outpatient,,,21686.93,5421.7325,1078.11,18433.89,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14226.63,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15180.85,Percent of Total Billed Charges, ,,85,,18433.89,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14747.11,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12144.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13012.16,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49507 - RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN INCARCERATED,49507,HCPCS,,,LT,Outpatient,,,21089.18,5272.295,1078.11,17925.8,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13834.5,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14762.43,Percent of Total Billed Charges, ,,85,,17925.8,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14340.64,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11809.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12653.51,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49507 - RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN INCARCERATED,49507,HCPCS,,,50,Outpatient,,,19629.83,4907.4575,1078.11,16685.36,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12877.17,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13740.88,Percent of Total Billed Charges, ,,85,,16685.36,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13348.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10992.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11777.9,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49520 - RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE,49520,HCPCS,,,RT,Outpatient,,,20340,5085,1078.11,17289,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13343.04,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14238,Percent of Total Billed Charges, ,,85,,17289,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13831.2,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11390.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12204,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49520 - RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE,49520,HCPCS,,,LT,Outpatient,,,19688.17,4922.0425,1078.11,16734.94,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12915.44,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13781.72,Percent of Total Billed Charges, ,,85,,16734.94,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13387.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11025.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11812.9,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49520 - RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE,49520,HCPCS,,,50,Outpatient,,,23301,5825.25,1078.11,19805.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15285.46,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16310.7,Percent of Total Billed Charges, ,,85,,19805.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15844.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13048.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13980.6,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49521 - RPR RECRT INGUN HERNIA ANY AGE INCARCERATED,49521,HCPCS,,,XS,Outpatient,,,13071,3267.75,1078.11,13976,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9215.21,,,9215.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8574.58,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9149.7,Percent of Total Billed Charges, ,,85,,11110.35,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8888.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7319.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7842.6,Percent of Total Billed Charges, ,9121.03,,,9121.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6140.01,,,6140.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6199.34,,,6199.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5932.38,,,5932.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6110.35,,,6110.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6214.17,,,6214.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49521 - RPR RECRT INGUN HERNIA ANY AGE INCARCERATED,49521,HCPCS,,,RT,Outpatient,,,16469.96,4117.49,1078.11,13999.47,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9215.21,,,9215.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10804.29,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11528.97,Percent of Total Billed Charges, ,,85,,13999.47,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11199.57,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9223.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9881.98,Percent of Total Billed Charges, ,9121.03,,,9121.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6140.01,,,6140.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6199.34,,,6199.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5932.38,,,5932.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6110.35,,,6110.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6214.17,,,6214.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49521 - RPR RECRT INGUN HERNIA ANY AGE INCARCERATED,49521,HCPCS,,,LT,Outpatient,,,19116,4779,1078.11,16248.6,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9215.21,,,9215.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12540.1,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13381.2,Percent of Total Billed Charges, ,,85,,16248.6,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12998.88,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10704.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11469.6,Percent of Total Billed Charges, ,9121.03,,,9121.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6140.01,,,6140.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6199.34,,,6199.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5932.38,,,5932.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6110.35,,,6110.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6214.17,,,6214.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49525 - RPR INGUN HERNIA SLIDING ANY AGE,49525,HCPCS,,,RT,Outpatient,,,19632,4908,1078.11,16687.2,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12878.59,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13742.4,Percent of Total Billed Charges, ,,85,,16687.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13349.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10993.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11779.2,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49525 - RPR INGUN HERNIA SLIDING ANY AGE,49525,HCPCS,,,LT,Outpatient,,,25987,6496.75,1078.11,22088.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17047.47,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18190.9,Percent of Total Billed Charges, ,,85,,22088.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17671.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14552.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15592.2,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49550 - RPR 1ST FEM HRNA ANY AGE REDUCIBLE,49550,HCPCS,,,RT,Outpatient,,,40712,10178,1078.11,34605.2,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26707.07,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28498.4,Percent of Total Billed Charges, ,,85,,34605.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,27684.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,22798.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,24427.2,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49550 - RPR 1ST FEM HRNA ANY AGE REDUCIBLE,49550,HCPCS,,,LT,Outpatient,,,7540.33,1885.0825,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4946.46,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5278.23,Percent of Total Billed Charges, ,,85,,6409.28,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5127.42,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4222.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4524.2,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49553 - RPR 1ST FEM HERNIA ANY AGE INCARCERATED,49553,HCPCS,,,RT,Outpatient,,,16896.25,4224.0625,1078.11,14361.81,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11083.94,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11827.38,Percent of Total Billed Charges, ,,85,,14361.81,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11489.45,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9461.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10137.75,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49591 - RPR AA HERNIA 1ST LESS THAN 3 CM REDUCIBLE,49591,HCPCS,,,XU,Outpatient,,,13510,3377.5,1078.11,11483.5,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8862.56,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9457,Percent of Total Billed Charges, ,,85,,11483.5,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9186.8,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7565.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8106,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49591 - RPR AA HERNIA 1ST LESS THAN 3 CM REDUCIBLE,49591,HCPCS,,,XS,Outpatient,,,14487.75,3621.9375,1078.11,12314.59,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9503.96,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10141.43,Percent of Total Billed Charges, ,,85,,12314.59,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9851.67,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8113.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8692.65,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49591 - RPR AA HERNIA 1ST LESS THAN 3 CM REDUCIBLE,49591,HCPCS,,,59,Outpatient,,,10433.5,2608.375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6844.38,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7303.45,Percent of Total Billed Charges, ,,85,,8868.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7094.78,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5842.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6260.1,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49591 - RPR AA HERNIA 1ST LESS THAN 3 CM REDUCIBLE,49591,HCPCS,,,50,Outpatient,,,15706.5,3926.625,1078.11,13350.53,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10303.46,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10994.55,Percent of Total Billed Charges, ,,85,,13350.53,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10680.42,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8795.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9423.9,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49592 - RPR AA HERNIA 1ST LESS THAN 3 CM NCRC8-STRANGULATED,49592,HCPCS,,,XU,Outpatient,,,11595,2898.75,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7606.32,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8116.5,Percent of Total Billed Charges, ,,85,,9855.75,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7884.6,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6493.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6957,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49592 - RPR AA HERNIA 1ST LESS THAN 3 CM NCRC8-STRANGULATED,49592,HCPCS,,,XS,Outpatient,,,11753.5,2938.375,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7710.3,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8227.45,Percent of Total Billed Charges, ,,85,,9990.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7992.38,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6581.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7052.1,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49593 - RPR AA HERNIA 1ST 3-10 CM REDUCIBLE,49593,HCPCS,,,XU,Outpatient,,,11687.07,2921.7675,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9215.21,,,9215.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7666.72,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8180.95,Percent of Total Billed Charges, ,,85,,9934.01,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7947.21,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6544.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7012.24,Percent of Total Billed Charges, ,9121.03,,,9121.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6140.01,,,6140.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6199.34,,,6199.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5932.38,,,5932.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6110.35,,,6110.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6214.17,,,6214.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49593 - RPR AA HERNIA 1ST 3-10 CM REDUCIBLE,49593,HCPCS,,,LT,Outpatient,,,11735.5,2933.875,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9215.21,,,9215.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7698.49,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8214.85,Percent of Total Billed Charges, ,,85,,9975.18,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7980.14,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6571.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7041.3,Percent of Total Billed Charges, ,9121.03,,,9121.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6140.01,,,6140.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6199.34,,,6199.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5932.38,,,5932.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6110.35,,,6110.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6214.17,,,6214.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49594 - RPR AA HERNIA 1ST 3-10 CM NCRC8-STRANGULATED,49594,HCPCS,,,XU,Outpatient,,,11075.47,2768.8675,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7265.51,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7752.83,Percent of Total Billed Charges, ,,85,,9414.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7531.32,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6202.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6645.28,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49594 - RPR AA HERNIA 1ST 3-10 CM NCRC8-STRANGULATED,49594,HCPCS,,,RT,Outpatient,,,24437,6109.25,1078.11,20771.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16030.67,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17105.9,Percent of Total Billed Charges, ,,85,,20771.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16617.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13684.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14662.2,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49595 - RPR AA HERNIA 1ST GREATER THAN 10 CM REDUCIBLE,49595,HCPCS,,,XS,Outpatient,,,19215.5,4803.875,1078.11,16333.18,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9215.21,,,9215.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12605.37,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13450.85,Percent of Total Billed Charges, ,,85,,16333.18,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13066.54,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10760.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11529.3,Percent of Total Billed Charges, ,9121.03,,,9121.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6140.01,,,6140.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6199.34,,,6199.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5932.38,,,5932.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5991.7,,,5991.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6110.35,,,6110.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6214.17,,,6214.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49613 - RPR AA HERNIA RECR LESS THAN 3 CM REDUCIBLE,49613,HCPCS,,,XS,Outpatient,,,14421.75,3605.4375,1078.11,12258.49,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9460.67,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10095.23,Percent of Total Billed Charges, ,,85,,12258.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9806.79,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8076.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8653.05,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49650 - LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA,49650,HCPCS,,,RT,Outpatient,,,21267.48,5316.87,1078.11,18077.36,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13951.47,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14887.24,Percent of Total Billed Charges, ,,85,,18077.36,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14461.89,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11909.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12760.49,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49650 - LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA,49650,HCPCS,,,LT,Outpatient,,,23136.25,5784.0625,1078.11,19665.81,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15177.38,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16195.38,Percent of Total Billed Charges, ,,85,,19665.81,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15732.65,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12956.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13881.75,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49650 - LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA,49650,HCPCS,,,50,Outpatient,,,24048.95,6012.2375,1078.11,20441.61,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15776.11,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16834.27,Percent of Total Billed Charges, ,,85,,20441.61,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16353.29,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13467.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14429.37,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49651 - LAPS SURG RPR RECURRENT INGUINAL HERNIA,49651,HCPCS,,,RT,Outpatient,,,21834.5,5458.625,1078.11,18559.33,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14323.43,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15284.15,Percent of Total Billed Charges, ,,85,,18559.33,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14847.46,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12227.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13100.7,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49651 - LAPS SURG RPR RECURRENT INGUINAL HERNIA,49651,HCPCS,,,LT,Outpatient,,,21740.84,5435.21,1078.11,18479.71,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14261.99,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15218.59,Percent of Total Billed Charges, ,,85,,18479.71,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14783.77,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12174.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13044.5,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49651 - LAPS SURG RPR RECURRENT INGUINAL HERNIA,49651,HCPCS,,,50,Outpatient,,,24586.33,6146.5825,1078.11,20898.38,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16128.63,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17210.43,Percent of Total Billed Charges, ,,85,,20898.38,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16718.7,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13768.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14751.8,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50080 - PERQ NL-PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION,50080,HCPCS,,,RT,Outpatient,,,13417.67,3354.4175,950.4,13881.75,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13881.75,,,13881.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13656.7,,,13656.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8801.99,Percent of Total Billed Charges, ,13881.75,,,13881.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9392.37,Percent of Total Billed Charges, ,,85,,11405.02,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9124.02,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7513.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8050.6,Percent of Total Billed Charges, ,13517.15,,,13517.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13446.58,,,13446.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9099.35,,,9099.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9187.26,,,9187.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8879.56,,,8879.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8791.64,,,8791.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8879.56,,,8879.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9055.39,,,9055.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9209.24,,,9209.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50080 - PERQ NL-PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION,50080,HCPCS,,,LT,Outpatient,,,19027,4756.75,950.4,16172.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13881.75,,,13881.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13656.7,,,13656.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12481.71,Percent of Total Billed Charges, ,13881.75,,,13881.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13318.9,Percent of Total Billed Charges, ,,85,,16172.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12938.36,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10655.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11416.2,Percent of Total Billed Charges, ,13517.15,,,13517.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13446.58,,,13446.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9099.35,,,9099.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9187.26,,,9187.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8879.56,,,8879.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8791.64,,,8791.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8879.56,,,8879.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9055.39,,,9055.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9209.24,,,9209.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50081 - PERQ NL-PL LITHOTRP COMPLEX GREATER THAN 2 CM MLT LOCATIONS,50081,HCPCS,,,RT,Outpatient,,,14786.58,3696.645,882.09,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13881.75,,,13881.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13656.7,,,13656.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9700,Percent of Total Billed Charges, ,13881.75,,,13881.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10350.61,Percent of Total Billed Charges, ,,85,,12568.59,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10054.87,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8280.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8871.95,Percent of Total Billed Charges, ,13517.15,,,13517.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13446.58,,,13446.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9099.35,,,9099.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9187.26,,,9187.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8879.56,,,8879.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8791.64,,,8791.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8879.56,,,8879.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9055.39,,,9055.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9209.24,,,9209.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50081 - PERQ NL-PL LITHOTRP COMPLEX GREATER THAN 2 CM MLT LOCATIONS,50081,HCPCS,,,LT,Outpatient,,,17322.34,4330.585,882.09,14723.99,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13881.75,,,13881.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13656.7,,,13656.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11363.46,Percent of Total Billed Charges, ,13881.75,,,13881.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12125.64,Percent of Total Billed Charges, ,,85,,14723.99,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11779.19,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9700.51,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10393.4,Percent of Total Billed Charges, ,13517.15,,,13517.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13446.58,,,13446.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9099.35,,,9099.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9187.26,,,9187.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8879.56,,,8879.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8791.64,,,8791.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8879.56,,,8879.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9055.39,,,9055.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9209.24,,,9209.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50200 - RENAL BIOPSY PRQ TROCAR-NEEDLE,50200,HCPCS,,,RT,Outpatient,,,2280.24,570.06,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1495.84,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1596.17,Percent of Total Billed Charges, ,,85,,1938.2,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1550.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1276.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1368.14,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50200 - RENAL BIOPSY PRQ TROCAR-NEEDLE,50200,HCPCS,,,LT,Outpatient,,,2391.86,597.965,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1569.06,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1674.3,Percent of Total Billed Charges, ,,85,,2033.08,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1626.46,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1339.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1435.12,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50200 - RENAL BIOPSY PRQ TROCAR-NEEDLE,50200,HCPCS,,,74,Outpatient,,,2156,539,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1414.34,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1509.2,Percent of Total Billed Charges, ,,85,,1832.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1466.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1207.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1293.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50200 - RENAL BIOPSY PRQ TROCAR-NEEDLE,50200,HCPCS,,,73,Outpatient,,,2156,539,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1414.34,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1509.2,Percent of Total Billed Charges, ,,85,,1832.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1466.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1207.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1293.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50200 - RENAL BIOPSY PRQ TROCAR-NEEDLE,50200,HCPCS,,,50,Outpatient,,,2156,539,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1414.34,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1509.2,Percent of Total Billed Charges, ,,85,,1832.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1466.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1207.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1293.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50382 - RMVL AND RPLCMT INTLY DWELLING URETERAL STENT PRQ,50382,HCPCS,,,RT,Outpatient,,,3609,902.25,882.09,3246,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2367.5,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2526.3,Percent of Total Billed Charges, ,,85,,3067.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2454.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2021.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2165.4,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50382 - RMVL AND RPLCMT INTLY DWELLING URETERAL STENT PRQ,50382,HCPCS,,,LT,Outpatient,,,2945,736.25,882.09,3246,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1931.92,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2061.5,Percent of Total Billed Charges, ,,85,,2503.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2002.6,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1649.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1767,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50387 - RMVL AND RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH,50387,HCPCS,,,RT,Outpatient,,,3787,946.75,882.09,3218.95,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2484.27,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2650.9,Percent of Total Billed Charges, ,,85,,3218.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2575.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2120.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2272.2,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50387 - RMVL AND RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH,50387,HCPCS,,,LT,Outpatient,,,3787,946.75,882.09,3218.95,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2484.27,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2650.9,Percent of Total Billed Charges, ,,85,,3218.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2575.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2120.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2272.2,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50387 - RMVL AND RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH,50387,HCPCS,,,50,Outpatient,,,3787,946.75,882.09,3218.95,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2484.27,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2650.9,Percent of Total Billed Charges, ,,85,,3218.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2575.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2120.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2272.2,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50389 - RMVL NFROS TUBE REQ FLUORO GUIDANCE,50389,HCPCS,,,RT,Outpatient,,,4116,1029,634.59,3498.6,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2700.1,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2881.2,Percent of Total Billed Charges, ,,85,,3498.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2798.88,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2304.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2469.6,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50390 - ASPIR AND-NJX RENAL CYST-PELVIS NEEDLE PRQ,50390,HCPCS,,,RT,Outpatient,,,1800,450,668.93,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50390 - ASPIR AND-NJX RENAL CYST-PELVIS NEEDLE PRQ,50390,HCPCS,,,LT,Outpatient,,,1800,450,668.93,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50390 - ASPIR AND-NJX RENAL CYST-PELVIS NEEDLE PRQ,50390,HCPCS,,,73,Outpatient,,,1800,450,668.93,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50391 - INSTLJ THER AGENT RENAL PELVISAND-URETER VIA TUB,50391,HCPCS,,,RT,Outpatient,,,4650.5,1162.625,231.23,3952.93,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,348.56,,,348.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,359.18,,,359.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3050.73,Percent of Total Billed Charges, ,348.56,,,348.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3255.35,Percent of Total Billed Charges, ,,85,,3952.93,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3162.34,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2604.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2790.3,Percent of Total Billed Charges, ,355.52,,,355.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,337.63,,,337.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,239.32,,,239.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,241.64,,,241.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,233.54,,,233.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,231.23,,,231.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,233.54,,,233.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.17,,,238.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,242.21,,,242.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50400 - PYELOPLASTY SIMPLE,50400,HCPCS,,,RT,Outpatient,,,21013.5,5253.375,0.01,17861.48,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13784.86,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14709.45,Percent of Total Billed Charges, ,,85,,17861.48,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,14289.18,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11767.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12608.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
50431 - NJX PX ANTEGRDE NFROSGRM AND-URTRGRM EXSTNG ACESS,50431,HCPCS,,,LT,Outpatient,,,3912,978,634.59,3325.2,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2566.27,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2738.4,Percent of Total Billed Charges, ,,85,,3325.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2660.16,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2190.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2347.2,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50431 - NJX PX ANTEGRDE NFROSGRM AND-URTRGRM EXSTNG ACESS,50431,HCPCS,,,50,Outpatient,,,9551,2387.75,634.59,8118.35,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6265.46,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6685.7,Percent of Total Billed Charges, ,,85,,8118.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6494.68,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5348.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5730.6,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50433 - PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RSANDI,50433,HCPCS,,,RT,Outpatient,,,7403.64,1850.91,742.5,6293.09,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4856.79,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5182.55,Percent of Total Billed Charges, ,,85,,6293.09,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5034.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4146.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4442.18,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50433 - PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RSANDI,50433,HCPCS,,,LT,Outpatient,,,7218,1804.5,742.5,6135.3,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4735.01,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5052.6,Percent of Total Billed Charges, ,,85,,6135.3,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4908.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4042.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4330.8,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50436 - PERQ DILATION XST TRC ENDOUROLOGIC PX W-IMG,50436,HCPCS,,,XU,Outpatient,,,10800,2700,742.5,9180,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7084.8,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7560,Percent of Total Billed Charges, ,,85,,9180,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7344,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6048,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6480,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50436 - PERQ DILATION XST TRC ENDOUROLOGIC PX W-IMG,50436,HCPCS,,,59,Outpatient,,,11965.5,2991.375,742.5,10170.68,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7849.37,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8375.85,Percent of Total Billed Charges, ,,85,,10170.68,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8136.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6700.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7179.3,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50437 - PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS,50437,HCPCS,,,XU,Outpatient,,,9260,2315,742.5,7871,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6074.56,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6482,Percent of Total Billed Charges, ,,85,,7871,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6296.8,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5185.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5556,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50541 - LAPAROSCOPY SURG ABLATION RENAL CYSTS,50541,HCPCS,,,XU,Outpatient,,,19519,4879.75,1078.11,16591.15,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12804.46,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13663.3,Percent of Total Billed Charges, ,,85,,16591.15,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13272.92,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10930.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11711.4,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50541 - LAPAROSCOPY SURG ABLATION RENAL CYSTS,50541,HCPCS,,,XS,Outpatient,,,16423.75,4105.9375,1078.11,15375.87,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10773.98,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11496.63,Percent of Total Billed Charges, ,,85,,13960.19,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11168.15,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9197.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9854.25,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50541 - LAPAROSCOPY SURG ABLATION RENAL CYSTS,50541,HCPCS,,,RT,Outpatient,,,19427.25,4856.8125,1078.11,16513.16,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12744.28,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13599.08,Percent of Total Billed Charges, ,,85,,16513.16,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13210.53,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10879.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11656.35,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50541 - LAPAROSCOPY SURG ABLATION RENAL CYSTS,50541,HCPCS,,,LT,Outpatient,,,21606.3,5401.575,1078.11,18365.36,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14173.73,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15124.41,Percent of Total Billed Charges, ,,85,,18365.36,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,14692.28,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12099.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12963.78,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50543 - LAPAROSCOPY SURG PARTIAL NEPHRECTOMY,50543,HCPCS,,,RT,Outpatient,,,32114.31,8028.5775,1078.11,27297.16,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21066.99,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22480.02,Percent of Total Billed Charges, ,,85,,27297.16,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21837.73,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17984.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19268.59,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50543 - LAPAROSCOPY SURG PARTIAL NEPHRECTOMY,50543,HCPCS,,,LT,Outpatient,,,30097.38,7524.345,1078.11,25582.77,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19743.88,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21068.17,Percent of Total Billed Charges, ,,85,,25582.77,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,20466.22,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16854.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18058.43,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50543 - LAPAROSCOPY SURG PARTIAL NEPHRECTOMY,50543,HCPCS,,,22,Outpatient,,,26531,6632.75,1078.11,22551.35,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17404.34,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18571.7,Percent of Total Billed Charges, ,,85,,22551.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,18041.08,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,14857.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,15918.6,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50544 - LAPAROSCOPY SURG PYELOPLASTY,50544,HCPCS,,,RT,Outpatient,,,29675.5,7418.875,1078.11,25224.18,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19467.13,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20772.85,Percent of Total Billed Charges, ,,85,,25224.18,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,20179.34,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16618.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17805.3,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50544 - LAPAROSCOPY SURG PYELOPLASTY,50544,HCPCS,,,LT,Outpatient,,,24513.5,6128.375,1078.11,20836.48,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16080.86,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17159.45,Percent of Total Billed Charges, ,,85,,20836.48,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,16669.18,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13727.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14708.1,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50545 - LAPAROSCOPY RADICAL NEPHRECTOMY,50545,HCPCS,,,RT,Outpatient,,,28008.75,7002.1875,0.01,23807.44,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18373.74,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19606.13,Percent of Total Billed Charges, ,,85,,23807.44,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19045.95,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15684.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16805.25,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
50545 - LAPAROSCOPY RADICAL NEPHRECTOMY,50545,HCPCS,,,LT,Outpatient,,,27237,6809.25,0.01,23151.45,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17867.47,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19065.9,Percent of Total Billed Charges, ,,85,,23151.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,18521.16,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15252.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16342.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
50590 - LITHOTRIPSY XTRCORP SHOCK WAVE,50590,HCPCS,,,RT,Outpatient,,,9551,2387.75,3279.07,12812,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6265.46,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6685.7,Percent of Total Billed Charges, ,,85,,8118.35,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6494.68,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5348.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5730.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50590 - LITHOTRIPSY XTRCORP SHOCK WAVE,50590,HCPCS,,,74,Outpatient,,,4417,1104.25,2473.52,12812,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2897.55,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3091.9,Percent of Total Billed Charges, ,,85,,3754.45,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3003.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2473.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2650.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50592 - ABLTJ 1-GREATER THAN RENAL TUMOR PRQ UNI RADIOFREQUENCY,50592,HCPCS,,,RT,Outpatient,,,6007.5,1501.875,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3940.92,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4205.25,Percent of Total Billed Charges, ,,85,,5106.38,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4085.1,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3364.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3604.5,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50592 - ABLTJ 1-GREATER THAN RENAL TUMOR PRQ UNI RADIOFREQUENCY,50592,HCPCS,,,LT,Outpatient,,,7933.25,1983.3125,1078.11,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5204.21,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5553.28,Percent of Total Billed Charges, ,,85,,6743.26,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5394.61,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4442.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4759.95,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50593 - ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY,50593,HCPCS,,,RT,Outpatient,,,15691,3922.75,1078.11,15375.87,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10293.3,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10983.7,Percent of Total Billed Charges, ,,85,,13337.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10669.88,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8786.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9414.6,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50593 - ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY,50593,HCPCS,,,LT,Outpatient,,,15014.25,3753.5625,1078.11,15375.87,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9849.35,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10509.98,Percent of Total Billed Charges, ,,85,,12762.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10209.69,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8407.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9008.55,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50593 - ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY,50593,HCPCS,,,74,Outpatient,,,15691,3922.75,1078.11,15375.87,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10293.3,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10983.7,Percent of Total Billed Charges, ,,85,,13337.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10669.88,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8786.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9414.6,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50688 - CHNG URTROST TUBE-XTRNLLY ACCESSIBLE STENT ILEAL,50688,HCPCS,,,RT,Outpatient,,,4270.5,1067.625,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2801.45,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2989.35,Percent of Total Billed Charges, ,,85,,3629.93,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2903.94,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2391.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2562.3,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50688 - CHNG URTROST TUBE-XTRNLLY ACCESSIBLE STENT ILEAL,50688,HCPCS,,,LT,Outpatient,,,3154,788.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2069.02,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2207.8,Percent of Total Billed Charges, ,,85,,2680.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2144.72,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1766.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1892.4,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50688 - CHNG URTROST TUBE-XTRNLLY ACCESSIBLE STENT ILEAL,50688,HCPCS,,,50,Outpatient,,,3154,788.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2069.02,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2207.8,Percent of Total Billed Charges, ,,85,,2680.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2144.72,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1766.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1892.4,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50783 - URETERONEOCYSTOSTOMY W-URETERAL TAILORING,50783,HCPCS,,,XU,Outpatient,,,19577,4894.25,0.01,16640.45,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12842.51,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13703.9,Percent of Total Billed Charges, ,,85,,16640.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13312.36,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10963.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11746.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
50947 - LAPS URTRONEOCSTOST W-CSTSCANDURTRL STENT PLMT,50947,HCPCS,,,RT,Outpatient,,,40461,10115.25,1078.11,34391.85,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26542.42,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28322.7,Percent of Total Billed Charges, ,,85,,34391.85,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,27513.48,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,22658.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,24276.6,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50947 - LAPS URTRONEOCSTOST W-CSTSCANDURTRL STENT PLMT,50947,HCPCS,,,LT,Outpatient,,,35899,8974.75,1078.11,30514.15,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,23549.74,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25129.3,Percent of Total Billed Charges, ,,85,,30514.15,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,24411.32,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,20103.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,21539.4,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50948 - LAPS URTRONEOCSTOST W-O CSTSCANDURTRL STENT PLMT,50948,HCPCS,,,LT,Outpatient,,,19640.5,4910.125,950.4,16694.43,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12884.17,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13748.35,Percent of Total Billed Charges, ,,85,,16694.43,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13355.54,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10998.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11784.3,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51040 - CYSTOSTOMY CYSTOTOMY W-DRAINAGE,51040,HCPCS,,,XS,Outpatient,,,9041,2260.25,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5930.9,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6328.7,Percent of Total Billed Charges, ,,85,,7684.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6147.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5062.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5424.6,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51050 - CYSTOLITHOTOMY CYSTOTOMY W-RMVL CALCULUS,51050,HCPCS,,,XS,Outpatient,,,16858.75,4214.6875,742.5,14329.94,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11059.34,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11801.13,Percent of Total Billed Charges, ,,85,,14329.94,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11463.95,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9440.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10115.25,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51525 - CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1-MULTIPLE,51525,HCPCS,,,XU,Outpatient,,,8714,2178.5,0.01,7406.9,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5716.38,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6099.8,Percent of Total Billed Charges, ,,85,,7406.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5925.52,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4879.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5228.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
51600 - NJX CSTOGRAPY-VOIDING URETHROCSTOGRAPY,51600,HCPCS,,,XU,Outpatient,,,725,181.25,0.01,6015,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51610 - NJX RETROGRADE URETHROCSTOGRAPY,51610,HCPCS,,,XU,Outpatient,,,5353,1338.25,0.01,6015,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3511.57,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3747.1,Percent of Total Billed Charges, ,,85,,4550.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3640.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2997.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3211.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51705 - CHANGE CYSTOSTOMY TUBE SIMPLE,51705,HCPCS,,,XS,Outpatient,,,4322.83,1080.7075,231.23,3674.41,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,348.56,,,348.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,359.18,,,359.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2835.78,Percent of Total Billed Charges, ,348.56,,,348.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3025.98,Percent of Total Billed Charges, ,,85,,3674.41,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2939.52,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2420.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2593.7,Percent of Total Billed Charges, ,355.52,,,355.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,337.63,,,337.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,239.32,,,239.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,241.64,,,241.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,233.54,,,233.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,231.23,,,231.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,233.54,,,233.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.17,,,238.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,242.21,,,242.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51705 - CHANGE CYSTOSTOMY TUBE SIMPLE,51705,HCPCS,,,59,Outpatient,,,4347,1086.75,231.23,3694.95,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,348.56,,,348.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,359.18,,,359.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2851.63,Percent of Total Billed Charges, ,348.56,,,348.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3042.9,Percent of Total Billed Charges, ,,85,,3694.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2955.96,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2434.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2608.2,Percent of Total Billed Charges, ,355.52,,,355.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,337.63,,,337.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,239.32,,,239.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,241.64,,,241.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,233.54,,,233.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,231.23,,,231.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,233.54,,,233.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.17,,,238.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,242.21,,,242.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51705 - CHANGE CYSTOSTOMY TUBE SIMPLE,51705,HCPCS,,,50,Outpatient,,,4218,1054.5,231.23,3585.3,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,348.56,,,348.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,359.18,,,359.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2767.01,Percent of Total Billed Charges, ,348.56,,,348.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2952.6,Percent of Total Billed Charges, ,,85,,3585.3,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2868.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2362.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2530.8,Percent of Total Billed Charges, ,355.52,,,355.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,337.63,,,337.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,239.32,,,239.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,241.64,,,241.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,233.54,,,233.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,231.23,,,231.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,233.54,,,233.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.17,,,238.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,242.21,,,242.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51720 - BLADDER INSTILLATION ANTICARCINOGENIC AGENT,51720,HCPCS,,,XU,Outpatient,,,4298.95,1074.7375,634.59,3654.11,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2820.11,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3009.27,Percent of Total Billed Charges, ,,85,,3654.11,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2923.29,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2407.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2579.37,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52000 - CYSTOURETHROSCOPY,52000,HCPCS,,,XU,Outpatient,,,11603.08,2900.77,634.59,9862.62,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7611.62,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8122.16,Percent of Total Billed Charges, ,,85,,9862.62,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7890.09,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6497.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6961.85,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52000 - CYSTOURETHROSCOPY,52000,HCPCS,,,XS,Outpatient,,,4269,1067.25,634.59,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2800.46,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2988.3,Percent of Total Billed Charges, ,,85,,3628.65,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2902.92,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2390.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2561.4,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52001 - CYSTO W-IRRIG AND EVAC MULTPLE OBSTRUCTING CLOTS,52001,HCPCS,,,XU,Outpatient,,,4362.05,1090.5125,742.5,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2861.5,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3053.44,Percent of Total Billed Charges, ,,85,,3707.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2966.19,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2442.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2617.23,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52001 - CYSTO W-IRRIG AND EVAC MULTPLE OBSTRUCTING CLOTS,52001,HCPCS,,,XS,Outpatient,,,3867.75,966.9375,742.5,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2537.24,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2707.43,Percent of Total Billed Charges, ,,85,,3287.59,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2630.07,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2165.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2320.65,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52001 - CYSTO W-IRRIG AND EVAC MULTPLE OBSTRUCTING CLOTS,52001,HCPCS,,,59,Outpatient,,,3738,934.5,742.5,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2452.13,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2616.6,Percent of Total Billed Charges, ,,85,,3177.3,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2541.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2093.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2242.8,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52005 - CYSTOURETHROSCOPY W-URETERAL CATHETERIZATION,52005,HCPCS,,,XU,Outpatient,,,7344.77,1836.1925,742.5,6243.05,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4818.17,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5141.34,Percent of Total Billed Charges, ,,85,,6243.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4994.44,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4113.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4406.86,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52005 - CYSTOURETHROSCOPY W-URETERAL CATHETERIZATION,52005,HCPCS,,,RT,Outpatient,,,7376.56,1844.14,742.5,6270.08,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4839.02,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5163.59,Percent of Total Billed Charges, ,,85,,6270.08,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5016.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4130.87,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4425.94,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52005 - CYSTOURETHROSCOPY W-URETERAL CATHETERIZATION,52005,HCPCS,,,LT,Outpatient,,,9994.46,2498.615,742.5,8495.29,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6556.37,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6996.12,Percent of Total Billed Charges, ,,85,,8495.29,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6796.23,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5596.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5996.68,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52005 - CYSTOURETHROSCOPY W-URETERAL CATHETERIZATION,52005,HCPCS,,,59,Outpatient,,,3607.5,901.875,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2366.52,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2525.25,Percent of Total Billed Charges, ,,85,,3066.38,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2453.1,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2020.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2164.5,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52005 - CYSTOURETHROSCOPY W-URETERAL CATHETERIZATION,52005,HCPCS,,,50,Outpatient,,,7906.5,1976.625,742.5,6720.53,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5186.66,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5534.55,Percent of Total Billed Charges, ,,85,,6720.53,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5376.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4427.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4743.9,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52204 - CYSTOURETHROSCOPY WITH BIOPSY,52204,HCPCS,,,XU,Outpatient,,,4231.33,1057.8325,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2775.75,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2961.93,Percent of Total Billed Charges, ,,85,,3596.63,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2877.3,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2369.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2538.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52204 - CYSTOURETHROSCOPY WITH BIOPSY,52204,HCPCS,,,XS,Outpatient,,,4936.33,1234.0825,742.5,4195.88,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3238.23,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3455.43,Percent of Total Billed Charges, ,,85,,4195.88,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3356.7,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2764.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2961.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52214 - CYSTO W-DESTRUCTION OF LESIONS,52214,HCPCS,,,79,Outpatient,,,2927,731.75,742.5,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1920.11,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2048.9,Percent of Total Billed Charges, ,,85,,2487.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1990.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1639.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1756.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52234 - CYSTO W-REMOVAL OF TUMORS SMALL,52234,HCPCS,,,XS,Outpatient,,,5052,1263,950.4,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3314.11,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3536.4,Percent of Total Billed Charges, ,,85,,4294.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3435.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2829.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3031.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52234 - CYSTO W-REMOVAL OF TUMORS SMALL,52234,HCPCS,,,RT,Outpatient,,,5340,1335,950.4,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3503.04,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3738,Percent of Total Billed Charges, ,,85,,4539,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3631.2,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2990.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3204,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52235 - CYSTOURETHROSCOPY W-DEST AND-RMVL MED BLADDER TUM,52235,HCPCS,,,RT,Outpatient,,,4779,1194.75,950.4,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3135.02,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3345.3,Percent of Total Billed Charges, ,,85,,4062.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3249.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2676.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2867.4,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52260 - CYSTOURETHROSCOPY W-DIL BLADDER GENERAL ANESTH,52260,HCPCS,,,XU,Outpatient,,,5014.25,1253.5625,742.5,4262.11,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3289.35,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3509.98,Percent of Total Billed Charges, ,,85,,4262.11,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3409.69,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2807.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3008.55,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52276 - CYSTOURETHROSCOPY W-INTERNAL URETHROTOMY,52276,HCPCS,,,XU,Outpatient,,,3738,934.5,950.4,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2452.13,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2616.6,Percent of Total Billed Charges, ,,85,,3177.3,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2541.84,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2093.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2242.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52276 - CYSTOURETHROSCOPY W-INTERNAL URETHROTOMY,52276,HCPCS,,,XS,Outpatient,,,5534.5,1383.625,950.4,4704.33,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3630.63,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3874.15,Percent of Total Billed Charges, ,,85,,4704.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3763.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3099.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3320.7,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52281 - CYSTO CALIBRATION DILAT URTL STRIX-STENOSIS,52281,HCPCS,,,XU,Outpatient,,,8560.34,2140.085,742.5,7276.29,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5615.58,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5992.24,Percent of Total Billed Charges, ,,85,,7276.29,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5821.03,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4793.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5136.2,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52281 - CYSTO CALIBRATION DILAT URTL STRIX-STENOSIS,52281,HCPCS,,,XS,Outpatient,,,6993.5,1748.375,742.5,5944.48,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4587.74,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4895.45,Percent of Total Billed Charges, ,,85,,5944.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4755.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3916.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4196.1,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52287 - CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER,52287,HCPCS,,,XU,Outpatient,,,3708,927,950.4,13976,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2432.45,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2595.6,Percent of Total Billed Charges, ,,85,,3151.8,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2521.44,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2076.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2224.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52290 - CYSTOURETHROSCOPY W-URETERAL MEATOTOMY UNI-BI,52290,HCPCS,,,XU,Outpatient,,,5165.5,1291.375,742.5,4390.68,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3388.57,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3615.85,Percent of Total Billed Charges, ,,85,,4390.68,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3512.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2892.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3099.3,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52290 - CYSTOURETHROSCOPY W-URETERAL MEATOTOMY UNI-BI,52290,HCPCS,,,59,Outpatient,,,4269,1067.25,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2800.46,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2988.3,Percent of Total Billed Charges, ,,85,,3628.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2902.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2390.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2561.4,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52300 - CYSTO W-RESCJ-FULG ORTHOPIC URETEROCELE UNI-BI,52300,HCPCS,,,LT,Outpatient,,,3390,847.5,950.4,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2223.84,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2373,Percent of Total Billed Charges, ,,85,,2881.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2305.2,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1898.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2034,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52310 - CYSTO W-SIMPLE REMOVAL STONE AND STENT,52310,HCPCS,,,XU,Outpatient,,,8009.25,2002.3125,1078.11,6807.86,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5254.07,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5606.48,Percent of Total Billed Charges, ,,85,,6807.86,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5446.29,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4485.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4805.55,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52310 - CYSTO W-SIMPLE REMOVAL STONE AND STENT,52310,HCPCS,,,XS,Outpatient,,,17620.5,4405.125,1078.11,14977.43,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11559.05,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12334.35,Percent of Total Billed Charges, ,,85,,14977.43,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11981.94,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9867.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10572.3,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52310 - CYSTO W-SIMPLE REMOVAL STONE AND STENT,52310,HCPCS,,,RT,Outpatient,,,7669.23,1917.3075,1078.11,6518.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5031.01,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5368.46,Percent of Total Billed Charges, ,,85,,6518.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5215.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4294.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4601.54,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52310 - CYSTO W-SIMPLE REMOVAL STONE AND STENT,52310,HCPCS,,,LT,Outpatient,,,7841.94,1960.485,1078.11,6665.65,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5144.31,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5489.36,Percent of Total Billed Charges, ,,85,,6665.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5332.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4391.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4705.16,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52310 - CYSTO W-SIMPLE REMOVAL STONE AND STENT,52310,HCPCS,,,50,Outpatient,,,6659.67,1664.9175,1078.11,5660.72,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4368.74,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4661.77,Percent of Total Billed Charges, ,,85,,5660.72,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4528.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3729.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3995.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52315 - CYSTO W-COMPLEX REMOVAL STONE AND STENT,52315,HCPCS,,,XU,Outpatient,,,7212,1803,1078.11,6130.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4731.07,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5048.4,Percent of Total Billed Charges, ,,85,,6130.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4904.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4038.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4327.2,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52317 - LITHOLAPAXY SMPL-SM LESS THAN 2.5 CM,52317,HCPCS,,,XU,Outpatient,,,7142.5,1785.625,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4685.48,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4999.75,Percent of Total Billed Charges, ,,85,,6071.13,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4856.9,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3999.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4285.5,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52317 - LITHOLAPAXY SMPL-SM LESS THAN 2.5 CM,52317,HCPCS,,,XS,Outpatient,,,6233.75,1558.4375,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4089.34,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4363.63,Percent of Total Billed Charges, ,,85,,5298.69,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4238.95,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3490.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3740.25,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52318 - LITHOLAPAXY COMP-LG GREATER THAN 2.5 CM,52318,HCPCS,,,XU,Outpatient,,,10358.5,2589.625,1078.11,8804.73,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6795.18,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7250.95,Percent of Total Billed Charges, ,,85,,8804.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7043.78,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5800.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6215.1,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52318 - LITHOLAPAXY COMP-LG GREATER THAN 2.5 CM,52318,HCPCS,,,XS,Outpatient,,,5347.5,1336.875,1078.11,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3507.96,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3743.25,Percent of Total Billed Charges, ,,85,,4545.38,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3636.3,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2994.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3208.5,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52320 - CYSTOURETHROSCOPY W-RMVL URETERAL CALCULUS,52320,HCPCS,,,RT,Outpatient,,,4786.17,1196.5425,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3139.73,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3350.32,Percent of Total Billed Charges, ,,85,,4068.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3254.6,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2680.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2871.7,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52320 - CYSTOURETHROSCOPY W-RMVL URETERAL CALCULUS,52320,HCPCS,,,LT,Outpatient,,,4702.5,1175.625,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3084.84,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3291.75,Percent of Total Billed Charges, ,,85,,3997.13,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3197.7,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2633.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2821.5,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52330 - CYSTO MANJ W-O RMVL URETERAL STONE,52330,HCPCS,,,XU,Outpatient,,,5786,1446.5,1078.11,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3795.62,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4050.2,Percent of Total Billed Charges, ,,85,,4918.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3934.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3240.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3471.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52330 - CYSTO MANJ W-O RMVL URETERAL STONE,52330,HCPCS,,,RT,Outpatient,,,3759,939.75,1078.11,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2465.9,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2631.3,Percent of Total Billed Charges, ,,85,,3195.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2556.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2105.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2255.4,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52330 - CYSTO MANJ W-O RMVL URETERAL STONE,52330,HCPCS,,,LT,Outpatient,,,5741.5,1435.375,1078.11,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3766.42,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4019.05,Percent of Total Billed Charges, ,,85,,4880.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3904.22,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3215.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3444.9,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,XU,Outpatient,,,4729.84,1182.46,1078.11,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3102.78,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3310.89,Percent of Total Billed Charges, ,,85,,4020.36,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3216.29,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2648.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2837.9,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,XS,Outpatient,,,6245,1561.25,1078.11,5308.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4096.72,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4371.5,Percent of Total Billed Charges, ,,85,,5308.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4246.6,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3497.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3747,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,RT,Outpatient,,,7177.16,1794.29,1078.11,6100.59,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4708.22,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5024.01,Percent of Total Billed Charges, ,,85,,6100.59,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4880.47,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4019.21,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4306.3,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,LT,Outpatient,,,6939.03,1734.7575,1078.11,5898.18,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4552,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4857.32,Percent of Total Billed Charges, ,,85,,5898.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4718.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3885.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4163.42,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,79,Outpatient,,,2927,731.75,1078.11,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1920.11,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2048.9,Percent of Total Billed Charges, ,,85,,2487.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1990.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1639.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1756.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,59,Outpatient,,,3755.75,938.9375,1078.11,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2463.77,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2629.03,Percent of Total Billed Charges, ,,85,,3192.39,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2553.91,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2103.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2253.45,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,50,Outpatient,,,6984,1746,1078.11,5936.4,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4581.5,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4888.8,Percent of Total Billed Charges, ,,85,,5936.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4749.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3911.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4190.4,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,22,Outpatient,,,8232,2058,1078.11,6997.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5400.19,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5762.4,Percent of Total Billed Charges, ,,85,,6997.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5597.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4609.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4939.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52341 - CYSTO W-TX URETERAL STRICTURE,52341,HCPCS,,,XU,Outpatient,,,7405,1851.25,1078.11,6294.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4857.68,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5183.5,Percent of Total Billed Charges, ,,85,,6294.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5035.4,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4146.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4443,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52341 - CYSTO W-TX URETERAL STRICTURE,52341,HCPCS,,,RT,Outpatient,,,3912,978,1078.11,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2566.27,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2738.4,Percent of Total Billed Charges, ,,85,,3325.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2660.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2190.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2347.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52341 - CYSTO W-TX URETERAL STRICTURE,52341,HCPCS,,,LT,Outpatient,,,8353,2088.25,1078.11,7100.05,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5479.57,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5847.1,Percent of Total Billed Charges, ,,85,,7100.05,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5680.04,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4677.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5011.8,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52344 - CYSTO W-URTROSCOPY W-TX URETERAL STRICTURE,52344,HCPCS,,,XU,Outpatient,,,4575,1143.75,1078.11,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3001.2,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3202.5,Percent of Total Billed Charges, ,,85,,3888.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3111,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2562,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2745,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52344 - CYSTO W-URTROSCOPY W-TX URETERAL STRICTURE,52344,HCPCS,,,RT,Outpatient,,,4611.1,1152.775,1078.11,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3024.88,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3227.77,Percent of Total Billed Charges, ,,85,,3919.44,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3135.55,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2582.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2766.66,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52344 - CYSTO W-URTROSCOPY W-TX URETERAL STRICTURE,52344,HCPCS,,,LT,Outpatient,,,5036,1259,1078.11,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3303.62,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3525.2,Percent of Total Billed Charges, ,,85,,4280.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3424.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2820.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3021.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52346 - CYSTO W-URTROSCOPY W-TX INTRA-RENAL STRICTURE,52346,HCPCS,,,RT,Outpatient,,,6500.5,1625.125,1078.11,7627.72,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4264.33,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4550.35,Percent of Total Billed Charges, ,,85,,5525.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4420.34,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3640.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3900.3,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52351 - CYSTO W-URTROSCOPYAND-PYELOSCOPY DX,52351,HCPCS,,,XU,Outpatient,,,5575.66,1393.915,742.5,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3657.63,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3902.96,Percent of Total Billed Charges, ,,85,,4739.31,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3791.45,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3122.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3345.4,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52351 - CYSTO W-URTROSCOPYAND-PYELOSCOPY DX,52351,HCPCS,,,RT,Outpatient,,,6528.47,1632.1175,742.5,5549.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4282.68,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4569.93,Percent of Total Billed Charges, ,,85,,5549.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4439.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3655.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3917.08,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52351 - CYSTO W-URTROSCOPYAND-PYELOSCOPY DX,52351,HCPCS,,,LT,Outpatient,,,5635.3,1408.825,742.5,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3696.76,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3944.71,Percent of Total Billed Charges, ,,85,,4790.01,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3832,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3155.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3381.18,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52351 - CYSTO W-URTROSCOPYAND-PYELOSCOPY DX,52351,HCPCS,,,74,Outpatient,,,4037,1009.25,742.5,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2648.27,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2825.9,Percent of Total Billed Charges, ,,85,,3431.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2745.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2260.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2422.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52351 - CYSTO W-URTROSCOPYAND-PYELOSCOPY DX,52351,HCPCS,,,50,Outpatient,,,5742.5,1435.625,742.5,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3767.08,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4019.75,Percent of Total Billed Charges, ,,85,,4881.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3904.9,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3215.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3445.5,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52352 - CYSTO W-URETEROSCOPY W-RMVL-MANJ STONES,52352,HCPCS,,,XU,Outpatient,,,5664.92,1416.23,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3716.19,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3965.44,Percent of Total Billed Charges, ,,85,,4815.18,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3852.15,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3172.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3398.95,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52352 - CYSTO W-URETEROSCOPY W-RMVL-MANJ STONES,52352,HCPCS,,,XS,Outpatient,,,3912,978,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2566.27,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2738.4,Percent of Total Billed Charges, ,,85,,3325.2,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2660.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2190.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2347.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52352 - CYSTO W-URETEROSCOPY W-RMVL-MANJ STONES,52352,HCPCS,,,RT,Outpatient,,,5096.35,1274.0875,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3343.21,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3567.45,Percent of Total Billed Charges, ,,85,,4331.9,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3465.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2853.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3057.81,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52352 - CYSTO W-URETEROSCOPY W-RMVL-MANJ STONES,52352,HCPCS,,,LT,Outpatient,,,4954.7,1238.675,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3250.28,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3468.29,Percent of Total Billed Charges, ,,85,,4211.5,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3369.2,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2774.63,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2972.82,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52352 - CYSTO W-URETEROSCOPY W-RMVL-MANJ STONES,52352,HCPCS,,,50,Outpatient,,,5130.5,1282.625,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3365.61,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3591.35,Percent of Total Billed Charges, ,,85,,4360.93,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3488.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2873.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3078.3,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52353 - CYSTO W-URETEROSCOPY W-LITHOTRIPSY,52353,HCPCS,,,XU,Outpatient,,,6727.1,1681.775,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4412.98,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4708.97,Percent of Total Billed Charges, ,,85,,5718.04,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4574.43,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3767.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4036.26,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52353 - CYSTO W-URETEROSCOPY W-LITHOTRIPSY,52353,HCPCS,,,XS,Outpatient,,,4846,1211.5,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3178.98,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3392.2,Percent of Total Billed Charges, ,,85,,4119.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3295.28,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2713.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2907.6,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52353 - CYSTO W-URETEROSCOPY W-LITHOTRIPSY,52353,HCPCS,,,RT,Outpatient,,,8763.87,2190.9675,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5749.1,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6134.71,Percent of Total Billed Charges, ,,85,,7449.29,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5959.43,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4907.77,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5258.32,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52353 - CYSTO W-URETEROSCOPY W-LITHOTRIPSY,52353,HCPCS,,,LT,Outpatient,,,8905.54,2226.385,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5842.03,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6233.88,Percent of Total Billed Charges, ,,85,,7569.71,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6055.77,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4987.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5343.32,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52353 - CYSTO W-URETEROSCOPY W-LITHOTRIPSY,52353,HCPCS,,,50,Outpatient,,,8701.5,2175.375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5708.18,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6091.05,Percent of Total Billed Charges, ,,85,,7396.28,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5917.02,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4872.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5220.9,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52354 - CYSTO-PYELOSCOPY BXAND-FULGURATION PELIVC LESION,52354,HCPCS,,,RT,Outpatient,,,5346.71,1336.6775,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3507.44,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3742.7,Percent of Total Billed Charges, ,,85,,4544.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3635.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2994.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3208.03,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52354 - CYSTO-PYELOSCOPY BXAND-FULGURATION PELIVC LESION,52354,HCPCS,,,LT,Outpatient,,,6308.88,1577.22,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4138.63,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4416.22,Percent of Total Billed Charges, ,,85,,5362.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4290.04,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3532.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3785.33,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52354 - CYSTO-PYELOSCOPY BXAND-FULGURATION PELIVC LESION,52354,HCPCS,,,79,Outpatient,,,2927,731.75,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1920.11,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2048.9,Percent of Total Billed Charges, ,,85,,2487.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1990.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1639.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1756.2,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52354 - CYSTO-PYELOSCOPY BXAND-FULGURATION PELIVC LESION,52354,HCPCS,,,50,Outpatient,,,5748,1437,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3770.69,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4023.6,Percent of Total Billed Charges, ,,85,,4885.8,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3908.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3218.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3448.8,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52356 - CYSTO-URETERO W-LITHOTRIPSY ANDINDWELL STENT INSRT,52356,HCPCS,,,XU,Outpatient,,,8420.14,2105.035,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5523.61,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5894.1,Percent of Total Billed Charges, ,,85,,7157.12,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5725.7,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4715.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5052.08,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52356 - CYSTO-URETERO W-LITHOTRIPSY ANDINDWELL STENT INSRT,52356,HCPCS,,,XS,Outpatient,,,3520.5,880.125,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2309.45,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2464.35,Percent of Total Billed Charges, ,,85,,2992.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2393.94,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1971.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2112.3,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52356 - CYSTO-URETERO W-LITHOTRIPSY ANDINDWELL STENT INSRT,52356,HCPCS,,,RT,Outpatient,,,10191.97,2547.9925,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6685.93,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7134.38,Percent of Total Billed Charges, ,,85,,8663.17,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6930.54,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5707.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6115.18,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52356 - CYSTO-URETERO W-LITHOTRIPSY ANDINDWELL STENT INSRT,52356,HCPCS,,,LT,Outpatient,,,10105.42,2526.355,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6629.16,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7073.79,Percent of Total Billed Charges, ,,85,,8589.61,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6871.69,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5659.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6063.25,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52356 - CYSTO-URETERO W-LITHOTRIPSY ANDINDWELL STENT INSRT,52356,HCPCS,,,59,Outpatient,,,10665.5,2666.375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6996.57,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7465.85,Percent of Total Billed Charges, ,,85,,9065.68,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7252.54,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5972.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6399.3,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52356 - CYSTO-URETERO W-LITHOTRIPSY ANDINDWELL STENT INSRT,52356,HCPCS,,,58,Outpatient,,,9026.5,2256.625,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5921.38,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6318.55,Percent of Total Billed Charges, ,,85,,7672.53,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6138.02,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5054.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5415.9,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52356 - CYSTO-URETERO W-LITHOTRIPSY ANDINDWELL STENT INSRT,52356,HCPCS,,,50,Outpatient,,,11841.95,2960.4875,1078.11,10065.66,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7507.77,,,7507.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7768.32,Percent of Total Billed Charges, ,7627.72,,,7627.72,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8289.37,Percent of Total Billed Charges, ,,85,,10065.66,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8052.53,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6631.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7105.17,Percent of Total Billed Charges, ,7431.05,,,7431.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7388.61,,,7388.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5002.36,,,5002.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5050.69,,,5050.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4833.2,,,4833.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4881.53,,,4881.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4978.2,,,4978.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5062.78,,,5062.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52500 - TRANSURETHRAL RESECTION BLADDER NECK,52500,HCPCS,,,XU,Outpatient,,,4014,1003.5,950.4,5199.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2633.18,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2809.8,Percent of Total Billed Charges, ,,85,,3411.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2729.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2247.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2408.4,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
53445 - INSJ INFLATABLE URETHRAL-BLADDER NECK SPHINCTER,53445,HCPCS,,,XS,Outpatient,,,10898.25,2724.5625,0.01,31278.19,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31278.19,,,31278.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29726.97,,,29726.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7149.25,Percent of Total Billed Charges, ,31278.19,,,31278.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7628.78,Percent of Total Billed Charges, ,,85,,9263.51,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7410.81,Percent of Total Billed Charges,0,12266,,,12266,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6103.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6538.95,Percent of Total Billed Charges, ,29423.18,,,29423.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30297.68,,,30297.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19806.83,,,19806.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19998.2,,,19998.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19328.4,,,19328.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19137.03,,,19137.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19328.4,,,19328.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19711.14,,,19711.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20046.04,,,20046.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54001 - SLITTING PREPUCE DORSAL-LAT SPX XCP NEWBORN,54001,HCPCS,,,XS,Outpatient,,,6752.75,1688.1875,742.5,5739.84,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4429.8,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4726.93,Percent of Total Billed Charges, ,,85,,5739.84,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4591.87,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3781.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4051.65,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54060 - DSTRJ LESION PENIS SIMPLE SURG EXCISION,54060,HCPCS,,,XU,Outpatient,,,6917,1729.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4537.55,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4841.9,Percent of Total Billed Charges, ,,85,,5879.45,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4703.56,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3873.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4150.2,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54161 - CIRCUMCISION AGE GREATER THAN 28 DAYS,54161,HCPCS,,,XS,Outpatient,,,8510.71,2127.6775,742.5,7234.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5583.03,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5957.5,Percent of Total Billed Charges, ,,85,,7234.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5787.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4766,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5106.43,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54162 - LYSIS-EXCISION PENILE POSTCIRCUMCISION ADHESIONS,54162,HCPCS,,,XU,Outpatient,,,5644.25,1411.0625,742.5,4797.61,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3702.63,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3950.98,Percent of Total Billed Charges, ,,85,,4797.61,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3838.09,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3160.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3386.55,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54360 - PLASTIC RPR PENIS CORRECT ANGULATION,54360,HCPCS,,,XS,Outpatient,,,5713.66,1428.415,1078.11,6722,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3748.16,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3999.56,Percent of Total Billed Charges, ,,85,,4856.61,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3885.29,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3199.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3428.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54406 - RMVL INFLATABLE PENILE PROSTH W-O RPLCMT PROSTH,54406,HCPCS,,,XS,Outpatient,,,22448.5,5612.125,3215,19081.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14726.22,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15713.95,Percent of Total Billed Charges, ,,85,,19081.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15264.98,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12571.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13469.1,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
54520 - ORCHIECTOMY SIMPLE SCROTAL-INGUINAL APPROACH,54520,HCPCS,,,XS,Outpatient,,,12451,3112.75,882.09,10583.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8167.86,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8715.7,Percent of Total Billed Charges, ,,85,,10583.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8466.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6972.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7470.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54520 - ORCHIECTOMY SIMPLE SCROTAL-INGUINAL APPROACH,54520,HCPCS,,,RT,Outpatient,,,15052.42,3763.105,882.09,12794.56,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9874.39,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10536.69,Percent of Total Billed Charges, ,,85,,12794.56,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10235.65,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8429.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9031.45,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54520 - ORCHIECTOMY SIMPLE SCROTAL-INGUINAL APPROACH,54520,HCPCS,,,LT,Outpatient,,,12599,3149.75,882.09,10709.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8264.94,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8819.3,Percent of Total Billed Charges, ,,85,,10709.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8567.32,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7055.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7559.4,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54520 - ORCHIECTOMY SIMPLE SCROTAL-INGUINAL APPROACH,54520,HCPCS,,,50,Outpatient,,,8731,2182.75,882.09,7421.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5727.54,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6111.7,Percent of Total Billed Charges, ,,85,,7421.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5937.08,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4889.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5238.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54530 - ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH,54530,HCPCS,,,RT,Outpatient,,,15287.58,3821.895,950.4,12994.44,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10028.65,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10701.31,Percent of Total Billed Charges, ,,85,,12994.44,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10395.55,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8561.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9172.55,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54530 - ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH,54530,HCPCS,,,LT,Outpatient,,,13546.6,3386.65,950.4,11514.61,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8886.57,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9482.62,Percent of Total Billed Charges, ,,85,,11514.61,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9211.69,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7586.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8127.96,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54600 - RDCTJ TORSION TSTIS W-WO FIXJ CLAT TESTIS,54600,HCPCS,,,RT,Outpatient,,,11972.75,2993.1875,1078.11,10176.84,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7854.12,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8380.93,Percent of Total Billed Charges, ,,85,,10176.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8141.47,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6704.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7183.65,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54600 - RDCTJ TORSION TSTIS W-WO FIXJ CLAT TESTIS,54600,HCPCS,,,LT,Outpatient,,,7963.5,1990.875,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5224.06,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5574.45,Percent of Total Billed Charges, ,,85,,6768.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5415.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4459.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4778.1,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54620 - FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE,54620,HCPCS,,,XU,Outpatient,,,9181.5,2295.375,0.01,7804.28,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6023.06,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6427.05,Percent of Total Billed Charges, ,,85,,7804.28,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6243.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5141.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5508.9,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54640 - ORCHIOPEXY INGUINAL OR SCROTAL APPROACH,54640,HCPCS,,,RT,Outpatient,,,7189.5,1797.375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4716.31,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5032.65,Percent of Total Billed Charges, ,,85,,6111.08,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4888.86,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4026.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4313.7,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54640 - ORCHIOPEXY INGUINAL OR SCROTAL APPROACH,54640,HCPCS,,,50,Outpatient,,,16914.58,4228.645,1078.11,14377.39,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11095.96,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11840.21,Percent of Total Billed Charges, ,,85,,14377.39,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11501.91,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9472.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10148.75,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54700 - IANDD EPIDIDYMIS TSTISAND-SCROTAL SPACE,54700,HCPCS,,,50,Outpatient,,,12967,3241.75,882.09,11021.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8506.35,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9076.9,Percent of Total Billed Charges, ,,85,,11021.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8817.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7261.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7780.2,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54830 - EXCISION LOCAL LESION EPIDIDYMIS,54830,HCPCS,,,RT,Outpatient,,,16133.33,4033.3325,882.09,13713.33,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10583.46,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11293.33,Percent of Total Billed Charges, ,,85,,13713.33,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10970.66,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9034.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9680,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54840 - EXCISION SPERMATOCELE W-WO EPIDIDYMECTOMY,54840,HCPCS,,,XU,Outpatient,,,6789.03,1697.2575,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4453.6,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4752.32,Percent of Total Billed Charges, ,,85,,5770.68,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4616.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3801.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4073.42,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54840 - EXCISION SPERMATOCELE W-WO EPIDIDYMECTOMY,54840,HCPCS,,,XS,Outpatient,,,10048.5,2512.125,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6591.82,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7033.95,Percent of Total Billed Charges, ,,85,,8541.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6832.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5627.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6029.1,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54840 - EXCISION SPERMATOCELE W-WO EPIDIDYMECTOMY,54840,HCPCS,,,RT,Outpatient,,,13890,3472.5,950.4,11806.5,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9111.84,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9723,Percent of Total Billed Charges, ,,85,,11806.5,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9445.2,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7778.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8334,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54840 - EXCISION SPERMATOCELE W-WO EPIDIDYMECTOMY,54840,HCPCS,,,LT,Outpatient,,,12499.86,3124.965,950.4,10624.88,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8199.91,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8749.9,Percent of Total Billed Charges, ,,85,,10624.88,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8499.9,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6999.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7499.92,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54840 - EXCISION SPERMATOCELE W-WO EPIDIDYMECTOMY,54840,HCPCS,,,50,Outpatient,,,6492.34,1623.085,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4258.98,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4544.64,Percent of Total Billed Charges, ,,85,,5518.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4414.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3635.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3895.4,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54860 - EPIDIDYMECTOMY UNILATERAL,54860,HCPCS,,,XS,Outpatient,,,8266,2066.5,950.4,7026.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5422.5,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5786.2,Percent of Total Billed Charges, ,,85,,7026.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5620.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4628.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4959.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54860 - EPIDIDYMECTOMY UNILATERAL,54860,HCPCS,,,RT,Outpatient,,,18857,4714.25,950.4,16028.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12370.19,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13199.9,Percent of Total Billed Charges, ,,85,,16028.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12822.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10559.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11314.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
54860 - EPIDIDYMECTOMY UNILATERAL,54860,HCPCS,,,LT,Outpatient,,,10668.5,2667.125,950.4,9068.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6998.54,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7467.95,Percent of Total Billed Charges, ,,85,,9068.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7254.58,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5974.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6401.1,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55000 - PNXR ASPIR HYDROCELE TUNICA VAGIS W-WO NJX MED,55000,HCPCS,,,50,Outpatient,,,8581,2145.25,668.93,7293.85,,,,,,,Service Paid at Rev Code level,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55040 - EXCISION HYDROCELE UNILATERAL,55040,HCPCS,,,XU,Outpatient,,,10126,2531.5,950.4,8607.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6642.66,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7088.2,Percent of Total Billed Charges, ,,85,,8607.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6885.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5670.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6075.6,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55040 - EXCISION HYDROCELE UNILATERAL,55040,HCPCS,,,RT,Outpatient,,,13376.21,3344.0525,950.4,11369.78,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8774.79,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9363.35,Percent of Total Billed Charges, ,,85,,11369.78,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9095.82,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7490.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8025.73,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55040 - EXCISION HYDROCELE UNILATERAL,55040,HCPCS,,,LT,Outpatient,,,13223.61,3305.9025,950.4,11240.07,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8674.69,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9256.53,Percent of Total Billed Charges, ,,85,,11240.07,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8992.05,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7405.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7934.17,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55110 - SCROTAL EXPLORATION,55110,HCPCS,,,74,Outpatient,,,15447,3861.75,882.09,13129.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10133.23,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10812.9,Percent of Total Billed Charges, ,,85,,13129.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10503.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8650.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9268.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55250 - VASECTOMY UNI-BI SPX W-POSTOP SEMEN EXAMS,55250,HCPCS,,,XU,Outpatient,,,7259.5,1814.875,882.09,6170.58,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4762.23,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5081.65,Percent of Total Billed Charges, ,,85,,6170.58,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4936.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4065.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4355.7,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55250 - VASECTOMY UNI-BI SPX W-POSTOP SEMEN EXAMS,55250,HCPCS,,,59,Outpatient,,,6170.78,1542.695,882.09,5245.16,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4048.03,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4319.55,Percent of Total Billed Charges, ,,85,,5245.16,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4196.13,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3455.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3702.47,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55500 - EXC HYDROCELE SPRMATIC CORD UNI SPX,55500,HCPCS,,,RT,Outpatient,,,23197,5799.25,950.4,19717.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15217.23,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16237.9,Percent of Total Billed Charges, ,,85,,19717.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15773.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12990.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13918.2,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55500 - EXC HYDROCELE SPRMATIC CORD UNI SPX,55500,HCPCS,,,50,Outpatient,,,13691,3422.75,950.4,11637.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8981.3,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9583.7,Percent of Total Billed Charges, ,,85,,11637.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9309.88,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7666.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8214.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55520 - EXC LESION SPERMATIC CORD SEPARATE PROCEDURE,55520,HCPCS,,,XU,Outpatient,,,13579.17,3394.7925,950.4,11542.29,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8907.94,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9505.42,Percent of Total Billed Charges, ,,85,,11542.29,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9233.84,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7604.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8147.5,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55520 - EXC LESION SPERMATIC CORD SEPARATE PROCEDURE,55520,HCPCS,,,XS,Outpatient,,,7879,1969.75,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5168.62,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5515.3,Percent of Total Billed Charges, ,,85,,6697.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5357.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4412.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4727.4,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55520 - EXC LESION SPERMATIC CORD SEPARATE PROCEDURE,55520,HCPCS,,,RT,Outpatient,,,9506,2376.5,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6235.94,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6654.2,Percent of Total Billed Charges, ,,85,,8080.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6464.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5323.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5703.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55520 - EXC LESION SPERMATIC CORD SEPARATE PROCEDURE,55520,HCPCS,,,LT,Outpatient,,,8731,2182.75,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5727.54,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6111.7,Percent of Total Billed Charges, ,,85,,7421.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5937.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4889.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5238.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55530 - EXC VARICOCELE-LIGATION SPERMATIC VEINS SPX,55530,HCPCS,,,XU,Outpatient,,,7103.5,1775.875,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4659.9,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4972.45,Percent of Total Billed Charges, ,,85,,6037.98,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4830.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3977.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4262.1,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55550 - LAPS LIGATION SPERMATIC VEINS VARICOCELE,55550,HCPCS,,,RT,Outpatient,,,17927,4481.75,1078.11,15237.95,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11760.11,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12548.9,Percent of Total Billed Charges, ,,85,,15237.95,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12190.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10039.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10756.2,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55550 - LAPS LIGATION SPERMATIC VEINS VARICOCELE,55550,HCPCS,,,LT,Outpatient,,,19642.67,4910.6675,1078.11,16696.27,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12885.59,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13749.87,Percent of Total Billed Charges, ,,85,,16696.27,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13357.02,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10999.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11785.6,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55550 - LAPS LIGATION SPERMATIC VEINS VARICOCELE,55550,HCPCS,,,50,Outpatient,,,12812,3203,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8404.67,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8968.4,Percent of Total Billed Charges, ,,85,,10890.2,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8712.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7174.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7687.2,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
55866 - LAPS SURG PRST8ECT RPBIC RAD W-NRV SPARING ROBOT,55866,HCPCS,,,74,Outpatient,,,39225,9806.25,1078.11,33341.25,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,25731.6,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,27457.5,Percent of Total Billed Charges, ,,85,,33341.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,26673,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,21966,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,23535,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
56440 - MARSUPIALIZATION BARTHOLINS GLAND CYST,56440,HCPCS,,,LT,Outpatient,,,9551,2387.75,882.09,8118.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6265.46,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6685.7,Percent of Total Billed Charges, ,,85,,8118.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6494.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5348.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5730.6,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
56606 - BIOPSY VULVA-PERINEUM EACH ADDL LESION,56606,HCPCS,,,XU,Outpatient,,,1586.25,396.5625,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1040.58,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1110.38,Percent of Total Billed Charges, ,,85,,1348.31,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1078.65,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,888.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,951.75,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
56740 - EXCISION BARTHOLINS GLAND OR CYST,56740,HCPCS,,,RT,Outpatient,,,13691,3422.75,950.4,11637.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8981.3,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9583.7,Percent of Total Billed Charges, ,,85,,11637.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9309.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7666.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8214.6,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
57061 - DESTRUCTION VAGINAL LESIONS SIMPLE,57061,HCPCS,,,XU,Outpatient,,,3823,955.75,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2507.89,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2676.1,Percent of Total Billed Charges, ,,85,,3249.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2599.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2140.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2293.8,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
57135 - EXCISION VAGINAL CYST-TUMOR,57135,HCPCS,,,XU,Outpatient,,,3823,955.75,882.09,4695.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2507.89,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2676.1,Percent of Total Billed Charges, ,,85,,3249.55,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2599.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2140.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2293.8,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
57250 - POST COLPORRHAPHY RECTOCELE W-WO PERINEORRHAPHY,57250,HCPCS,,,XU,Outpatient,,,8111,2027.75,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7290.42,,,7290.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5320.82,Percent of Total Billed Charges, ,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5677.7,Percent of Total Billed Charges, ,,85,,6894.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5515.48,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4542.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4866.6,Percent of Total Billed Charges, ,7215.92,,,7215.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7283.24,,,7283.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4857.54,,,4857.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4904.48,,,4904.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4693.28,,,4693.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4834.08,,,4834.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4916.21,,,4916.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
57267 - INSJ MESH-PROSTH PELVIC FLOOR DEFECT EACH SITE,57267,HCPCS,,,XU,Outpatient,,,4693.13,1173.2825,0.01,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3078.69,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3285.19,Percent of Total Billed Charges, ,,85,,3989.16,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3191.33,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2628.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2815.88,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
57267 - INSJ MESH-PROSTH PELVIC FLOOR DEFECT EACH SITE,57267,HCPCS,,,XS,Outpatient,,,4714.25,1178.5625,0.01,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3092.55,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3299.98,Percent of Total Billed Charges, ,,85,,4007.11,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3205.69,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2639.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2828.55,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
57268 - REPAIR ENTEROCELE VAGINAL APPROACH SPX,57268,HCPCS,,,XU,Outpatient,,,11675.17,2918.7925,1078.11,9923.89,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7290.42,,,7290.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7658.91,Percent of Total Billed Charges, ,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8172.62,Percent of Total Billed Charges, ,,85,,9923.89,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7939.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6538.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7005.1,Percent of Total Billed Charges, ,7215.92,,,7215.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7283.24,,,7283.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4857.54,,,4857.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4904.48,,,4904.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4693.28,,,4693.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4834.08,,,4834.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4916.21,,,4916.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
57282 - COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH,57282,HCPCS,,,XU,Outpatient,,,8370.76,2092.69,882.09,11234.41,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11234.41,,,11234.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10921.07,,,10921.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5491.22,Percent of Total Billed Charges, ,11234.41,,,11234.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5859.53,Percent of Total Billed Charges, ,,85,,7115.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5692.12,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4687.63,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5022.46,Percent of Total Billed Charges, ,10809.46,,,10809.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10882.24,,,10882.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7276.61,,,7276.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7346.91,,,7346.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7100.85,,,7100.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7030.54,,,7030.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7100.85,,,7100.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7241.46,,,7241.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7364.49,,,7364.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
57283 - COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH,57283,HCPCS,,,XU,Outpatient,,,8023.2,2005.8,950.4,11234.41,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11234.41,,,11234.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10921.07,,,10921.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5263.22,Percent of Total Billed Charges, ,11234.41,,,11234.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5616.24,Percent of Total Billed Charges, ,,85,,6819.72,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5455.78,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4492.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4813.92,Percent of Total Billed Charges, ,10809.46,,,10809.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10882.24,,,10882.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7276.61,,,7276.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7346.91,,,7346.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7100.85,,,7100.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7030.54,,,7030.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7100.85,,,7100.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7241.46,,,7241.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7364.49,,,7364.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
57500 - BIOPSY CERVIX SINGLE-MULT-EXCISION OF LESION SPX,57500,HCPCS,,,XU,Outpatient,,,12141,3035.25,742.5,10319.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1141.16,,,1141.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1285.96,,,1285.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7964.5,Percent of Total Billed Charges, ,1141.16,,,1141.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8498.7,Percent of Total Billed Charges, ,,85,,10319.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8255.88,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6798.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7284.6,Percent of Total Billed Charges, ,1272.82,,,1272.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1105.39,,,1105.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,856.82,,,856.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,865.1,,,865.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,836.13,,,836.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,827.85,,,827.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,836.13,,,836.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,852.69,,,852.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,867.17,,,867.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
57500 - BIOPSY CERVIX SINGLE-MULT-EXCISION OF LESION SPX,57500,HCPCS,,,XS,Outpatient,,,4167,1041.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1141.16,,,1141.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1285.96,,,1285.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2733.55,Percent of Total Billed Charges, ,1141.16,,,1141.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2916.9,Percent of Total Billed Charges, ,,85,,3541.95,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2833.56,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2333.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2500.2,Percent of Total Billed Charges, ,1272.82,,,1272.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1105.39,,,1105.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,856.82,,,856.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,865.1,,,865.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,836.13,,,836.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,827.85,,,827.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,836.13,,,836.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,852.69,,,852.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,867.17,,,867.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
57500 - BIOPSY CERVIX SINGLE-MULT-EXCISION OF LESION SPX,57500,HCPCS,,,59,Outpatient,,,4575,1143.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1141.16,,,1141.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1285.96,,,1285.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3001.2,Percent of Total Billed Charges, ,1141.16,,,1141.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3202.5,Percent of Total Billed Charges, ,,85,,3888.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3111,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2562,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2745,Percent of Total Billed Charges, ,1272.82,,,1272.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1105.39,,,1105.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,856.82,,,856.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,865.1,,,865.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,836.13,,,836.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,827.85,,,827.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,836.13,,,836.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,852.69,,,852.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,867.17,,,867.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58301 - REMOVAL INTRAUTERINE DEVICE IUD,58301,HCPCS,,,59,Outpatient,,,4290.5,1072.625,72.29,3646.93,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,473.6,,,473.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,449.24,,,449.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2814.57,Percent of Total Billed Charges, ,473.6,,,473.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3003.35,Percent of Total Billed Charges, ,,85,,3646.93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2917.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2402.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2574.3,Percent of Total Billed Charges, ,444.66,,,444.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,458.76,,,458.76,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,299.33,,,299.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,302.22,,,302.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.1,,,292.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.21,,,289.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.1,,,292.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.89,,,297.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,302.95,,,302.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.29,,,72.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.29,,,72.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.29,,,72.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,72.29,,,72.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58350 - CHROMOTUBATION OVIDUCT W-MATERIALS,58350,HCPCS,,,XU,Outpatient,,,7237.2,1809.3,950.4,7518.94,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7290.42,,,7290.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4747.6,Percent of Total Billed Charges, ,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5066.04,Percent of Total Billed Charges, ,,85,,6151.62,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4921.3,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4052.83,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4342.32,Percent of Total Billed Charges, ,7215.92,,,7215.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7283.24,,,7283.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4857.54,,,4857.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4904.48,,,4904.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4693.28,,,4693.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4834.08,,,4834.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4916.21,,,4916.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58350 - CHROMOTUBATION OVIDUCT W-MATERIALS,58350,HCPCS,,,59,Outpatient,,,7568.5,1892.125,950.4,7518.94,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7290.42,,,7290.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4964.94,Percent of Total Billed Charges, ,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5297.95,Percent of Total Billed Charges, ,,85,,6433.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5146.58,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4238.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4541.1,Percent of Total Billed Charges, ,7215.92,,,7215.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7283.24,,,7283.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4857.54,,,4857.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4904.48,,,4904.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4693.28,,,4693.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4834.08,,,4834.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4916.21,,,4916.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58350 - CHROMOTUBATION OVIDUCT W-MATERIALS,58350,HCPCS,,,50,Outpatient,,,9428.5,2357.125,950.4,8014.23,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7290.42,,,7290.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6185.1,Percent of Total Billed Charges, ,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6599.95,Percent of Total Billed Charges, ,,85,,8014.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6411.38,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5279.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5657.1,Percent of Total Billed Charges, ,7215.92,,,7215.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7283.24,,,7283.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4857.54,,,4857.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4904.48,,,4904.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4693.28,,,4693.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4834.08,,,4834.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4916.21,,,4916.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58546 - LAPS MYOMECTOMY EXC 5-GREATER THAN MYOMAS GREATER THAN 250 GRAMS,58546,HCPCS,,,XU,Outpatient,,,20752.5,5188.125,1078.11,17639.63,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13613.64,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14526.75,Percent of Total Billed Charges, ,,85,,17639.63,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14111.7,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11621.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12451.5,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE,58555,HCPCS,,,XU,Outpatient,,,13772.75,3443.1875,1078.11,11706.84,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9034.92,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9640.93,Percent of Total Billed Charges, ,,85,,11706.84,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9365.47,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7712.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8263.65,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE,58555,HCPCS,,,74,Outpatient,,,9536.5,2384.125,1078.11,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6255.94,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6675.55,Percent of Total Billed Charges, ,,85,,8106.03,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6484.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5340.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5721.9,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58555 - HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE,58555,HCPCS,,,59,Outpatient,,,5799,1449.75,1078.11,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3804.14,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4059.3,Percent of Total Billed Charges, ,,85,,4929.15,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3943.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3247.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3479.4,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58558 - HYSTEROSCOPY BX ENDOMETRIUMAND-POLYPC W-WO DANDC,58558,HCPCS,,,XU,Outpatient,,,16514,4128.5,1078.11,14036.9,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10833.18,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11559.8,Percent of Total Billed Charges, ,,85,,14036.9,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11229.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9247.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9908.4,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58558 - HYSTEROSCOPY BX ENDOMETRIUMAND-POLYPC W-WO DANDC,58558,HCPCS,,,74,Outpatient,,,9461.75,2365.4375,1078.11,8042.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6206.91,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.23,Percent of Total Billed Charges, ,,85,,8042.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6433.99,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.05,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58559 - HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS,58559,HCPCS,,,53,Outpatient,,,14081,3520.25,1078.11,11968.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7290.42,,,7290.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9237.14,Percent of Total Billed Charges, ,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9856.7,Percent of Total Billed Charges, ,,85,,11968.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9575.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7885.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8448.6,Percent of Total Billed Charges, ,7215.92,,,7215.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7283.24,,,7283.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4857.54,,,4857.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4904.48,,,4904.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4693.28,,,4693.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4834.08,,,4834.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4916.21,,,4916.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58563 - HYSTEROSCOPY ENDOMETRIAL ABLATION,58563,HCPCS,,,74,Outpatient,,,6867,1716.75,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7290.42,,,7290.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4504.75,Percent of Total Billed Charges, ,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4806.9,Percent of Total Billed Charges, ,,85,,5836.95,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4669.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3845.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4120.2,Percent of Total Billed Charges, ,7215.92,,,7215.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7283.24,,,7283.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4857.54,,,4857.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4904.48,,,4904.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4693.28,,,4693.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4834.08,,,4834.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4916.21,,,4916.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58563 - HYSTEROSCOPY ENDOMETRIAL ABLATION,58563,HCPCS,,,53,Outpatient,,,11088,2772,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7290.42,,,7290.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7273.73,Percent of Total Billed Charges, ,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7761.6,Percent of Total Billed Charges, ,,85,,9424.8,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7539.84,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6209.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6652.8,Percent of Total Billed Charges, ,7215.92,,,7215.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7283.24,,,7283.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4857.54,,,4857.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4904.48,,,4904.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4693.28,,,4693.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4834.08,,,4834.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4916.21,,,4916.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58573 - LAPAROSCOPY TOT HYSTERECTOMY GREATER THAN 250 G W-TUBE-OVAR,58573,HCPCS,,,22,Outpatient,,,49161,12290.25,1078.11,41786.85,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,32249.62,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,34412.7,Percent of Total Billed Charges, ,,85,,41786.85,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,33429.48,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,27530.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,29496.6,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58600 - LIG-TRNSXJ FLP TUBE ABDL-VAG APPR UNI-BI,58600,HCPCS,,,LT,Outpatient,,,5510.66,1377.665,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3614.99,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3857.46,Percent of Total Billed Charges, ,,85,,4684.06,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3747.25,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3085.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3306.4,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58660 - LAPAROSCOPY W-LYSIS OF ADHESIONS,58660,HCPCS,,,XU,Outpatient,,,7811.5,1952.875,1078.11,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5124.34,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5468.05,Percent of Total Billed Charges, ,,85,,6639.78,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5311.82,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4374.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4686.9,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58660 - LAPAROSCOPY W-LYSIS OF ADHESIONS,58660,HCPCS,,,74,Outpatient,,,4539,1134.75,1078.11,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2977.58,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3177.3,Percent of Total Billed Charges, ,,85,,3858.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3086.52,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2541.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2723.4,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58661 - LAPAROSCOPY W-RMVL ADNEXAL STRUCTURES,58661,HCPCS,,,RT,Outpatient,,,15650.74,3912.685,1078.11,13303.13,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10266.89,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10955.52,Percent of Total Billed Charges, ,,85,,13303.13,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10642.5,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8764.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9390.44,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58661 - LAPAROSCOPY W-RMVL ADNEXAL STRUCTURES,58661,HCPCS,,,LT,Outpatient,,,12754.17,3188.5425,1078.11,10841.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8366.74,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8927.92,Percent of Total Billed Charges, ,,85,,10841.04,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8672.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7142.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7652.5,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58661 - LAPAROSCOPY W-RMVL ADNEXAL STRUCTURES,58661,HCPCS,,,FP,Outpatient,,,14517,3629.25,1078.11,12339.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9523.15,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10161.9,Percent of Total Billed Charges, ,,85,,12339.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9871.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8129.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8710.2,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58661 - LAPAROSCOPY W-RMVL ADNEXAL STRUCTURES,58661,HCPCS,,,74,Outpatient,,,27537,6884.25,1078.11,23406.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18064.27,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19275.9,Percent of Total Billed Charges, ,,85,,23406.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18725.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15420.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16522.2,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58661 - LAPAROSCOPY W-RMVL ADNEXAL STRUCTURES,58661,HCPCS,,,50,Outpatient,,,10555.08,2638.77,1078.11,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6924.13,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7388.56,Percent of Total Billed Charges, ,,85,,8971.82,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7177.45,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5910.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6333.05,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58662 - LAPS FULG-EXC OVARY VISCERA-PERITONEAL SURFACE,58662,HCPCS,,,RT,Outpatient,,,16686.87,4171.7175,1078.11,14183.84,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10946.59,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11680.81,Percent of Total Billed Charges, ,,85,,14183.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11347.07,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9344.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10012.12,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58662 - LAPS FULG-EXC OVARY VISCERA-PERITONEAL SURFACE,58662,HCPCS,,,LT,Outpatient,,,12166.33,3041.5825,1078.11,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7981.11,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8516.43,Percent of Total Billed Charges, ,,85,,10341.38,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8273.1,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6813.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7299.8,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58662 - LAPS FULG-EXC OVARY VISCERA-PERITONEAL SURFACE,58662,HCPCS,,,50,Outpatient,,,9808.33,2452.0825,1078.11,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6434.26,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6865.83,Percent of Total Billed Charges, ,,85,,8337.08,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6669.66,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5492.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5885,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58662 - LAPS FULG-EXC OVARY VISCERA-PERITONEAL SURFACE,58662,HCPCS,,,22,Outpatient,,,24975,6243.75,1078.11,21228.75,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16383.6,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17482.5,Percent of Total Billed Charges, ,,85,,21228.75,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16983,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13986,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14985,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58671 - LAPAROSCOPY W-PLMT OCCLUSION DEVICE OVIDUCTS,58671,HCPCS,,,FP,Outpatient,,,13587,3396.75,1078.11,11548.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8913.07,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9510.9,Percent of Total Billed Charges, ,,85,,11548.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9239.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7608.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8152.2,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58672 - LAPAROSCOPY FIMBRIOPLASTY,58672,HCPCS,,,XU,Outpatient,,,5943.66,1485.915,1078.11,10452,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3899.04,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4160.56,Percent of Total Billed Charges, ,,85,,5052.11,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4041.69,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3328.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3566.2,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58673 - LAPAROSCOPY SALPINGOSTOMY,58673,HCPCS,,,XU,Outpatient,,,12390.83,3097.7075,1078.11,15375.87,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8128.38,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8673.58,Percent of Total Billed Charges, ,,85,,10532.21,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8425.76,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6938.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7434.5,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58925 - OVARIAN CYSTECTOMY UNI-BI,58925,HCPCS,,,RT,Outpatient,,,7504.25,1876.0625,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7290.42,,,7290.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4922.79,Percent of Total Billed Charges, ,7518.94,,,7518.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5252.98,Percent of Total Billed Charges, ,,85,,6378.61,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5102.89,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4202.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4502.55,Percent of Total Billed Charges, ,7215.92,,,7215.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7283.24,,,7283.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4857.54,,,4857.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4904.48,,,4904.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4693.28,,,4693.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4740.21,,,4740.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4834.08,,,4834.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4916.21,,,4916.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
58940 - OOPHORECTOMY PARTIAL-TOTAL UNI-BI,58940,HCPCS,,,RT,Outpatient,,,19073,4768.25,0.01,16212.05,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4017.61,,,4017.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12511.89,Percent of Total Billed Charges, ,4017.61,,,4017.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13351.1,Percent of Total Billed Charges, ,,85,,16212.05,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12969.64,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10680.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11443.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3891.67,,,3891.67,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
59120 - TX ECTOPIC PREGNANCY ABDOMINAL-VAGINAL APPR,59120,HCPCS,,,RT,Outpatient,,,23235,5808.75,0.01,19749.75,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5425.3,,,5425.3,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15242.16,Percent of Total Billed Charges, ,5425.3,,,5425.3,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16264.5,Percent of Total Billed Charges, ,,85,,19749.75,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15799.8,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13011.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13941,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5255.22,,,5255.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
59151 - LAPS TX ECTOPIC PREG W-SALPINGAND-OOPHORECTOMY,59151,HCPCS,,,RT,Outpatient,,,20482.86,5120.715,1078.11,17410.43,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13436.76,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14338,Percent of Total Billed Charges, ,,85,,17410.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13928.34,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11470.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12289.72,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
59151 - LAPS TX ECTOPIC PREG W-SALPINGAND-OOPHORECTOMY,59151,HCPCS,,,LT,Outpatient,,,17653.15,4413.2875,1078.11,15005.18,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11580.47,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12357.21,Percent of Total Billed Charges, ,,85,,15005.18,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12004.14,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9885.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10591.89,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
59151 - LAPS TX ECTOPIC PREG W-SALPINGAND-OOPHORECTOMY,59151,HCPCS,,,50,Outpatient,,,21669,5417.25,1078.11,18418.65,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14214.86,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15168.3,Percent of Total Billed Charges, ,,85,,18418.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14734.92,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12134.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13001.4,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60100 - BIOPSY THYROID PERCUTANEOUS CORE NEEDLE,60100,HCPCS,,,RT,Outpatient,,,1928,482,668.93,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1264.77,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1349.6,Percent of Total Billed Charges, ,,85,,1638.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1311.04,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1079.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1156.8,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60210 - PRTL THYROID LOBECTOMY UNI W-WO ISTHMUSECTOMY,60210,HCPCS,,,RT,Outpatient,,,15602.25,3900.5625,882.09,13261.91,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10235.08,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10921.58,Percent of Total Billed Charges, ,,85,,13261.91,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10609.53,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8737.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9361.35,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60210 - PRTL THYROID LOBECTOMY UNI W-WO ISTHMUSECTOMY,60210,HCPCS,,,LT,Outpatient,,,15369.83,3842.4575,882.09,13064.36,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10082.61,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10758.88,Percent of Total Billed Charges, ,,85,,13064.36,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10451.48,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8607.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9221.9,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60220 - TOTAL THYROID LOBECTOMY UNI W-WO ISTHMUSECTOMY,60220,HCPCS,,,XU,Outpatient,,,10372.77,2593.1925,1078.11,10452,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6804.54,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7260.94,Percent of Total Billed Charges, ,,85,,8816.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7053.48,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5808.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6223.66,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60220 - TOTAL THYROID LOBECTOMY UNI W-WO ISTHMUSECTOMY,60220,HCPCS,,,XS,Outpatient,,,9273.5,2318.375,1078.11,10452,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6083.42,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6491.45,Percent of Total Billed Charges, ,,85,,7882.48,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6305.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5193.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5564.1,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60220 - TOTAL THYROID LOBECTOMY UNI W-WO ISTHMUSECTOMY,60220,HCPCS,,,RT,Outpatient,,,22381.48,5595.37,1078.11,19024.26,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14682.25,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15667.04,Percent of Total Billed Charges, ,,85,,19024.26,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15219.41,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12533.63,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13428.89,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60220 - TOTAL THYROID LOBECTOMY UNI W-WO ISTHMUSECTOMY,60220,HCPCS,,,LT,Outpatient,,,22486.42,5621.605,1078.11,19113.46,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14751.09,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15740.49,Percent of Total Billed Charges, ,,85,,19113.46,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15290.77,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12592.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13491.85,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60225 - TOTAL THYROID LOBEC UNI W-CONTRALAT STOT LOBEC,60225,HCPCS,,,LT,Outpatient,,,16175,4043.75,1078.11,13748.75,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10610.8,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11322.5,Percent of Total Billed Charges, ,,85,,13748.75,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10999,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9058,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9705,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60240 - THYROIDECTOMY TOTAL-COMPLETE,60240,HCPCS,,,RT,Outpatient,,,9351,2337.75,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6134.26,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6545.7,Percent of Total Billed Charges, ,,85,,7948.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6358.68,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5236.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5610.6,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60240 - THYROIDECTOMY TOTAL-COMPLETE,60240,HCPCS,,,LT,Outpatient,,,17417,4354.25,950.4,14804.45,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11425.55,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12191.9,Percent of Total Billed Charges, ,,85,,14804.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11843.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9753.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10450.2,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60260 - THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL,60260,HCPCS,,,RT,Outpatient,,,22527.5,5631.875,882.09,19148.38,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14778.04,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15769.25,Percent of Total Billed Charges, ,,85,,19148.38,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15318.7,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12615.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13516.5,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60271 - THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH,60271,HCPCS,,,LT,Outpatient,,,22112,5528,882.09,18795.2,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14505.47,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15478.4,Percent of Total Billed Charges, ,,85,,18795.2,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15036.16,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12382.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13267.2,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60500 - PARATHYROIDECTOMY-EXPLORATION PARATHYROIDS,60500,HCPCS,,,XU,Outpatient,,,8511.58,2127.895,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5583.6,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5958.11,Percent of Total Billed Charges, ,,85,,7234.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5787.87,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4766.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5106.95,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60500 - PARATHYROIDECTOMY-EXPLORATION PARATHYROIDS,60500,HCPCS,,,RT,Outpatient,,,17386.46,4346.615,950.4,14778.49,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11405.52,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12170.52,Percent of Total Billed Charges, ,,85,,14778.49,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11822.79,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9736.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10431.88,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60500 - PARATHYROIDECTOMY-EXPLORATION PARATHYROIDS,60500,HCPCS,,,LT,Outpatient,,,14498.79,3624.6975,950.4,12323.97,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9511.21,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10149.15,Percent of Total Billed Charges, ,,85,,12323.97,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9859.18,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8119.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8699.27,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60500 - PARATHYROIDECTOMY-EXPLORATION PARATHYROIDS,60500,HCPCS,,,50,Outpatient,,,13828.33,3457.0825,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9071.38,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9679.83,Percent of Total Billed Charges, ,,85,,11754.08,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9403.26,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7743.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8297,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60502 - PARATHYROIDECTOMY-EXPLOR PARATHYROIDS RE-EXPLOR,60502,HCPCS,,,RT,Outpatient,,,23765,5941.25,0.01,20200.25,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15589.84,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16635.5,Percent of Total Billed Charges, ,,85,,20200.25,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16160.2,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13308.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14259,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60512 - PARATHYROID AUTOTRANSPLANTATION ADD-ON,60512,HCPCS,,,RT,Outpatient,,,9577.83,2394.4575,0.01,8141.16,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6283.06,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6704.48,Percent of Total Billed Charges, ,,85,,8141.16,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6512.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5363.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5746.7,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60512 - PARATHYROID AUTOTRANSPLANTATION ADD-ON,60512,HCPCS,,,LT,Outpatient,,,8718.75,2179.6875,0.01,7410.94,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5719.5,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6103.13,Percent of Total Billed Charges, ,,85,,7410.94,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5928.75,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4882.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5231.25,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
60650 - LAPAROSCOPY ADRENALECTOMY PRTL-COMPL TABDL,60650,HCPCS,,,RT,Outpatient,,,46551,11637.75,0.01,39568.35,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,30537.46,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,32585.7,Percent of Total Billed Charges, ,,85,,39568.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,31654.68,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,26068.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,27930.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
61783 - STEREOTACTIC COMPUTER ASSISTED PX SPINAL,61783,HCPCS,,,XU,Outpatient,,,5832.71,1458.1775,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3826.26,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4082.9,Percent of Total Billed Charges, ,,85,,4957.8,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3966.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3266.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3499.63,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
62273 - INJECTION EPIDURAL BLOOD-CLOT PATCH,62273,HCPCS,,,LT,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62290 - INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR,62290,HCPCS,,,XU,Outpatient,,,2532.5,633.125,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1661.32,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1772.75,Percent of Total Billed Charges, ,,85,,2152.63,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1722.1,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1418.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1519.5,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62304 - MYELOGRAPHY VIA LUMBAR INJECT RSANDI LUMBOSACRAL,62304,HCPCS,,,73,Outpatient,,,6349,1587.25,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1201.63,,,1201.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.94,Percent of Total Billed Charges, ,1201.63,,,1201.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4444.3,Percent of Total Billed Charges, ,,85,,5396.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4317.32,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3555.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3809.4,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1163.96,,,1163.96,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62322 - NJX DX-THER SBST INTRLMNR LMBR-SAC W-O IMG GDN,62322,HCPCS,,,XP,Outpatient,,,6306.25,1576.5625,846.43,5360.31,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4136.9,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4414.38,Percent of Total Billed Charges, ,,85,,5360.31,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4288.25,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3531.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3783.75,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62350 - IMPLTJ REVJ-RPSG ITHCL-EDRL CATH PMP W-O LAM,62350,HCPCS,,,CG,Outpatient,,,15602,3900.5,1078.11,13261.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10234.91,Percent of Total Billed Charges, ,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10921.4,Percent of Total Billed Charges, ,,85,,13261.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10609.36,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8737.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9361.2,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9708.61,,,9708.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62350 - IMPLTJ REVJ-RPSG ITHCL-EDRL CATH PMP W-O LAM,62350,HCPCS,,,74,Outpatient,,,12373.5,3093.375,1078.11,10517.48,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8117.02,Percent of Total Billed Charges, ,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8661.45,Percent of Total Billed Charges, ,,85,,10517.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8413.98,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6929.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7424.1,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9708.61,,,9708.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62351 - IMPLTJ REVJ-RPSG ITHCL-EDRL CATH W-LAM,62351,HCPCS,,,CG,Outpatient,,,18133.67,4533.4175,1078.11,15413.62,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11895.69,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12693.57,Percent of Total Billed Charges, ,,85,,15413.62,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12330.9,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10154.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10880.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62362 - IMPLTJ-RPLCMT ITHCL-EDRL DRUG NFS PRGRBL PUMP,62362,HCPCS,,,RT,Outpatient,,,15137,3784.25,742.5,27477.03,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27477.03,,,27477.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26102.12,,,26102.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9929.87,Percent of Total Billed Charges, ,27477.03,,,27477.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10595.9,Percent of Total Billed Charges, ,,85,,12866.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10293.16,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8476.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9082.2,Percent of Total Billed Charges, ,25835.37,,,25835.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26615.68,,,26615.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17391.61,,,17391.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17559.65,,,17559.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16971.52,,,16971.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16803.49,,,16803.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16971.52,,,16971.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17307.59,,,17307.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17601.66,,,17601.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62362 - IMPLTJ-RPLCMT ITHCL-EDRL DRUG NFS PRGRBL PUMP,62362,HCPCS,,,74,Outpatient,,,12373.5,3093.375,742.5,27477.03,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27477.03,,,27477.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26102.12,,,26102.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8117.02,Percent of Total Billed Charges, ,27477.03,,,27477.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8661.45,Percent of Total Billed Charges, ,,85,,10517.48,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8413.98,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6929.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7424.1,Percent of Total Billed Charges, ,25835.37,,,25835.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26615.68,,,26615.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17391.61,,,17391.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17559.65,,,17559.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16971.52,,,16971.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16803.49,,,16803.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16971.52,,,16971.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17307.59,,,17307.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17601.66,,,17601.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63005 - LAMINECTOMY W-O FFD 1-2 VERT SEG LUMBAR,63005,HCPCS,,,RT,Outpatient,,,19399.5,4849.875,882.09,16489.58,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12726.07,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13579.65,Percent of Total Billed Charges, ,,85,,16489.58,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13191.66,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10863.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11639.7,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63005 - LAMINECTOMY W-O FFD 1-2 VERT SEG LUMBAR,63005,HCPCS,,,LT,Outpatient,,,20562,5140.5,882.09,17477.7,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13488.67,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14393.4,Percent of Total Billed Charges, ,,85,,17477.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13982.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11514.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12337.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63012 - LAMINECTOMY W-RMVL ABNORMAL FACETS LUMBAR,63012,HCPCS,,,XU,Outpatient,,,5972.4,1493.1,0.01,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3917.89,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4180.68,Percent of Total Billed Charges, ,,85,,5076.54,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4061.23,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3344.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3583.44,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63020 - LAMNOTMY INCL W-DCMPRSN NRV ROOT 1 INTRSPC CERVC,63020,HCPCS,,,RT,Outpatient,,,21957,5489.25,950.4,18663.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14403.79,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15369.9,Percent of Total Billed Charges, ,,85,,18663.45,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14930.76,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12295.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13174.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63020 - LAMNOTMY INCL W-DCMPRSN NRV ROOT 1 INTRSPC CERVC,63020,HCPCS,,,LT,Outpatient,,,23795.58,5948.895,950.4,20226.24,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15609.9,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16656.91,Percent of Total Billed Charges, ,,85,,20226.24,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16180.99,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13325.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14277.35,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63030 - LAMNOTMY INCL W-DCMPRSN NRV ROOT 1 INTRSPC LUMBR,63030,HCPCS,,,XU,Outpatient,,,10315.4,2578.85,882.09,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6766.9,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7220.78,Percent of Total Billed Charges, ,,85,,8768.09,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7014.47,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5776.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6189.24,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63030 - LAMNOTMY INCL W-DCMPRSN NRV ROOT 1 INTRSPC LUMBR,63030,HCPCS,,,XS,Outpatient,,,4662.75,1165.6875,882.09,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3058.76,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3263.93,Percent of Total Billed Charges, ,,85,,3963.34,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3170.67,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2611.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2797.65,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63030 - LAMNOTMY INCL W-DCMPRSN NRV ROOT 1 INTRSPC LUMBR,63030,HCPCS,,,RT,Outpatient,,,20663.73,5165.9325,882.09,17564.17,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13555.41,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14464.61,Percent of Total Billed Charges, ,,85,,17564.17,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14051.34,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11571.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12398.24,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63030 - LAMNOTMY INCL W-DCMPRSN NRV ROOT 1 INTRSPC LUMBR,63030,HCPCS,,,LT,Outpatient,,,21102.66,5275.665,882.09,17937.26,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13843.34,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14771.86,Percent of Total Billed Charges, ,,85,,17937.26,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14349.81,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11817.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12661.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63030 - LAMNOTMY INCL W-DCMPRSN NRV ROOT 1 INTRSPC LUMBR,63030,HCPCS,,,50,Outpatient,,,19512.79,4878.1975,882.09,16585.87,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12800.39,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13658.95,Percent of Total Billed Charges, ,,85,,16585.87,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13268.7,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10927.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11707.67,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63035 - LAMNOTMY W-DCMPRSN NRV EACH ADDL CRVCL-LMBR,63035,HCPCS,,,XS,Outpatient,,,4662.75,1165.6875,0.01,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3058.76,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3263.93,Percent of Total Billed Charges, ,,85,,3963.34,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3170.67,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2611.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2797.65,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63035 - LAMNOTMY W-DCMPRSN NRV EACH ADDL CRVCL-LMBR,63035,HCPCS,,,RT,Outpatient,,,12296,3074,0.01,10451.6,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8066.18,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8607.2,Percent of Total Billed Charges, ,,85,,10451.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8361.28,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6885.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7377.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63035 - LAMNOTMY W-DCMPRSN NRV EACH ADDL CRVCL-LMBR,63035,HCPCS,,,LT,Outpatient,,,17692,4423,0.01,15038.2,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11605.95,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12384.4,Percent of Total Billed Charges, ,,85,,15038.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12030.56,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9907.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10615.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63035 - LAMNOTMY W-DCMPRSN NRV EACH ADDL CRVCL-LMBR,63035,HCPCS,,,50,Outpatient,,,11831,2957.75,0.01,10056.35,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7761.14,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8281.7,Percent of Total Billed Charges, ,,85,,10056.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8045.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6625.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7098.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63042 - LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR,63042,HCPCS,,,XU,Outpatient,,,17566,4391.5,1078.11,14931.1,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11523.3,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12296.2,Percent of Total Billed Charges, ,,85,,14931.1,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11944.88,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9836.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10539.6,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63042 - LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR,63042,HCPCS,,,RT,Outpatient,,,20940.09,5235.0225,1078.11,17799.08,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13736.7,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14658.06,Percent of Total Billed Charges, ,,85,,17799.08,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14239.26,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11726.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12564.05,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63042 - LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR,63042,HCPCS,,,LT,Outpatient,,,23235.75,5808.9375,1078.11,19750.39,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15242.65,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16265.03,Percent of Total Billed Charges, ,,85,,19750.39,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15800.31,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13012.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13941.45,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63047 - LAM FACETECTOMY AND FORAMOTOMY 1 VRT SGM LUMBAR,63047,HCPCS,,,XU,Outpatient,,,8917.37,2229.3425,882.09,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5849.79,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6242.16,Percent of Total Billed Charges, ,,85,,7579.76,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6063.81,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4993.73,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5350.42,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63047 - LAM FACETECTOMY AND FORAMOTOMY 1 VRT SGM LUMBAR,63047,HCPCS,,,XS,Outpatient,,,12373.5,3093.375,882.09,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8117.02,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8661.45,Percent of Total Billed Charges, ,,85,,10517.48,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8413.98,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6929.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7424.1,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63047 - LAM FACETECTOMY AND FORAMOTOMY 1 VRT SGM LUMBAR,63047,HCPCS,,,RT,Outpatient,,,16699.4,4174.85,882.09,14194.49,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10954.81,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11689.58,Percent of Total Billed Charges, ,,85,,14194.49,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11355.59,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9351.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10019.64,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63047 - LAM FACETECTOMY AND FORAMOTOMY 1 VRT SGM LUMBAR,63047,HCPCS,,,LT,Outpatient,,,21182,5295.5,882.09,18004.7,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13895.39,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14827.4,Percent of Total Billed Charges, ,,85,,18004.7,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14403.76,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11861.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12709.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63047 - LAM FACETECTOMY AND FORAMOTOMY 1 VRT SGM LUMBAR,63047,HCPCS,,,CG,Outpatient,,,37767,9441.75,882.09,32101.95,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24775.15,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26436.9,Percent of Total Billed Charges, ,,85,,32101.95,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25681.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,21149.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,22660.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63048 - LAM FACETECTOMYANDFORAMOT 1 VRT SGM EA ADDL SGM,63048,HCPCS,,,XU,Outpatient,,,8828.08,2207.02,0.01,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5791.22,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6179.66,Percent of Total Billed Charges, ,,85,,7503.87,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6003.09,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4943.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5296.85,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63048 - LAM FACETECTOMYANDFORAMOT 1 VRT SGM EA ADDL SGM,63048,HCPCS,,,RT,Outpatient,,,9743.5,2435.875,0.01,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6391.74,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6820.45,Percent of Total Billed Charges, ,,85,,8281.98,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6625.58,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5456.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5846.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63052 - LAM FACETEC-FORAMOT DRG ARTHRD LUMBAR 1 VRT SGM,63052,HCPCS,,,XU,Outpatient,,,5275.93,1318.9825,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3461.01,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3693.15,Percent of Total Billed Charges, ,,85,,4484.54,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3587.63,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2954.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3165.56,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63053 - LAM FACETEC-FORAMOT DRG ARTHRD LMBR EA ADDL SGM,63053,HCPCS,,,XU,Outpatient,,,5395.29,1348.8225,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3539.31,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3776.7,Percent of Total Billed Charges, ,,85,,4586,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3668.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3021.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3237.17,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63056 - TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR,63056,HCPCS,,,RT,Outpatient,,,20562,5140.5,950.4,17477.7,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13488.67,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14393.4,Percent of Total Billed Charges, ,,85,,17477.7,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13982.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11514.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12337.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63056 - TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR,63056,HCPCS,,,LT,Outpatient,,,21724.5,5431.125,950.4,18465.83,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14251.27,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15207.15,Percent of Total Billed Charges, ,,85,,18465.83,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14772.66,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12165.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13034.7,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63267 - LAM EXC-EVAC ISPI LESION OTH-THN NEO XDRL LUMBAR,63267,HCPCS,,,XU,Outpatient,,,6303,1575.75,3246,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4134.77,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4412.1,Percent of Total Billed Charges, ,,85,,5357.55,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4286.04,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3529.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3781.8,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63267 - LAM EXC-EVAC ISPI LESION OTH-THN NEO XDRL LUMBAR,63267,HCPCS,,,RT,Outpatient,,,19089.5,4772.375,3246,16226.08,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12522.71,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13362.65,Percent of Total Billed Charges, ,,85,,16226.08,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12980.86,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10690.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11453.7,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63267 - LAM EXC-EVAC ISPI LESION OTH-THN NEO XDRL LUMBAR,63267,HCPCS,,,LT,Outpatient,,,18857,4714.25,3246,16028.45,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12370.19,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13199.9,Percent of Total Billed Charges, ,,85,,16028.45,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12822.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10559.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11314.2,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
63650 - PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL,63650,HCPCS,,,XU,Outpatient,,,5575.66,1393.915,882.09,10712.56,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9692.45,,,9692.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3657.63,Percent of Total Billed Charges, ,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3902.96,Percent of Total Billed Charges, ,,85,,4739.31,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3791.45,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3122.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3345.4,Percent of Total Billed Charges, ,9593.4,,,9593.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10376.75,,,10376.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6458,,,6458,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6520.39,,,6520.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6239.61,,,6239.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6426.8,,,6426.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6535.99,,,6535.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63655 - LAM IMPLTJ NSTIM ELTRDS PLATE-PADDLE EDRL,63655,HCPCS,,,74,Outpatient,,,4600,1150,950.4,34901.53,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34901.53,,,34901.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31670.27,,,31670.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3017.6,Percent of Total Billed Charges, ,34901.53,,,34901.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3220,Percent of Total Billed Charges, ,,85,,3910,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3128,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2576,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2760,Percent of Total Billed Charges, ,31346.61,,,31346.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33807.44,,,33807.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21101.62,,,21101.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21305.5,,,21305.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20591.92,,,20591.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20388.04,,,20388.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20591.92,,,20591.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20999.68,,,20999.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21356.47,,,21356.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
63744 - RPLCMT IRRIGATION-REVJ LUMBOSARACH SHUNT,63744,HCPCS,,,74,Outpatient,,,8260,2065,742.5,10022.8,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5418.56,Percent of Total Billed Charges, ,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5782,Percent of Total Billed Charges, ,,85,,7021,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5616.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4625.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4956,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9708.61,,,9708.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64415 - INJECTION AAAND-STRD BRACHIAL PLEXUS W-IMG GDN,64415,HCPCS,,,XU,Outpatient,,,8996.07,2249.0175,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5901.42,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6297.25,Percent of Total Billed Charges, ,,85,,7646.66,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6117.33,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5037.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5397.64,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64415 - INJECTION AAAND-STRD BRACHIAL PLEXUS W-IMG GDN,64415,HCPCS,,,XP,Outpatient,,,10313.26,2578.315,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6765.5,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7219.28,Percent of Total Billed Charges, ,,85,,8766.27,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7013.02,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5775.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6187.96,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64415 - INJECTION AAAND-STRD BRACHIAL PLEXUS W-IMG GDN,64415,HCPCS,,,RT,Outpatient,,,14801.75,3700.4375,742.5,12581.49,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9709.95,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10361.23,Percent of Total Billed Charges, ,,85,,12581.49,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10065.19,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8288.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8881.05,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64415 - INJECTION AAAND-STRD BRACHIAL PLEXUS W-IMG GDN,64415,HCPCS,,,LT,Outpatient,,,10406,2601.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6826.34,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7284.2,Percent of Total Billed Charges, ,,85,,8845.1,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7076.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5827.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6243.6,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64415 - INJECTION AAAND-STRD BRACHIAL PLEXUS W-IMG GDN,64415,HCPCS,,,59,Outpatient,,,22609.5,5652.375,742.5,19218.08,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14831.83,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15826.65,Percent of Total Billed Charges, ,,85,,19218.08,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15374.46,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12661.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13565.7,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64417 - INJECTION AAAND-STRD AXILLARY NERVE W-IMG GDN,64417,HCPCS,,,XU,Outpatient,,,12020.66,3005.165,742.5,10217.56,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7885.55,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8414.46,Percent of Total Billed Charges, ,,85,,10217.56,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8174.05,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6731.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7212.4,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64417 - INJECTION AAAND-STRD AXILLARY NERVE W-IMG GDN,64417,HCPCS,,,XP,Outpatient,,,9966.23,2491.5575,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6537.85,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6976.36,Percent of Total Billed Charges, ,,85,,8471.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6777.04,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5581.09,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5979.74,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64420 - INJECTION AAAND-STRD INTERCOSTAL NRV SINGLE LVL,64420,HCPCS,,,XP,Outpatient,,,10632.08,2658.02,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6974.64,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7442.46,Percent of Total Billed Charges, ,,85,,9037.27,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7229.81,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5953.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6379.25,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64420 - INJECTION AAAND-STRD INTERCOSTAL NRV SINGLE LVL,64420,HCPCS,,,LT,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64420 - INJECTION AAAND-STRD INTERCOSTAL NRV SINGLE LVL,64420,HCPCS,,,50,Outpatient,,,21488.5,5372.125,658.41,18265.23,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14096.46,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15041.95,Percent of Total Billed Charges, ,,85,,18265.23,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14612.18,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12033.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12893.1,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64425 - INJECTION AAAND-STRD ILIOINGUINAL IH NERVES,64425,HCPCS,,,RT,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64425 - INJECTION AAAND-STRD ILIOINGUINAL IH NERVES,64425,HCPCS,,,LT,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64445 - INJECTION AAAND-STRD SCIATIC NERVE W-IMG GDN,64445,HCPCS,,,XU,Outpatient,,,14048.5,3512.125,658.41,11941.23,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9215.82,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9833.95,Percent of Total Billed Charges, ,,85,,11941.23,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9552.98,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7867.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8429.1,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64445 - INJECTION AAAND-STRD SCIATIC NERVE W-IMG GDN,64445,HCPCS,,,XS,Outpatient,,,10699,2674.75,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7018.54,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7489.3,Percent of Total Billed Charges, ,,85,,9094.15,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7275.32,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5991.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6419.4,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64445 - INJECTION AAAND-STRD SCIATIC NERVE W-IMG GDN,64445,HCPCS,,,XP,Outpatient,,,7879.3,1969.825,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5168.82,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5515.51,Percent of Total Billed Charges, ,,85,,6697.41,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5357.92,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4412.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4727.58,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64445 - INJECTION AAAND-STRD SCIATIC NERVE W-IMG GDN,64445,HCPCS,,,RT,Outpatient,,,6076.91,1519.2275,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3986.45,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4253.84,Percent of Total Billed Charges, ,,85,,5165.37,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4132.3,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3403.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3646.15,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64445 - INJECTION AAAND-STRD SCIATIC NERVE W-IMG GDN,64445,HCPCS,,,LT,Outpatient,,,6864.89,1716.2225,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4503.37,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4805.42,Percent of Total Billed Charges, ,,85,,5835.16,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4668.13,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3844.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4118.93,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64445 - INJECTION AAAND-STRD SCIATIC NERVE W-IMG GDN,64445,HCPCS,,,50,Outpatient,,,14717.5,3679.375,658.41,12509.88,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9654.68,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10302.25,Percent of Total Billed Charges, ,,85,,12509.88,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10007.9,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8241.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8830.5,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64447 - INJECTION AAAND-STRD FEMORAL NERVE W-IMG GDN,64447,HCPCS,,,XU,Outpatient,,,3468.66,867.165,658.41,9153,,,,,,,Service Paid at Rev Code level,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2275.44,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2428.06,Percent of Total Billed Charges, ,,85,,2948.36,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2358.69,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1942.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2081.2,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64447 - INJECTION AAAND-STRD FEMORAL NERVE W-IMG GDN,64447,HCPCS,,,XS,Outpatient,,,11102.33,2775.5825,658.41,9436.98,,,,,,,Service Paid at Rev Code level,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7283.13,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7771.63,Percent of Total Billed Charges, ,,85,,9436.98,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7549.58,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6217.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6661.4,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64447 - INJECTION AAAND-STRD FEMORAL NERVE W-IMG GDN,64447,HCPCS,,,XP,Outpatient,,,12785.74,3196.435,658.41,10867.88,,,,,,,Service Paid at Rev Code level,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8387.45,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8950.02,Percent of Total Billed Charges, ,,85,,10867.88,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8694.3,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7160.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7671.44,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64447 - INJECTION AAAND-STRD FEMORAL NERVE W-IMG GDN,64447,HCPCS,,,RT,Outpatient,,,4230.7,1057.675,658.41,9153,,,,,,,Service Paid at Rev Code level,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2775.34,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2961.49,Percent of Total Billed Charges, ,,85,,3596.1,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2876.88,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2369.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2538.42,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64447 - INJECTION AAAND-STRD FEMORAL NERVE W-IMG GDN,64447,HCPCS,,,LT,Outpatient,,,9020.92,2255.23,658.41,9153,,,,,,,Service Paid at Rev Code level,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5917.72,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6314.64,Percent of Total Billed Charges, ,,85,,7667.78,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6134.23,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5051.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5412.55,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64447 - INJECTION AAAND-STRD FEMORAL NERVE W-IMG GDN,64447,HCPCS,,,59,Outpatient,,,11125.5,2781.375,658.41,9456.68,,,,,,,Service Paid at Rev Code level,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7298.33,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7787.85,Percent of Total Billed Charges, ,,85,,9456.68,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7565.34,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6230.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6675.3,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,XU,Outpatient,,,6730.21,1682.5525,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4415.02,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4711.15,Percent of Total Billed Charges, ,,85,,5720.68,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4576.54,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3768.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4038.13,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,XS,Outpatient,,,8025.4,2006.35,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5264.66,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5617.78,Percent of Total Billed Charges, ,,85,,6821.59,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5457.27,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4494.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4815.24,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,XP,Outpatient,,,8307.5,2076.875,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5449.72,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5815.25,Percent of Total Billed Charges, ,,85,,7061.38,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5649.1,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4652.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4984.5,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,LT,Outpatient,,,16887.75,4221.9375,658.41,14354.59,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11078.36,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11821.43,Percent of Total Billed Charges, ,,85,,14354.59,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11483.67,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9457.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10132.65,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,50,Outpatient,,,7279,1819.75,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4775.02,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5095.3,Percent of Total Billed Charges, ,,85,,6187.15,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4949.72,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4076.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4367.4,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64455 - NJX AAAND-STRD PLANTAR COMMON DIGITAL NERVES,64455,HCPCS,,,XS,Outpatient,,,6264.25,1566.0625,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4109.35,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4384.98,Percent of Total Billed Charges, ,,85,,5324.61,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4259.69,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3507.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3758.55,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64483 - NJX AAAND-STRD TFRML EPI LUMBAR-SACRAL 1 LEVEL,64483,HCPCS,,,XU,Outpatient,,,9656.38,2414.095,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6334.59,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6759.47,Percent of Total Billed Charges, ,,85,,8207.92,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6566.34,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5407.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5793.83,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64483 - NJX AAAND-STRD TFRML EPI LUMBAR-SACRAL 1 LEVEL,64483,HCPCS,,,RT,Outpatient,,,2703,675.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1773.17,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1892.1,Percent of Total Billed Charges, ,,85,,2297.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1838.04,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1513.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1621.8,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64484 - NJX AAAND-STRD TFRML EPI LUMBAR-SACRAL EA ADDL,64484,HCPCS,,,RT,Outpatient,,,3606,901.5,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2365.54,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2524.2,Percent of Total Billed Charges, ,,85,,3065.1,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2452.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2019.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2163.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
64486 - TAP BLOCK UNILATERAL BY INJECTION(S),64486,HCPCS,,,XP,Outpatient,,,16981.41,4245.3525,0.01,14434.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11139.8,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11886.99,Percent of Total Billed Charges, ,,85,,14434.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11547.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9509.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10188.85,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64486 - TAP BLOCK UNILATERAL BY INJECTION(S),64486,HCPCS,,,LT,Outpatient,,,16576.5,4144.125,0.01,14090.03,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10874.18,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11603.55,Percent of Total Billed Charges, ,,85,,14090.03,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11272.02,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9282.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9945.9,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64488 - TAP BLOCK BILATERAL BY INJECTION(S),64488,HCPCS,,,XS,Outpatient,,,11376.75,2844.1875,0.01,9670.24,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7463.15,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7963.73,Percent of Total Billed Charges, ,,85,,9670.24,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7736.19,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6370.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6826.05,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64488 - TAP BLOCK BILATERAL BY INJECTION(S),64488,HCPCS,,,XP,Outpatient,,,18679.74,4669.935,0.01,15877.78,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12253.91,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13075.82,Percent of Total Billed Charges, ,,85,,15877.78,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,12702.22,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10460.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11207.84,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64488 - TAP BLOCK BILATERAL BY INJECTION(S),64488,HCPCS,,,59,Outpatient,,,17391.66,4347.915,0.01,14782.91,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11408.93,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12174.16,Percent of Total Billed Charges, ,,85,,14782.91,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11826.33,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9739.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64490 - NJX DX-THER AGT PVRT FACET JT CRV-THRC 1 LEVEL,64490,HCPCS,,,XP,Outpatient,,,4116,1029,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2700.1,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2881.2,Percent of Total Billed Charges, ,,85,,3498.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2798.88,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2304.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2469.6,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64493 - NJX DX-THER AGT PVRT FACET JT LMBR-SAC 1 LEVEL,64493,HCPCS,,,50,Outpatient,,,4561,1140.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2992.02,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3192.7,Percent of Total Billed Charges, ,,85,,3876.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3101.48,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2554.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2736.6,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64530 - INJX ANES CELIAC PLEXUS W-WO RADIOLOGIC MONITRNG,64530,HCPCS,,,XU,Outpatient,,,1628,407,846.43,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1067.97,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1139.6,Percent of Total Billed Charges, ,,85,,1383.8,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1107.04,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,911.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,976.8,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64530 - INJX ANES CELIAC PLEXUS W-WO RADIOLOGIC MONITRNG,64530,HCPCS,,,XS,Outpatient,,,1800,450,846.43,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64530 - INJX ANES CELIAC PLEXUS W-WO RADIOLOGIC MONITRNG,64530,HCPCS,,,RT,Outpatient,,,1800,450,846.43,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64561 - PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W-IMAGING,64561,HCPCS,,,XU,Outpatient,,,7782.09,1945.5225,1078.11,10712.56,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9692.45,,,9692.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5105.05,Percent of Total Billed Charges, ,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5447.46,Percent of Total Billed Charges, ,,85,,6614.78,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5291.82,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4357.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4669.25,Percent of Total Billed Charges, ,9593.4,,,9593.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10376.75,,,10376.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6458,,,6458,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6520.39,,,6520.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6239.61,,,6239.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6426.8,,,6426.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6535.99,,,6535.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64561 - PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W-IMAGING,64561,HCPCS,,,LT,Outpatient,,,15485,3871.25,1078.11,13162.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9692.45,,,9692.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10158.16,Percent of Total Billed Charges, ,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10839.5,Percent of Total Billed Charges, ,,85,,13162.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10529.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8671.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9291,Percent of Total Billed Charges, ,9593.4,,,9593.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10376.75,,,10376.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6458,,,6458,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6520.39,,,6520.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6239.61,,,6239.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6426.8,,,6426.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6535.99,,,6535.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64561 - PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W-IMAGING,64561,HCPCS,,,50,Outpatient,,,9249.16,2312.29,1078.11,10712.56,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9692.45,,,9692.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6067.45,Percent of Total Billed Charges, ,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6474.41,Percent of Total Billed Charges, ,,85,,7861.79,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6289.43,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5179.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5549.5,Percent of Total Billed Charges, ,9593.4,,,9593.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10376.75,,,10376.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6458,,,6458,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6520.39,,,6520.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6239.61,,,6239.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6426.8,,,6426.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6535.99,,,6535.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64581 - OPEN IMPLANTATION NEA SACRAL NERVE,64581,HCPCS,,,74,Outpatient,,,2208.5,552.125,1078.11,11151,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9692.45,,,9692.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1448.78,Percent of Total Billed Charges, ,10712.56,,,10712.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1545.95,Percent of Total Billed Charges, ,,85,,1877.23,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1501.78,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1236.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1325.1,Percent of Total Billed Charges, ,9593.4,,,9593.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10376.75,,,10376.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6458,,,6458,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6520.39,,,6520.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6239.61,,,6239.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6302.01,,,6302.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6426.8,,,6426.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6535.99,,,6535.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64582 - OPEN IMPLTJ HPGLSL NRV NSTIM RA PGANDRESPIR SENSOR,64582,HCPCS,,,RT,Outpatient,,,24600.32,6150.08,1078.11,47624.4,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47624.4,,,47624.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45005.09,,,45005.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16137.81,Percent of Total Billed Charges, ,47624.4,,,47624.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17220.22,Percent of Total Billed Charges, ,,85,,20910.27,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16728.22,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13776.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14760.19,Percent of Total Billed Charges, ,44545.16,,,44545.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46131.48,,,46131.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29986.5,,,29986.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30276.22,,,30276.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29262.18,,,29262.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28972.46,,,28972.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29262.18,,,29262.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29841.63,,,29841.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30348.65,,,30348.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64582 - OPEN IMPLTJ HPGLSL NRV NSTIM RA PGANDRESPIR SENSOR,64582,HCPCS,,,LT,Outpatient,,,27692,6923,1078.11,47624.4,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47624.4,,,47624.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45005.09,,,45005.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18165.95,Percent of Total Billed Charges, ,47624.4,,,47624.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19384.4,Percent of Total Billed Charges, ,,85,,23538.2,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18830.56,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15507.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16615.2,Percent of Total Billed Charges, ,44545.16,,,44545.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46131.48,,,46131.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29986.5,,,29986.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30276.22,,,30276.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29262.18,,,29262.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28972.46,,,28972.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29262.18,,,29262.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29841.63,,,29841.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30348.65,,,30348.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64584 - REMOVAL HYPOGLOSSAL NERVE NSTIM RA PGANDRESPIR SNR,64584,HCPCS,,,RT,Outpatient,,,23042,5760.5,950.4,19585.7,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15115.55,Percent of Total Billed Charges, ,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16129.4,Percent of Total Billed Charges, ,,85,,19585.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15668.56,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12903.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13825.2,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9708.61,,,9708.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64585 - REVJ-RMVL PERPH NEUROSTIMULATOR ELECTRODE ARRAY,64585,HCPCS,,,73,Outpatient,,,2208.5,552.125,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5268.29,,,5268.29,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5078.92,,,5078.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1448.78,Percent of Total Billed Charges, ,5268.29,,,5268.29,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1545.95,Percent of Total Billed Charges, ,,85,,1877.23,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1501.78,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1236.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1325.1,Percent of Total Billed Charges, ,5027.01,,,5027.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5103.14,,,5103.14,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3384.04,,,3384.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3416.73,,,3416.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3302.3,,,3302.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3269.6,,,3269.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3302.3,,,3302.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3367.69,,,3367.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3424.91,,,3424.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64590 - INS-RPLC PERPH SAC-GSTRC NPG-RCVR PCKT CRTJANDCONN,64590,HCPCS,,,XU,Outpatient,,,8390.83,2097.7075,1078.11,34901.53,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34901.53,,,34901.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31670.27,,,31670.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5504.38,Percent of Total Billed Charges, ,34901.53,,,34901.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5873.58,Percent of Total Billed Charges, ,,85,,7132.21,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5705.76,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4698.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5034.5,Percent of Total Billed Charges, ,31346.61,,,31346.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33807.44,,,33807.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21101.62,,,21101.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21305.5,,,21305.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20591.92,,,20591.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20388.04,,,20388.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20591.92,,,20591.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20999.68,,,20999.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21356.47,,,21356.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64590 - INS-RPLC PERPH SAC-GSTRC NPG-RCVR PCKT CRTJANDCONN,64590,HCPCS,,,74,Outpatient,,,2208.5,552.125,1078.11,34901.53,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34901.53,,,34901.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31670.27,,,31670.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1448.78,Percent of Total Billed Charges, ,34901.53,,,34901.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1545.95,Percent of Total Billed Charges, ,,85,,1877.23,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1501.78,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1236.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1325.1,Percent of Total Billed Charges, ,31346.61,,,31346.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33807.44,,,33807.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21101.62,,,21101.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21305.5,,,21305.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20591.92,,,20591.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20388.04,,,20388.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20591.92,,,20591.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20999.68,,,20999.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21356.47,,,21356.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64590 - INS-RPLC PERPH SAC-GSTRC NPG-RCVR PCKT CRTJANDCONN,64590,HCPCS,,,58,Outpatient,,,10655,2663.75,1078.11,34901.53,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34901.53,,,34901.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31670.27,,,31670.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6989.68,Percent of Total Billed Charges, ,34901.53,,,34901.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7458.5,Percent of Total Billed Charges, ,,85,,9056.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7245.4,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5966.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6393,Percent of Total Billed Charges, ,31346.61,,,31346.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33807.44,,,33807.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21101.62,,,21101.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21305.5,,,21305.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20591.92,,,20591.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20388.04,,,20388.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20591.92,,,20591.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20999.68,,,20999.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21356.47,,,21356.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64595 - REV-RMV PRPH SAC-GSTRC NPG-RCV DTCH CONN ELTR RA,64595,HCPCS,,,XU,Outpatient,,,5820.66,1455.165,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5268.29,,,5268.29,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5078.92,,,5078.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3818.35,Percent of Total Billed Charges, ,5268.29,,,5268.29,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4074.46,Percent of Total Billed Charges, ,,85,,4947.56,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3958.05,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3259.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3492.4,Percent of Total Billed Charges, ,5027.01,,,5027.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5103.14,,,5103.14,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3384.04,,,3384.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3416.73,,,3416.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3302.3,,,3302.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3269.6,,,3269.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3302.3,,,3302.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3367.69,,,3367.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3424.91,,,3424.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64595 - REV-RMV PRPH SAC-GSTRC NPG-RCV DTCH CONN ELTR RA,64595,HCPCS,,,73,Outpatient,,,2208.5,552.125,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5268.29,,,5268.29,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5078.92,,,5078.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1448.78,Percent of Total Billed Charges, ,5268.29,,,5268.29,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1545.95,Percent of Total Billed Charges, ,,85,,1877.23,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1501.78,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1236.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1325.1,Percent of Total Billed Charges, ,5027.01,,,5027.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5103.14,,,5103.14,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3384.04,,,3384.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3416.73,,,3416.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3302.3,,,3302.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3269.6,,,3269.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3302.3,,,3302.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3367.69,,,3367.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3424.91,,,3424.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64610 - DSTRJ NEURLYTIC TRIGEM NRV 2-3 DIV RADIO MONITOR,64610,HCPCS,,,RT,Outpatient,,,11598,2899.5,882.09,9858.3,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7608.29,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8118.6,Percent of Total Billed Charges, ,,85,,9858.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7886.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6494.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6958.8,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64612 - CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL,64612,HCPCS,,,50,Outpatient,,,5910,1477.5,280.65,5023.5,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3876.96,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4137,Percent of Total Billed Charges, ,,85,,5023.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4018.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3309.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3546,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64633 - DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL-THORA,64633,HCPCS,,,RT,Outpatient,,,9462,2365.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64634 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL-THORA,64634,HCPCS,,,XU,Outpatient,,,838,209.5,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,549.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,586.6,Percent of Total Billed Charges, ,,85,,712.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,569.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,469.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,502.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
64634 - DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL-THORA,64634,HCPCS,,,RT,Outpatient,,,838,209.5,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,549.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,586.6,Percent of Total Billed Charges, ,,85,,712.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,569.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,469.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,502.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE,64640,HCPCS,,,RT,Outpatient,,,5111.95,1277.9875,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3353.44,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3578.37,Percent of Total Billed Charges, ,,85,,4345.16,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3476.13,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2862.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3067.17,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64702 - NEUROPLASTY DIGITAL 1-BOTH SAME DIGIT,64702,HCPCS,,,XU,Outpatient,,,7025.32,1756.33,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4608.61,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4917.72,Percent of Total Billed Charges, ,,85,,5971.52,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4777.22,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3934.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4215.19,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64702 - NEUROPLASTY DIGITAL 1-BOTH SAME DIGIT,64702,HCPCS,,,RT,Outpatient,,,5975.66,1493.915,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3920.03,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4182.96,Percent of Total Billed Charges, ,,85,,5079.31,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4063.45,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3346.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3585.4,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64702 - NEUROPLASTY DIGITAL 1-BOTH SAME DIGIT,64702,HCPCS,,,F7,Outpatient,,,6686.2,1671.55,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4386.15,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4680.34,Percent of Total Billed Charges, ,,85,,5683.27,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4546.62,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3744.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4011.72,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64704 - NEUROPLASTY NERVE HAND-FOOT,64704,HCPCS,,,RT,Outpatient,,,4658.4,1164.6,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3055.91,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3260.88,Percent of Total Billed Charges, ,,85,,3959.64,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3167.71,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2608.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2795.04,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64704 - NEUROPLASTY NERVE HAND-FOOT,64704,HCPCS,,,LT,Outpatient,,,8895.5,2223.875,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5835.45,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6226.85,Percent of Total Billed Charges, ,,85,,7561.18,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6048.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4981.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5337.3,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64708 - NEURP MAJOR PRPH NRV ARM-LEG OPN OTH-THN SPEC,64708,HCPCS,,,XU,Outpatient,,,5365.75,1341.4375,950.4,4560.89,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3519.93,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3756.03,Percent of Total Billed Charges, ,,85,,4560.89,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3648.71,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3004.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3219.45,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64708 - NEURP MAJOR PRPH NRV ARM-LEG OPN OTH-THN SPEC,64708,HCPCS,,,RT,Outpatient,,,12646.47,3161.6175,950.4,10749.5,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8296.08,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8852.53,Percent of Total Billed Charges, ,,85,,10749.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8599.6,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7082.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7587.88,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64708 - NEURP MAJOR PRPH NRV ARM-LEG OPN OTH-THN SPEC,64708,HCPCS,,,LT,Outpatient,,,14613.78,3653.445,950.4,12421.71,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9586.64,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10229.65,Percent of Total Billed Charges, ,,85,,12421.71,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9937.37,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8183.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8768.27,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64712 - NEURP MAJOR PRPH NRV OPN ARM-LEG SCIATIC NRV,64712,HCPCS,,,LT,Outpatient,,,11174,2793.5,950.4,9497.9,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7330.14,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7821.8,Percent of Total Billed Charges, ,,85,,9497.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7598.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6257.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6704.4,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64713 - NEURP MAJOR PRPH NRV OPN ARM-LEG BRACH PLEXUS,64713,HCPCS,,,LT,Outpatient,,,17101,4275.25,950.4,14535.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11218.26,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11970.7,Percent of Total Billed Charges, ,,85,,14535.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11628.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9576.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10260.6,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64718 - NEUROPLASTY AND-TRANSPOSITION ULNAR NERVE ELBOW,64718,HCPCS,,,XU,Outpatient,,,9498.52,2374.63,950.4,8073.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6231.03,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6648.96,Percent of Total Billed Charges, ,,85,,8073.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6458.99,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5319.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5699.11,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64718 - NEUROPLASTY AND-TRANSPOSITION ULNAR NERVE ELBOW,64718,HCPCS,,,XS,Outpatient,,,6186.75,1546.6875,950.4,5258.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4058.51,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4330.73,Percent of Total Billed Charges, ,,85,,5258.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4206.99,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3464.58,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3712.05,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64718 - NEUROPLASTY AND-TRANSPOSITION ULNAR NERVE ELBOW,64718,HCPCS,,,RT,Outpatient,,,8369.11,2092.2775,950.4,7113.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5490.14,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5858.38,Percent of Total Billed Charges, ,,85,,7113.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5690.99,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4686.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5021.47,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64718 - NEUROPLASTY AND-TRANSPOSITION ULNAR NERVE ELBOW,64718,HCPCS,,,LT,Outpatient,,,9422.95,2355.7375,950.4,8009.51,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6181.46,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6596.07,Percent of Total Billed Charges, ,,85,,8009.51,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6407.61,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5276.85,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5653.77,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64719 - NEUROPLASTY AND-TRANSPOSITION ULNAR NERVE WRIST,64719,HCPCS,,,XU,Outpatient,,,5606.44,1401.61,950.4,4765.47,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3677.82,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3924.51,Percent of Total Billed Charges, ,,85,,4765.47,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3812.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3139.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3363.86,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64719 - NEUROPLASTY AND-TRANSPOSITION ULNAR NERVE WRIST,64719,HCPCS,,,XS,Outpatient,,,5683,1420.75,950.4,4830.55,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3728.05,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3978.1,Percent of Total Billed Charges, ,,85,,4830.55,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3864.44,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3182.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3409.8,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64719 - NEUROPLASTY AND-TRANSPOSITION ULNAR NERVE WRIST,64719,HCPCS,,,RT,Outpatient,,,11759,2939.75,950.4,9995.15,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7713.9,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8231.3,Percent of Total Billed Charges, ,,85,,9995.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7996.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6585.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7055.4,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64719 - NEUROPLASTY AND-TRANSPOSITION ULNAR NERVE WRIST,64719,HCPCS,,,LT,Outpatient,,,6307.08,1576.77,950.4,5361.02,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4137.44,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4414.96,Percent of Total Billed Charges, ,,85,,5361.02,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4288.81,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3531.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3784.25,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64721 - NEUROPLASTY AND-TRANSPOS MEDIAN NRV CARPAL TUNNE,64721,HCPCS,,,XU,Outpatient,,,6858.08,1714.52,950.4,5829.37,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4498.9,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4800.66,Percent of Total Billed Charges, ,,85,,5829.37,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4663.49,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3840.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4114.85,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64721 - NEUROPLASTY AND-TRANSPOS MEDIAN NRV CARPAL TUNNE,64721,HCPCS,,,XS,Outpatient,,,6825.21,1706.3025,950.4,5801.43,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4477.34,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4777.65,Percent of Total Billed Charges, ,,85,,5801.43,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4641.14,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3822.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4095.13,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64721 - NEUROPLASTY AND-TRANSPOS MEDIAN NRV CARPAL TUNNE,64721,HCPCS,,,RT,Outpatient,,,9103.9,2275.975,950.4,7738.32,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5972.16,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6372.73,Percent of Total Billed Charges, ,,85,,7738.32,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6190.65,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5098.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5462.34,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64721 - NEUROPLASTY AND-TRANSPOS MEDIAN NRV CARPAL TUNNE,64721,HCPCS,,,LT,Outpatient,,,9177.72,2294.43,950.4,7801.06,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6020.58,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6424.4,Percent of Total Billed Charges, ,,85,,7801.06,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6240.85,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5139.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5506.63,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64721 - NEUROPLASTY AND-TRANSPOS MEDIAN NRV CARPAL TUNNE,64721,HCPCS,,,50,Outpatient,,,14652.48,3663.12,950.4,12454.61,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9612.03,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10256.74,Percent of Total Billed Charges, ,,85,,12454.61,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9963.69,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8205.39,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8791.49,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64722 - DECOMPRESSION UNSPECIFIED NERVE,64722,HCPCS,,,XP,Outpatient,,,9523.66,2380.915,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6247.52,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6666.56,Percent of Total Billed Charges, ,,85,,8095.11,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6476.09,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5333.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5714.2,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64722 - DECOMPRESSION UNSPECIFIED NERVE,64722,HCPCS,,,LT,Outpatient,,,16222,4055.5,950.4,13788.7,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10641.63,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11355.4,Percent of Total Billed Charges, ,,85,,13788.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11030.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9084.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9733.2,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64726 - DECOMPRESSION PLANTAR DIGITAL NERVE,64726,HCPCS,,,LT,Outpatient,,,12013.5,3003.375,950.4,10211.48,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7880.86,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8409.45,Percent of Total Billed Charges, ,,85,,10211.48,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8169.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6727.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7208.1,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64727 - INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE,64727,HCPCS,,,RT,Outpatient,,,7954.25,1988.5625,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5217.99,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5567.98,Percent of Total Billed Charges, ,,85,,6761.11,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5408.89,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4454.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4772.55,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64772 - TRANSECTION-AVULSION OTH SPINAL NRV XDRL,64772,HCPCS,,,XU,Outpatient,,,2787.23,696.8075,950.4,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1828.42,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1951.06,Percent of Total Billed Charges, ,,85,,2369.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1895.32,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1560.85,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1672.34,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64772 - TRANSECTION-AVULSION OTH SPINAL NRV XDRL,64772,HCPCS,,,RT,Outpatient,,,7259.88,1814.97,950.4,6170.9,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4762.48,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5081.92,Percent of Total Billed Charges, ,,85,,6170.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4936.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4065.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4355.93,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64772 - TRANSECTION-AVULSION OTH SPINAL NRV XDRL,64772,HCPCS,,,LT,Outpatient,,,8579.84,2144.96,950.4,7292.86,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5628.38,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6005.89,Percent of Total Billed Charges, ,,85,,7292.86,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5834.29,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4804.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5147.9,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64774 - EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE,64774,HCPCS,,,XU,Outpatient,,,7557.33,1889.3325,742.5,6423.73,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4957.61,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5290.13,Percent of Total Billed Charges, ,,85,,6423.73,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5138.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4232.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4534.4,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64774 - EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE,64774,HCPCS,,,RT,Outpatient,,,7734.53,1933.6325,742.5,6574.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5073.85,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5414.17,Percent of Total Billed Charges, ,,85,,6574.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5259.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4331.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4640.72,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64776 - EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT,64776,HCPCS,,,XU,Outpatient,,,4404.25,1101.0625,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2889.19,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3082.98,Percent of Total Billed Charges, ,,85,,3743.61,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2994.89,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2466.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2642.55,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64776 - EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT,64776,HCPCS,,,F9,Outpatient,,,8087.5,2021.875,742.5,6874.38,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5305.4,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5661.25,Percent of Total Billed Charges, ,,85,,6874.38,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5499.5,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4529,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4852.5,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64776 - EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT,64776,HCPCS,,,F5,Outpatient,,,11746.88,2936.72,742.5,9984.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7705.95,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8222.82,Percent of Total Billed Charges, ,,85,,9984.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7987.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6578.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7048.13,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64776 - EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT,64776,HCPCS,,,F3,Outpatient,,,9041,2260.25,742.5,7684.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5930.9,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6328.7,Percent of Total Billed Charges, ,,85,,7684.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6147.88,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5062.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5424.6,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64776 - EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT,64776,HCPCS,,,F1,Outpatient,,,16687,4171.75,742.5,14183.95,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10946.67,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11680.9,Percent of Total Billed Charges, ,,85,,14183.95,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11347.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9344.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10012.2,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64782 - EXC NEUROMA HAND-FOOT XCP DIGITAL NERVE,64782,HCPCS,,,XU,Outpatient,,,7014.4,1753.6,742.5,5962.24,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4601.45,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4910.08,Percent of Total Billed Charges, ,,85,,5962.24,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4769.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3928.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4208.64,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64782 - EXC NEUROMA HAND-FOOT XCP DIGITAL NERVE,64782,HCPCS,,,RT,Outpatient,,,11598.5,2899.625,742.5,9858.73,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7608.62,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8118.95,Percent of Total Billed Charges, ,,85,,9858.73,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7886.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6495.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6959.1,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64782 - EXC NEUROMA HAND-FOOT XCP DIGITAL NERVE,64782,HCPCS,,,LT,Outpatient,,,11271.33,2817.8325,742.5,9580.63,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7393.99,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7889.93,Percent of Total Billed Charges, ,,85,,9580.63,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7664.5,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6311.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6762.8,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64831 - SUTURE DIGITAL NERVE HAND-FOOT 1 NERVE,64831,HCPCS,,,XU,Outpatient,,,5758.29,1439.5725,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3777.44,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4030.8,Percent of Total Billed Charges, ,,85,,4894.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3915.64,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3224.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3454.97,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64831 - SUTURE DIGITAL NERVE HAND-FOOT 1 NERVE,64831,HCPCS,,,RT,Outpatient,,,5872.33,1468.0825,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3852.25,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4110.63,Percent of Total Billed Charges, ,,85,,4991.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3993.18,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3288.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3523.4,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64831 - SUTURE DIGITAL NERVE HAND-FOOT 1 NERVE,64831,HCPCS,,,F9,Outpatient,,,9738.5,2434.625,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6388.46,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6816.95,Percent of Total Billed Charges, ,,85,,8277.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6622.18,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5453.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5843.1,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64831 - SUTURE DIGITAL NERVE HAND-FOOT 1 NERVE,64831,HCPCS,,,F8,Outpatient,,,8708.5,2177.125,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5712.78,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6095.95,Percent of Total Billed Charges, ,,85,,7402.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5921.78,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4876.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5225.1,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64831 - SUTURE DIGITAL NERVE HAND-FOOT 1 NERVE,64831,HCPCS,,,F2,Outpatient,,,5383.4,1345.85,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3531.51,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3768.38,Percent of Total Billed Charges, ,,85,,4575.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3660.71,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3014.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3230.04,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64857 - SUTR PRPH NRV ARM-LEG XCP SCIATIC W-O TRPOS,64857,HCPCS,,,RT,Outpatient,,,10419.75,2604.9375,1078.11,10022.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6835.36,Percent of Total Billed Charges, ,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7293.83,Percent of Total Billed Charges, ,,85,,8856.79,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7085.43,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5835.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6251.85,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9708.61,,,9708.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64857 - SUTR PRPH NRV ARM-LEG XCP SCIATIC W-O TRPOS,64857,HCPCS,,,LT,Outpatient,,,7891.75,1972.9375,1078.11,10022.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5176.99,Percent of Total Billed Charges, ,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5524.23,Percent of Total Billed Charges, ,,85,,6707.99,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5366.39,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4419.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4735.05,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9708.61,,,9708.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64859 - SUTURE EACH ADDITIONAL PERIPHERAL NERVE,64859,HCPCS,,,RT,Outpatient,,,10419.75,2604.9375,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6835.36,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7293.83,Percent of Total Billed Charges, ,,85,,8856.79,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7085.43,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5835.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6251.85,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64890 - NERVE GRAFT 1 STRAND HAND-FOOT LESS THAN 4 CM,64890,HCPCS,,,LT,Outpatient,,,7060.66,1765.165,1078.11,10022.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4631.79,Percent of Total Billed Charges, ,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4942.46,Percent of Total Billed Charges, ,,85,,6001.56,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4801.25,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3953.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4236.4,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9708.61,,,9708.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64892 - NERVE GRAFT 1 STRAND ARM-LEG LESS THAN 4 CM,64892,HCPCS,,,RT,Outpatient,,,7014.4,1753.6,1078.11,10022.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4601.45,Percent of Total Billed Charges, ,10022.8,,,10022.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4910.08,Percent of Total Billed Charges, ,,85,,5962.24,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4769.79,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3928.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4208.64,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9708.61,,,9708.61,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64910 - NERVE REPAIR W-CONDUIT EACH NERVE,64910,HCPCS,,,RT,Outpatient,,,9451.27,2362.8175,0.01,9457.89,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6200.03,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6615.89,Percent of Total Billed Charges, ,,85,,8033.58,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6426.86,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5292.71,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5670.76,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64910 - NERVE REPAIR W-CONDUIT EACH NERVE,64910,HCPCS,,,LT,Outpatient,,,6997.66,1749.415,0.01,9457.89,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4590.46,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4898.36,Percent of Total Billed Charges, ,,85,,5948.01,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4758.41,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3918.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4198.6,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64910 - NERVE REPAIR W-CONDUIT EACH NERVE,64910,HCPCS,,,FA,Outpatient,,,4404.25,1101.0625,0.01,9457.89,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2889.19,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3082.98,Percent of Total Billed Charges, ,,85,,3743.61,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2994.89,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2466.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2642.55,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64910 - NERVE REPAIR W-CONDUIT EACH NERVE,64910,HCPCS,,,F7,Outpatient,,,7112.33,1778.0825,0.01,9457.89,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4665.69,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4978.63,Percent of Total Billed Charges, ,,85,,6045.48,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4836.38,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3982.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4267.4,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64910 - NERVE REPAIR W-CONDUIT EACH NERVE,64910,HCPCS,,,F2,Outpatient,,,10513.5,2628.375,0.01,9457.89,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6896.86,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7359.45,Percent of Total Billed Charges, ,,85,,8936.48,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7149.18,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5887.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6308.1,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64912 - NERVE REPAIR W-NERVE ALLOGRAFT FIRST STRAND,64912,HCPCS,,,XU,Outpatient,,,7954.25,1988.5625,0.01,13976,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5217.99,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5567.98,Percent of Total Billed Charges, ,,85,,6761.11,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5408.89,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4454.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4772.55,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64912 - NERVE REPAIR W-NERVE ALLOGRAFT FIRST STRAND,64912,HCPCS,,,RT,Outpatient,,,6225.5,1556.375,0.01,13976,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4083.93,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4357.85,Percent of Total Billed Charges, ,,85,,5291.68,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4233.34,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3486.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3735.3,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64912 - NERVE REPAIR W-NERVE ALLOGRAFT FIRST STRAND,64912,HCPCS,,,LT,Outpatient,,,11423.25,2855.8125,0.01,13976,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7493.65,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7996.28,Percent of Total Billed Charges, ,,85,,9709.76,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7767.81,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6397.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6853.95,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64912 - NERVE REPAIR W-NERVE ALLOGRAFT FIRST STRAND,64912,HCPCS,,,F5,Outpatient,,,8662.33,2165.5825,0.01,13976,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9457.89,,,9457.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5682.49,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6063.63,Percent of Total Billed Charges, ,,85,,7362.98,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5890.38,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4850.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5197.4,Percent of Total Billed Charges, ,9361.24,,,9361.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6301.71,,,6301.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6362.6,,,6362.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6088.61,,,6088.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6149.5,,,6149.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6271.27,,,6271.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6377.82,,,6377.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64913 - NERVE REPAIR W-NERVE ALLOGRAFT EA ADDL STRAND,64913,HCPCS,,,LT,Outpatient,,,14311,3577.75,0.01,12164.35,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9388.02,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10017.7,Percent of Total Billed Charges, ,,85,,12164.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9731.48,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8014.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8586.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
64999 - UNLISTED PROCEDURE NERVOUS SYSTEM,64999,HCPCS,,,XP,Outpatient,,,12880.04,3220.01,0.01,10948.03,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8449.31,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9016.03,Percent of Total Billed Charges, ,,85,,10948.03,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,8758.43,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7212.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7728.02,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64999 - UNLISTED PROCEDURE NERVOUS SYSTEM,64999,HCPCS,,,RT,Outpatient,,,32236.5,8059.125,0.01,27401.03,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21147.14,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22565.55,Percent of Total Billed Charges, ,,85,,27401.03,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21920.82,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18052.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19341.9,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64999 - UNLISTED PROCEDURE NERVOUS SYSTEM,64999,HCPCS,,,LT,Outpatient,,,15871,3967.75,0.01,13490.35,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10411.38,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11109.7,Percent of Total Billed Charges, ,,85,,13490.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10792.28,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8887.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9522.6,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65093 - EVISCERATION OCULAR CONTENTS W-IMPLANT,65093,HCPCS,,,RT,Outpatient,,,17077,4269.25,1078.11,14515.45,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11202.51,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11953.9,Percent of Total Billed Charges, ,,85,,14515.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11612.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9563.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10246.2,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65093 - EVISCERATION OCULAR CONTENTS W-IMPLANT,65093,HCPCS,,,LT,Outpatient,,,15546,3886.5,1078.11,13214.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10198.18,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10882.2,Percent of Total Billed Charges, ,,85,,13214.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10571.28,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8705.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9327.6,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65103 - ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT,65103,HCPCS,,,RT,Outpatient,,,12831,3207.75,1078.11,10906.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8417.14,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8981.7,Percent of Total Billed Charges, ,,85,,10906.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8725.08,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7185.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7698.6,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65103 - ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT,65103,HCPCS,,,LT,Outpatient,,,12331,3082.75,1078.11,10481.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8089.14,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8631.7,Percent of Total Billed Charges, ,,85,,10481.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8385.08,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6905.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7398.6,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65105 - ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT,65105,HCPCS,,,LT,Outpatient,,,10387.75,2596.9375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6814.36,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7271.43,Percent of Total Billed Charges, ,,85,,8829.59,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7063.67,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5817.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6232.65,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65110 - EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY,65110,HCPCS,,,RT,Outpatient,,,11905.5,2976.375,1078.11,10119.68,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7810.01,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8333.85,Percent of Total Billed Charges, ,,85,,10119.68,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8095.74,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6667.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7143.3,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65135 - INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED,65135,HCPCS,,,LT,Outpatient,,,11456,2864,950.4,9737.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7515.14,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8019.2,Percent of Total Billed Charges, ,,85,,9737.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7790.08,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6415.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6873.6,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65220 - RMVL FB XTRNL EYE CORNEAL W-O SLIT LAMP,65220,HCPCS,,,LT,Outpatient,,,6224.33,1556.0825,379.38,5290.68,,,,,,,Service Paid at Rev Code level,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,589.32,,,589.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4083.16,Percent of Total Billed Charges, ,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4357.03,Percent of Total Billed Charges, ,,85,,5290.68,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4232.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3485.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3734.6,Percent of Total Billed Charges, ,583.3,,,583.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.28,,,593.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.66,,,392.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.45,,,396.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.38,,,379.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,390.76,,,390.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.4,,,397.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65265 - RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ,65265,HCPCS,,,RT,Outpatient,,,6790.5,1697.625,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4454.57,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4753.35,Percent of Total Billed Charges, ,,85,,5771.93,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4617.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3802.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4074.3,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65275 - RPR LAC CORNEA NONPERFOR W-WO RMVL FOREIGN BODY,65275,HCPCS,,,RT,Outpatient,,,13277,3319.25,950.4,11285.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8709.71,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9293.9,Percent of Total Billed Charges, ,,85,,11285.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9028.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7435.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7966.2,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65275 - RPR LAC CORNEA NONPERFOR W-WO RMVL FOREIGN BODY,65275,HCPCS,,,LT,Outpatient,,,14517,3629.25,950.4,12339.45,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9523.15,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10161.9,Percent of Total Billed Charges, ,,85,,12339.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9871.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8129.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8710.2,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65285 - RPR LAC CORNAND-SCLRA PERF W-REPOS-RESCJ UVEAL T,65285,HCPCS,,,RT,Outpatient,,,18082,4520.5,1078.11,15369.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7620.15,,,7620.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11861.79,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12657.4,Percent of Total Billed Charges, ,,85,,15369.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12295.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10125.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10849.2,Percent of Total Billed Charges, ,7542.27,,,7542.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5077.23,,,5077.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5126.29,,,5126.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4905.54,,,4905.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5052.71,,,5052.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5138.55,,,5138.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65285 - RPR LAC CORNAND-SCLRA PERF W-REPOS-RESCJ UVEAL T,65285,HCPCS,,,LT,Outpatient,,,13142,3285.5,1078.11,11170.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7620.15,,,7620.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8621.15,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9199.4,Percent of Total Billed Charges, ,,85,,11170.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8936.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7359.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7885.2,Percent of Total Billed Charges, ,7542.27,,,7542.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5077.23,,,5077.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5126.29,,,5126.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4905.54,,,4905.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5052.71,,,5052.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5138.55,,,5138.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65400 - EXCISION LESION CORNEA XCP PTERYGIUM,65400,HCPCS,,,RT,Outpatient,,,8033.72,2008.43,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5270.12,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5623.6,Percent of Total Billed Charges, ,,85,,6828.66,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5462.93,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4498.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4820.23,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65400 - EXCISION LESION CORNEA XCP PTERYGIUM,65400,HCPCS,,,LT,Outpatient,,,8425.72,2106.43,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5527.27,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5898,Percent of Total Billed Charges, ,,85,,7161.86,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5729.49,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4718.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5055.43,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65426 - EXCISION-TRANSPOSITION PTERYGIUM W-GRAFG,65426,HCPCS,,,RT,Outpatient,,,9620.06,2405.015,742.5,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6310.76,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6734.04,Percent of Total Billed Charges, ,,85,,8177.05,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6541.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5387.23,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5772.04,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65426 - EXCISION-TRANSPOSITION PTERYGIUM W-GRAFG,65426,HCPCS,,,LT,Outpatient,,,9142.43,2285.6075,742.5,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5997.43,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6399.7,Percent of Total Billed Charges, ,,85,,7771.07,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6216.85,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5119.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5485.46,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65435 - RMVL CORNEAL EPITHELIUM W-WO CHEMOCAUTERIZATION,65435,HCPCS,,,LT,Outpatient,,,8581,2145.25,882.09,7293.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5835.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65730 - KERATOPLASTY PENTRG EXCEPT APHAKIA-PSEUDOPHAKIA,65730,HCPCS,,,RT,Outpatient,,,15307.63,3826.9075,1078.11,13011.49,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10041.81,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10715.34,Percent of Total Billed Charges, ,,85,,13011.49,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10409.19,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8572.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9184.58,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65730 - KERATOPLASTY PENTRG EXCEPT APHAKIA-PSEUDOPHAKIA,65730,HCPCS,,,LT,Outpatient,,,15831,3957.75,1078.11,13456.35,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10385.14,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11081.7,Percent of Total Billed Charges, ,,85,,13456.35,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10765.08,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8865.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9498.6,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65755 - KERATOPLASTY PENETRATING PSEUDOPHAKIA,65755,HCPCS,,,RT,Outpatient,,,20768.5,5192.125,1078.11,17653.23,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13624.14,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14537.95,Percent of Total Billed Charges, ,,85,,17653.23,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14122.58,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11630.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12461.1,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65755 - KERATOPLASTY PENETRATING PSEUDOPHAKIA,65755,HCPCS,,,LT,Outpatient,,,15539.33,3884.8325,1078.11,13208.43,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10193.8,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10877.53,Percent of Total Billed Charges, ,,85,,13208.43,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10566.74,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8702.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9323.6,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65756 - KERATOPLASTY ENDOTHELIAL,65756,HCPCS,,,RT,Outpatient,,,10242.36,2560.59,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6718.99,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7169.65,Percent of Total Billed Charges, ,,85,,8706.01,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6964.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5735.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6145.42,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65756 - KERATOPLASTY ENDOTHELIAL,65756,HCPCS,,,LT,Outpatient,,,10320.18,2580.045,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6770.04,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7224.13,Percent of Total Billed Charges, ,,85,,8772.15,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7017.72,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5779.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6192.11,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65756 - KERATOPLASTY ENDOTHELIAL,65756,HCPCS,,,LR,Outpatient,,,8706,2176.5,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5711.14,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6094.2,Percent of Total Billed Charges, ,,85,,7400.1,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5920.08,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4875.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5223.6,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65756 - KERATOPLASTY ENDOTHELIAL,65756,HCPCS,,,74,Outpatient,,,8581,2145.25,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65800 - PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX,65800,HCPCS,,,LT,Outpatient,,,8581,2145.25,674,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65815 - PARACEN ANT CHAM RMVL BLOOD W-WO IRRIGAND-AIR IN,65815,HCPCS,,,LT,Outpatient,,,13331,3332.75,742.5,11331.35,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8745.14,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9331.7,Percent of Total Billed Charges, ,,85,,11331.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9065.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7465.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7998.6,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65820 - GONIOTOMY,65820,HCPCS,,,RT,Outpatient,,,5236.1,1309.025,1078.11,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3434.88,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3665.27,Percent of Total Billed Charges, ,,85,,4450.69,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3560.55,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2932.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3141.66,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65820 - GONIOTOMY,65820,HCPCS,,,LT,Outpatient,,,5130.58,1282.645,1078.11,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3365.66,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3591.41,Percent of Total Billed Charges, ,,85,,4360.99,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3488.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2873.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3078.35,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65850 - TRABECULOTOMY AB EXTERNO,65850,HCPCS,,,LT,Outpatient,,,4696.75,1174.1875,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3081.07,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3287.73,Percent of Total Billed Charges, ,,85,,3992.24,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3193.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2630.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2818.05,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65875 - SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE,65875,HCPCS,,,LT,Outpatient,,,6086.5,1521.625,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3992.74,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4260.55,Percent of Total Billed Charges, ,,85,,5173.53,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4138.82,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3408.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3651.9,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65920 - RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE,65920,HCPCS,,,XP,Outpatient,,,4860.34,1215.085,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3188.38,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3402.24,Percent of Total Billed Charges, ,,85,,4131.29,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3305.03,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2721.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2916.2,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65920 - RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE,65920,HCPCS,,,RT,Outpatient,,,8294,2073.5,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5440.86,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5805.8,Percent of Total Billed Charges, ,,85,,7049.9,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5639.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4644.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4976.4,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65920 - RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE,65920,HCPCS,,,LT,Outpatient,,,5148.25,1287.0625,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3377.25,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3603.78,Percent of Total Billed Charges, ,,85,,4376.01,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3500.81,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2883.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3088.95,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66020 - INJX ANTERIOR CHAMBER EYE AIR-LIQUID SPX,66020,HCPCS,,,RT,Outpatient,,,9581,2395.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6285.14,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6706.7,Percent of Total Billed Charges, ,,85,,8143.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6515.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5365.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5748.6,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66170 - FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO,66170,HCPCS,,,RT,Outpatient,,,10472.83,2618.2075,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6870.18,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7330.98,Percent of Total Billed Charges, ,,85,,8901.91,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7121.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5864.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6283.7,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66170 - FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO,66170,HCPCS,,,LT,Outpatient,,,8736.12,2184.03,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5730.89,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6115.28,Percent of Total Billed Charges, ,,85,,7425.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5940.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4892.23,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5241.67,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66172 - FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING,66172,HCPCS,,,RT,Outpatient,,,6290.5,1572.625,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4126.57,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4403.35,Percent of Total Billed Charges, ,,85,,5346.93,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4277.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3522.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3774.3,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66174 - TRLUML DILAT AQUEOUS O-F CAN WO RETENTION DEV-ST,66174,HCPCS,,,RT,Outpatient,,,6231.08,1557.77,1078.11,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4087.59,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4361.76,Percent of Total Billed Charges, ,,85,,5296.42,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4237.13,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3489.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3738.65,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66180 - AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W-GRAFT,66180,HCPCS,,,RT,Outpatient,,,9798.5,2449.625,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7620.15,,,7620.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6427.82,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6858.95,Percent of Total Billed Charges, ,,85,,8328.73,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6662.98,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5487.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5879.1,Percent of Total Billed Charges, ,7542.27,,,7542.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5077.23,,,5077.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5126.29,,,5126.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4905.54,,,4905.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5052.71,,,5052.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5138.55,,,5138.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66180 - AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W-GRAFT,66180,HCPCS,,,LT,Outpatient,,,9964.58,2491.145,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7620.15,,,7620.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6536.76,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6975.21,Percent of Total Billed Charges, ,,85,,8469.89,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6775.91,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5580.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5978.75,Percent of Total Billed Charges, ,7542.27,,,7542.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5077.23,,,5077.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5126.29,,,5126.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4905.54,,,4905.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5052.71,,,5052.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5138.55,,,5138.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66183 - INSERT ANTER DRAINAGE DEV W-O EXTRAOC RESERVOIR,66183,HCPCS,,,RT,Outpatient,,,7685.75,1921.4375,1078.11,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5041.85,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5380.03,Percent of Total Billed Charges, ,,85,,6532.89,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5226.31,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4304.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4611.45,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66183 - INSERT ANTER DRAINAGE DEV W-O EXTRAOC RESERVOIR,66183,HCPCS,,,LT,Outpatient,,,6876.14,1719.035,1078.11,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4510.75,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4813.3,Percent of Total Billed Charges, ,,85,,5844.72,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4675.78,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3850.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4125.68,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66184 - REVJ SHUNT EXTRAOCULAR RESERVOIR W-O GRAFT,66184,HCPCS,,,LT,Outpatient,,,5415.5,1353.875,1078.11,9153,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3552.57,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3790.85,Percent of Total Billed Charges, ,,85,,4603.18,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3682.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3032.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3249.3,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66185 - REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W-GRAFT,66185,HCPCS,,,LT,Outpatient,,,15339,3834.75,1078.11,13038.15,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10062.38,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10737.3,Percent of Total Billed Charges, ,,85,,13038.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10430.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8589.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9203.4,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66250 - REVJ-RPR OPRATIVE WOUND ANTERIOR SEGMENT,66250,HCPCS,,,RT,Outpatient,,,9646.64,2411.66,1078.11,8199.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6328.2,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6752.65,Percent of Total Billed Charges, ,,85,,8199.64,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6559.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5402.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5787.98,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66250 - REVJ-RPR OPRATIVE WOUND ANTERIOR SEGMENT,66250,HCPCS,,,LT,Outpatient,,,12206.33,3051.5825,1078.11,10375.38,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8007.35,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8544.43,Percent of Total Billed Charges, ,,85,,10375.38,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8300.3,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6835.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7323.8,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66680 - REPAIR IRIS CILIARY BODY,66680,HCPCS,,,XU,Outpatient,,,7290.5,1822.625,1078.11,6196.93,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4782.57,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5103.35,Percent of Total Billed Charges, ,,85,,6196.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4957.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4082.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4374.3,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66682 - SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE,66682,HCPCS,,,LT,Outpatient,,,6353,1588.25,1078.11,5400.05,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4167.57,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4447.1,Percent of Total Billed Charges, ,,85,,5400.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4320.04,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3557.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3811.8,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL,66710,HCPCS,,,RT,Outpatient,,,7201.5,1800.375,742.5,6121.28,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4724.18,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5041.05,Percent of Total Billed Charges, ,,85,,6121.28,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4897.02,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4032.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4320.9,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL,66710,HCPCS,,,LT,Outpatient,,,7212,1803,742.5,6130.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4731.07,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5048.4,Percent of Total Billed Charges, ,,85,,6130.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4904.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4038.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4327.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66710 - CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL,66710,HCPCS,,,50,Outpatient,,,7688,1922,742.5,6534.8,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5043.33,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5381.6,Percent of Total Billed Charges, ,,85,,6534.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5227.84,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4305.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4612.8,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66821 - POST-CATARACT LASER SURGERY,66821,HCPCS,,,RT,Outpatient,,,6853,1713.25,521.58,5825.05,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4495.57,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4797.1,Percent of Total Billed Charges, ,,85,,5825.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4660.04,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3837.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4111.8,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66821 - POST-CATARACT LASER SURGERY,66821,HCPCS,,,LT,Outpatient,,,8363.5,2090.875,521.58,7108.98,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5486.46,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5854.45,Percent of Total Billed Charges, ,,85,,7108.98,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5687.18,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4683.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5018.1,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66825 - REPOSITIONING IO LENS PROSTHESIS REQ INC SPX,66825,HCPCS,,,XU,Outpatient,,,5838.25,1459.5625,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3829.89,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4086.78,Percent of Total Billed Charges, ,,85,,4962.51,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3970.01,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3269.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3502.95,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66825 - REPOSITIONING IO LENS PROSTHESIS REQ INC SPX,66825,HCPCS,,,RT,Outpatient,,,9816.13,2454.0325,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6439.38,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6871.29,Percent of Total Billed Charges, ,,85,,8343.71,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6674.97,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5497.03,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5889.68,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66825 - REPOSITIONING IO LENS PROSTHESIS REQ INC SPX,66825,HCPCS,,,LT,Outpatient,,,8001.5,2000.375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5248.98,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5601.05,Percent of Total Billed Charges, ,,85,,6801.28,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5441.02,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4480.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4800.9,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66830 - RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ,66830,HCPCS,,,XU,Outpatient,,,7603,1900.75,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4987.57,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5322.1,Percent of Total Billed Charges, ,,85,,6462.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5170.04,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4257.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4561.8,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66830 - RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ,66830,HCPCS,,,RT,Outpatient,,,11345,2836.25,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7442.32,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7941.5,Percent of Total Billed Charges, ,,85,,9643.25,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7714.6,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6353.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6807,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66850 - RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR,66850,HCPCS,,,XU,Outpatient,,,8739.09,2184.7725,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5732.84,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6117.36,Percent of Total Billed Charges, ,,85,,7428.23,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5942.58,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4893.89,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5243.45,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66850 - RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR,66850,HCPCS,,,RT,Outpatient,,,8222,2055.5,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5393.63,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5755.4,Percent of Total Billed Charges, ,,85,,6988.7,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5590.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4604.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4933.2,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66850 - RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR,66850,HCPCS,,,LT,Outpatient,,,7717.92,1929.48,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5062.96,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5402.54,Percent of Total Billed Charges, ,,85,,6560.23,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5248.19,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4322.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4630.75,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66852 - RMVL LENS MATERIAL PARS PLANA W-WO VITRECTOMY,66852,HCPCS,,,RT,Outpatient,,,12259.38,3064.845,1078.11,10420.47,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8042.15,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8581.57,Percent of Total Billed Charges, ,,85,,10420.47,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8336.38,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6865.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7355.63,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66852 - RMVL LENS MATERIAL PARS PLANA W-WO VITRECTOMY,66852,HCPCS,,,LT,Outpatient,,,11733.5,2933.375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7697.18,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8213.45,Percent of Total Billed Charges, ,,85,,9973.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7978.78,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6570.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7040.1,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66920 - RMVL LENS MATERIAL INTRACAPSULAR,66920,HCPCS,,,XU,Outpatient,,,16505.5,4126.375,1078.11,14029.68,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10827.61,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11553.85,Percent of Total Billed Charges, ,,85,,14029.68,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11223.74,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9243.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9903.3,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66982 - XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP,66982,HCPCS,,,RT,Outpatient,,,8777.75,2194.4375,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5758.2,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6144.43,Percent of Total Billed Charges, ,,85,,7461.09,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5968.87,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4915.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5266.65,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66982 - XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP,66982,HCPCS,,,LT,Outpatient,,,8905.57,2226.3925,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5842.05,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6233.9,Percent of Total Billed Charges, ,,85,,7569.73,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6055.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4987.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5343.34,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66982 - XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP,66982,HCPCS,,,CG,Outpatient,,,9104.5,2276.125,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5972.55,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6373.15,Percent of Total Billed Charges, ,,85,,7738.83,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6191.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5098.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5462.7,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66984 - XCAPSL CTRC RMVL INSJ IO LENS PROSTH W-O ECP,66984,HCPCS,,,XU,Outpatient,,,8007.81,2001.9525,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5253.12,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5605.47,Percent of Total Billed Charges, ,,85,,6806.64,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5445.31,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4484.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4804.69,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66984 - XCAPSL CTRC RMVL INSJ IO LENS PROSTH W-O ECP,66984,HCPCS,,,RT,Outpatient,,,8665.86,2166.465,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5684.8,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6066.1,Percent of Total Billed Charges, ,,85,,7365.98,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5892.78,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4852.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5199.52,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66984 - XCAPSL CTRC RMVL INSJ IO LENS PROSTH W-O ECP,66984,HCPCS,,,LT,Outpatient,,,8665.27,2166.3175,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5684.42,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6065.69,Percent of Total Billed Charges, ,,85,,7365.48,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5892.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4852.55,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5199.16,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66984 - XCAPSL CTRC RMVL INSJ IO LENS PROSTH W-O ECP,66984,HCPCS,,,50,Outpatient,,,9018.5,2254.625,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5916.14,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6312.95,Percent of Total Billed Charges, ,,85,,7665.73,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6132.58,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5050.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5411.1,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66985 - INSJ IO LENS PROSTHESIS NOT W-CONCURRENT RMVL,66985,HCPCS,,,RT,Outpatient,,,7532.58,1883.145,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4941.37,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5272.81,Percent of Total Billed Charges, ,,85,,6402.69,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5122.15,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4218.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4519.55,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66985 - INSJ IO LENS PROSTHESIS NOT W-CONCURRENT RMVL,66985,HCPCS,,,LT,Outpatient,,,7543.17,1885.7925,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4948.32,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5280.22,Percent of Total Billed Charges, ,,85,,6411.69,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5129.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4224.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4525.9,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66986 - EXCHANGE INTRAOCULAR LENS,66986,HCPCS,,,RT,Outpatient,,,8452.41,2113.1025,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5544.78,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5916.69,Percent of Total Billed Charges, ,,85,,7184.55,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5747.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4733.35,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5071.45,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66986 - EXCHANGE INTRAOCULAR LENS,66986,HCPCS,,,LT,Outpatient,,,8016.25,2004.0625,1078.11,13976,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5258.66,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5611.38,Percent of Total Billed Charges, ,,85,,6813.81,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5451.05,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4489.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4809.75,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66991 - XCAPSL CTRC RMVL INSJ IO LENS PROSTH INSJ 1+,66991,HCPCS,,,RT,Outpatient,,,8581,2145.25,1078.11,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7626.99,,,7626.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7620.15,,,7620.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,7626.99,,,7626.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5835.08,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,7542.27,,,7542.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7387.9,,,7387.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5077.23,,,5077.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5126.29,,,5126.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4905.54,,,4905.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5052.71,,,5052.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5138.55,,,5138.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66991 - XCAPSL CTRC RMVL INSJ IO LENS PROSTH INSJ 1+,66991,HCPCS,,,LT,Outpatient,,,8211.5,2052.875,1078.11,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7626.99,,,7626.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7620.15,,,7620.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5386.74,Percent of Total Billed Charges, ,7626.99,,,7626.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5748.05,Percent of Total Billed Charges, ,,85,,6979.78,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5583.82,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4598.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4926.9,Percent of Total Billed Charges, ,7542.27,,,7542.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7387.9,,,7387.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5077.23,,,5077.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5126.29,,,5126.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4905.54,,,4905.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5052.71,,,5052.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5138.55,,,5138.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
66999 - UNLISTED PROCEDURE ANTERIOR SEGMENT EYE,66999,HCPCS,,,RT,Outpatient,,,6084,1521,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3991.1,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4258.8,Percent of Total Billed Charges, ,,85,,5171.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4137.12,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3407.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3650.4,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67005 - RMVL VITREOUS ANT APPR PARTIAL REMOVAL,67005,HCPCS,,,LT,Outpatient,,,4665.5,1166.375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3060.57,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3265.85,Percent of Total Billed Charges, ,,85,,3965.68,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3172.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2612.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2799.3,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67010 - RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT,67010,HCPCS,,,RT,Outpatient,,,10357.5,2589.375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6794.52,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7250.25,Percent of Total Billed Charges, ,,85,,8803.88,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7043.1,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5800.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6214.5,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67010 - RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT,67010,HCPCS,,,LT,Outpatient,,,12707,3176.75,1078.11,10800.95,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8335.79,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8894.9,Percent of Total Billed Charges, ,,85,,10800.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8640.76,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7115.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7624.2,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67015 - ASPIRATION-RELEASE VITREOUS SUBRETINAL-CHOROIDAL,67015,HCPCS,,,RT,Outpatient,,,17167.8,4291.95,882.09,14592.63,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11262.08,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12017.46,Percent of Total Billed Charges, ,,85,,14592.63,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11674.1,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9613.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10300.68,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67015 - ASPIRATION-RELEASE VITREOUS SUBRETINAL-CHOROIDAL,67015,HCPCS,,,LT,Outpatient,,,6069.5,1517.375,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3981.59,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4248.65,Percent of Total Billed Charges, ,,85,,5159.08,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4127.26,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3398.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3641.7,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX,67028,HCPCS,,,XU,Outpatient,,,6738.4,1684.6,315.35,5727.64,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.57,,,539.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,489.86,,,489.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4420.39,Percent of Total Billed Charges, ,539.57,,,539.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4716.88,Percent of Total Billed Charges, ,,85,,5727.64,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4582.11,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3773.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4043.04,Percent of Total Billed Charges, ,484.85,,,484.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,522.66,,,522.66,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,326.39,,,326.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,329.54,,,329.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,318.5,,,318.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,315.35,,,315.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,318.5,,,318.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,324.81,,,324.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,330.33,,,330.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67028 - INTRAVITREAL NJX PHARMACOLOGIC AGT SPX,67028,HCPCS,,,RT,Outpatient,,,5910,1477.5,315.35,5023.5,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.57,,,539.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,489.86,,,489.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3876.96,Percent of Total Billed Charges, ,539.57,,,539.57,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4137,Percent of Total Billed Charges, ,,85,,5023.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4018.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3309.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3546,Percent of Total Billed Charges, ,484.85,,,484.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,522.66,,,522.66,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,326.39,,,326.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,329.54,,,329.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,318.5,,,318.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,315.35,,,315.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,318.5,,,318.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,324.81,,,324.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,330.33,,,330.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67036 - VITRECTOMY MECHANICAL PARS PLANA,67036,HCPCS,,,XU,Outpatient,,,9191.5,2297.875,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6029.62,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6434.05,Percent of Total Billed Charges, ,,85,,7812.78,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6250.22,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5147.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5514.9,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67036 - VITRECTOMY MECHANICAL PARS PLANA,67036,HCPCS,,,RT,Outpatient,,,9407.62,2351.905,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6171.4,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6585.33,Percent of Total Billed Charges, ,,85,,7996.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6397.18,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5268.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5644.57,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67036 - VITRECTOMY MECHANICAL PARS PLANA,67036,HCPCS,,,LT,Outpatient,,,10894.82,2723.705,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7147,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7626.37,Percent of Total Billed Charges, ,,85,,9260.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7408.48,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6101.1,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6536.89,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67039 - VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC,67039,HCPCS,,,XU,Outpatient,,,5672.5,1418.125,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3721.16,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3970.75,Percent of Total Billed Charges, ,,85,,4821.63,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3857.3,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3176.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3403.5,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67039 - VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC,67039,HCPCS,,,XS,Outpatient,,,9352.5,2338.125,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6135.24,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6546.75,Percent of Total Billed Charges, ,,85,,7949.63,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6359.7,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5237.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5611.5,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67039 - VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC,67039,HCPCS,,,RT,Outpatient,,,10503.9,2625.975,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6890.56,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7352.73,Percent of Total Billed Charges, ,,85,,8928.32,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7142.65,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5882.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6302.34,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67039 - VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC,67039,HCPCS,,,LT,Outpatient,,,9825.88,2456.47,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6445.78,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6878.12,Percent of Total Billed Charges, ,,85,,8352,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6681.6,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5502.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5895.53,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67040 - VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC,67040,HCPCS,,,XU,Outpatient,,,6114.1,1528.525,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4010.85,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4279.87,Percent of Total Billed Charges, ,,85,,5196.99,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4157.59,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3423.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3668.46,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67040 - VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC,67040,HCPCS,,,XS,Outpatient,,,7363,1840.75,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4830.13,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5154.1,Percent of Total Billed Charges, ,,85,,6258.55,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5006.84,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4123.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4417.8,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67040 - VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC,67040,HCPCS,,,RT,Outpatient,,,10981.72,2745.43,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7204.01,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7687.2,Percent of Total Billed Charges, ,,85,,9334.46,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7467.57,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6149.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6589.03,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67040 - VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC,67040,HCPCS,,,LT,Outpatient,,,11093.02,2773.255,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7277.02,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7765.11,Percent of Total Billed Charges, ,,85,,9429.07,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7543.25,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6212.09,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6655.81,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67040 - VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC,67040,HCPCS,,,50,Outpatient,,,12407.5,3101.875,950.4,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8139.32,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8685.25,Percent of Total Billed Charges, ,,85,,10546.38,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8437.1,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6948.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7444.5,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67041 - VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE,67041,HCPCS,,,RT,Outpatient,,,11236.2,2809.05,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7370.95,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7865.34,Percent of Total Billed Charges, ,,85,,9550.77,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7640.62,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6292.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6741.72,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67041 - VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE,67041,HCPCS,,,LT,Outpatient,,,11656.06,2914.015,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7646.38,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8159.24,Percent of Total Billed Charges, ,,85,,9907.65,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7926.12,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6527.39,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6993.64,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67042 - VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA,67042,HCPCS,,,RT,Outpatient,,,11803.89,2950.9725,882.09,10033.31,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7743.35,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8262.72,Percent of Total Billed Charges, ,,85,,10033.31,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8026.65,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6610.18,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7082.33,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67042 - VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA,67042,HCPCS,,,LT,Outpatient,,,12151.09,3037.7725,882.09,10328.43,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7971.12,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8505.76,Percent of Total Billed Charges, ,,85,,10328.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8262.74,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6804.61,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7290.65,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67101 - RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX,67101,HCPCS,,,LT,Outpatient,,,24831,6207.75,950.4,21106.35,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16289.14,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17381.7,Percent of Total Billed Charges, ,,85,,21106.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,16885.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,13905.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,14898.6,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67105 - RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC,67105,HCPCS,,,XU,Outpatient,,,6983.5,1745.875,521.58,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4581.18,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4888.45,Percent of Total Billed Charges, ,,85,,5935.98,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4748.78,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3910.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4190.1,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67105 - RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC,67105,HCPCS,,,RT,Outpatient,,,10021.25,2505.3125,521.58,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6573.94,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7014.88,Percent of Total Billed Charges, ,,85,,8518.06,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6814.45,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5611.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6012.75,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67105 - RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC,67105,HCPCS,,,LT,Outpatient,,,12006,3001.5,521.58,10205.1,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7875.94,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8404.2,Percent of Total Billed Charges, ,,85,,10205.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8164.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6723.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7203.6,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67107 - REPAIR RETINAL DETACHMENT SCLERAL BUCKLING,67107,HCPCS,,,RT,Outpatient,,,20648.55,5162.1375,1078.11,17551.27,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13545.45,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14453.99,Percent of Total Billed Charges, ,,85,,17551.27,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14041.01,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11563.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12389.13,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67107 - REPAIR RETINAL DETACHMENT SCLERAL BUCKLING,67107,HCPCS,,,LT,Outpatient,,,18511.3,4627.825,1078.11,15734.61,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12143.41,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12957.91,Percent of Total Billed Charges, ,,85,,15734.61,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12587.68,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10366.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11106.78,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67108 - RPR RETINAL DTCHMNT W-VITRECTOMY ANY METH,67108,HCPCS,,,RT,Outpatient,,,14928.55,3732.1375,1078.11,12689.27,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9793.13,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10449.99,Percent of Total Billed Charges, ,,85,,12689.27,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10151.41,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8359.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8957.13,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67108 - RPR RETINAL DTCHMNT W-VITRECTOMY ANY METH,67108,HCPCS,,,LT,Outpatient,,,15411.26,3852.815,1078.11,13099.57,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10109.79,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10787.88,Percent of Total Billed Charges, ,,85,,13099.57,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10479.66,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8630.31,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9246.76,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67108 - RPR RETINAL DTCHMNT W-VITRECTOMY ANY METH,67108,HCPCS,,,74,Outpatient,,,8581,2145.25,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67108 - RPR RETINAL DTCHMNT W-VITRECTOMY ANY METH,67108,HCPCS,,,50,Outpatient,,,11897,2974.25,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7804.43,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8327.9,Percent of Total Billed Charges, ,,85,,10112.45,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8089.96,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6662.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7138.2,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67113 - RPR COMPLEX RETINA DETACH VITRECT ANDMEMBRANE PEEL,67113,HCPCS,,,RT,Outpatient,,,15441.03,3860.2575,950.4,13124.88,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7620.15,,,7620.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10129.32,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10808.72,Percent of Total Billed Charges, ,,85,,13124.88,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10499.9,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8646.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9264.62,Percent of Total Billed Charges, ,7542.27,,,7542.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5077.23,,,5077.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5126.29,,,5126.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4905.54,,,4905.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5052.71,,,5052.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5138.55,,,5138.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67113 - RPR COMPLEX RETINA DETACH VITRECT ANDMEMBRANE PEEL,67113,HCPCS,,,LT,Outpatient,,,15653.73,3913.4325,950.4,13305.67,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7620.15,,,7620.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10268.85,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10957.61,Percent of Total Billed Charges, ,,85,,13305.67,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10644.54,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8766.09,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9392.24,Percent of Total Billed Charges, ,7542.27,,,7542.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5077.23,,,5077.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5126.29,,,5126.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4905.54,,,4905.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5052.71,,,5052.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5138.55,,,5138.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67113 - RPR COMPLEX RETINA DETACH VITRECT ANDMEMBRANE PEEL,67113,HCPCS,,,50,Outpatient,,,18314,4578.5,950.4,15566.9,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7620.15,,,7620.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12013.98,Percent of Total Billed Charges, ,6481.51,,,6481.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12819.8,Percent of Total Billed Charges, ,,85,,15566.9,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12453.52,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10255.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10988.4,Percent of Total Billed Charges, ,7542.27,,,7542.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6278.32,,,6278.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5077.23,,,5077.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5126.29,,,5126.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4905.54,,,4905.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4954.6,,,4954.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5052.71,,,5052.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5138.55,,,5138.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67120 - RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR,67120,HCPCS,,,LT,Outpatient,,,13088.38,3272.095,1078.11,11125.12,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8585.98,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9161.87,Percent of Total Billed Charges, ,,85,,11125.12,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8900.1,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7329.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7853.03,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67121 - RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR,67121,HCPCS,,,XU,Outpatient,,,6742,1685.5,742.5,5730.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4422.75,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4719.4,Percent of Total Billed Charges, ,,85,,5730.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4584.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3775.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4045.2,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67121 - RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR,67121,HCPCS,,,RT,Outpatient,,,11332.88,2833.22,742.5,9632.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7434.37,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7933.02,Percent of Total Billed Charges, ,,85,,9632.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7706.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6346.41,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6799.73,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67121 - RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR,67121,HCPCS,,,LT,Outpatient,,,8066.17,2016.5425,742.5,6856.24,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3368.3,,,3368.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5291.41,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5646.32,Percent of Total Billed Charges, ,,85,,6856.24,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5485,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4517.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4839.7,Percent of Total Billed Charges, ,3333.88,,,3333.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2244.27,,,2244.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2265.96,,,2265.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2168.38,,,2168.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2190.06,,,2190.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2233.43,,,2233.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2271.38,,,2271.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67145 - PROPH RETINAL DTCHMNT W-O DRG PHOTOCOAGULATION,67145,HCPCS,,,XU,Outpatient,,,10682.5,2670.625,521.58,9080.13,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7007.72,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7477.75,Percent of Total Billed Charges, ,,85,,9080.13,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7264.1,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5982.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6409.5,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67145 - PROPH RETINAL DTCHMNT W-O DRG PHOTOCOAGULATION,67145,HCPCS,,,RT,Outpatient,,,9389,2347.25,521.58,7980.65,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6159.18,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6572.3,Percent of Total Billed Charges, ,,85,,7980.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6384.52,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5257.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5633.4,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67145 - PROPH RETINAL DTCHMNT W-O DRG PHOTOCOAGULATION,67145,HCPCS,,,LT,Outpatient,,,6441.21,1610.3025,521.58,5475.03,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4225.43,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4508.85,Percent of Total Billed Charges, ,,85,,5475.03,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4380.02,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3607.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3864.73,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67210 - DSTRJ LOCLZD LESION RETINA 1-GREATER THAN SESS PC,67210,HCPCS,,,RT,Outpatient,,,7212,1803,521.58,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4731.07,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5048.4,Percent of Total Billed Charges, ,,85,,6130.2,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4904.16,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4038.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4327.2,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67210 - DSTRJ LOCLZD LESION RETINA 1-GREATER THAN SESS PC,67210,HCPCS,,,50,Outpatient,,,7722,1930.5,521.58,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5065.63,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5405.4,Percent of Total Billed Charges, ,,85,,6563.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5250.96,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4324.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4633.2,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67228 - TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION,67228,HCPCS,,,XU,Outpatient,,,9147.14,2286.785,521.58,7775.07,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6000.52,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6403,Percent of Total Billed Charges, ,,85,,7775.07,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6220.06,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5122.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5488.28,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67228 - TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION,67228,HCPCS,,,XS,Outpatient,,,8943.1,2235.775,521.58,7601.64,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5866.67,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6260.17,Percent of Total Billed Charges, ,,85,,7601.64,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6081.31,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5008.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5365.86,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67228 - TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION,67228,HCPCS,,,RT,Outpatient,,,8365.18,2091.295,521.58,7110.4,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5487.56,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5855.63,Percent of Total Billed Charges, ,,85,,7110.4,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5688.32,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4684.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5019.11,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67228 - TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION,67228,HCPCS,,,LT,Outpatient,,,7901.69,1975.4225,521.58,6716.44,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5183.51,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5531.18,Percent of Total Billed Charges, ,,85,,6716.44,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5373.15,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4424.95,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4741.01,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67228 - TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION,67228,HCPCS,,,50,Outpatient,,,8852.32,2213.08,521.58,7524.47,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,810.2,,,810.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5807.12,Percent of Total Billed Charges, ,861,,,861,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6196.62,Percent of Total Billed Charges, ,,85,,7524.47,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6019.58,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4957.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5311.39,Percent of Total Billed Charges, ,801.93,,,801.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,834.01,,,834.01,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.84,,,539.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,545.05,,,545.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.58,,,521.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.8,,,526.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,537.23,,,537.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.36,,,546.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67255 - SCLERAL REINFORCEMENT SPX W-GRAFT,67255,HCPCS,,,LT,Outpatient,,,10513.5,2628.375,1078.11,8936.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5941.18,,,5941.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6896.86,Percent of Total Billed Charges, ,3502.99,,,3502.99,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7359.45,Percent of Total Billed Charges, ,,85,,8936.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7149.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5887.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6308.1,Percent of Total Billed Charges, ,5880.46,,,5880.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3393.18,,,3393.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3958.55,,,3958.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3996.8,,,3996.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3824.69,,,3824.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3862.94,,,3862.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3939.43,,,3939.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4006.36,,,4006.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67311 - STRABISMUS RECESSION-RESCJ 1 HRZNTL MUSC,67311,HCPCS,,,XS,Outpatient,,,6790.5,1697.625,1078.11,5771.93,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4454.57,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4753.35,Percent of Total Billed Charges, ,,85,,5771.93,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4617.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3802.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4074.3,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67311 - STRABISMUS RECESSION-RESCJ 1 HRZNTL MUSC,67311,HCPCS,,,RT,Outpatient,,,8674.69,2168.6725,1078.11,7373.49,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5690.6,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6072.28,Percent of Total Billed Charges, ,,85,,7373.49,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5898.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4857.83,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5204.81,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67311 - STRABISMUS RECESSION-RESCJ 1 HRZNTL MUSC,67311,HCPCS,,,LT,Outpatient,,,8787.98,2196.995,1078.11,7469.78,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5764.91,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6151.59,Percent of Total Billed Charges, ,,85,,7469.78,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5975.83,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4921.27,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5272.79,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67311 - STRABISMUS RECESSION-RESCJ 1 HRZNTL MUSC,67311,HCPCS,,,50,Outpatient,,,11443.7,2860.925,1078.11,9727.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7507.07,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8010.59,Percent of Total Billed Charges, ,,85,,9727.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7781.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6408.47,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6866.22,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67312 - STRABISMUS RECESSION-RESCJ 2 HRZNTL MUSC,67312,HCPCS,,,RT,Outpatient,,,11973.64,2993.41,1078.11,10177.59,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7854.71,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8381.55,Percent of Total Billed Charges, ,,85,,10177.59,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8142.08,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6705.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7184.18,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67312 - STRABISMUS RECESSION-RESCJ 2 HRZNTL MUSC,67312,HCPCS,,,LT,Outpatient,,,11273.98,2818.495,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7395.73,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7891.79,Percent of Total Billed Charges, ,,85,,9582.88,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7666.31,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6313.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6764.39,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67312 - STRABISMUS RECESSION-RESCJ 2 HRZNTL MUSC,67312,HCPCS,,,50,Outpatient,,,12727.13,3181.7825,1078.11,10818.06,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8349,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8908.99,Percent of Total Billed Charges, ,,85,,10818.06,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8654.45,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7127.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7636.28,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67314 - STRABISMUS RECESSION-RESCJ 1 VER MUSC,67314,HCPCS,,,RT,Outpatient,,,7660.56,1915.14,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5025.33,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5362.39,Percent of Total Billed Charges, ,,85,,6511.48,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5209.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4289.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4596.34,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67314 - STRABISMUS RECESSION-RESCJ 1 VER MUSC,67314,HCPCS,,,LT,Outpatient,,,7817.41,1954.3525,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5128.22,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5472.19,Percent of Total Billed Charges, ,,85,,6644.8,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5315.84,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4377.75,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4690.45,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67314 - STRABISMUS RECESSION-RESCJ 1 VER MUSC,67314,HCPCS,,,50,Outpatient,,,8389.97,2097.4925,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5503.82,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5872.98,Percent of Total Billed Charges, ,,85,,7131.47,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5705.18,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4698.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5033.98,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67320 - TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC,67320,HCPCS,,,RT,Outpatient,,,4068.66,1017.165,0.01,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2669.04,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2848.06,Percent of Total Billed Charges, ,,85,,3458.36,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2766.69,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2278.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2441.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67320 - TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC,67320,HCPCS,,,LT,Outpatient,,,7728,1932,0.01,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5069.57,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5409.6,Percent of Total Billed Charges, ,,85,,6568.8,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5255.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4327.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4636.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67332 - STRABISMUS SCARRING EO MUSC-RSTCV MYOPATHY,67332,HCPCS,,,RT,Outpatient,,,5228,1307,0.01,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3429.57,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3659.6,Percent of Total Billed Charges, ,,85,,4443.8,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3555.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2927.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3136.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67345 - CHEMODENERVATION EXTRAOCULAR MUSCLE,67345,HCPCS,,,RT,Outpatient,,,5540.5,1385.125,284.2,4709.43,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3634.57,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3878.35,Percent of Total Billed Charges, ,,85,,4709.43,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3767.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3102.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3324.3,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67400 - ORBITOTOMY W-O BONE FLAP EXPL W-WO BIOPSY,67400,HCPCS,,,RT,Outpatient,,,7435.75,1858.9375,1078.11,6320.39,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4877.85,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5205.03,Percent of Total Billed Charges, ,,85,,6320.39,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5056.31,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4164.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4461.45,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67400 - ORBITOTOMY W-O BONE FLAP EXPL W-WO BIOPSY,67400,HCPCS,,,LT,Outpatient,,,17636.5,4409.125,1078.11,14991.03,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11569.54,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12345.55,Percent of Total Billed Charges, ,,85,,14991.03,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11992.82,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9876.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10581.9,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67400 - ORBITOTOMY W-O BONE FLAP EXPL W-WO BIOPSY,67400,HCPCS,,,50,Outpatient,,,11831,2957.75,1078.11,10056.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7761.14,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8281.7,Percent of Total Billed Charges, ,,85,,10056.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8045.08,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6625.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7098.6,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67405 - ORBITOTOMY W-O BONE FLAP EXPL W-DRAINAGE ONLY,67405,HCPCS,,,RT,Outpatient,,,20562,5140.5,1078.11,17477.7,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13488.67,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14393.4,Percent of Total Billed Charges, ,,85,,17477.7,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13982.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11514.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12337.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67412 - ORBITOTOMY W-O BONE FLAP W-REMOVAL LESION,67412,HCPCS,,,RT,Outpatient,,,16496,4124,1078.11,14021.6,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10821.38,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11547.2,Percent of Total Billed Charges, ,,85,,14021.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11217.28,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9237.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9897.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67412 - ORBITOTOMY W-O BONE FLAP W-REMOVAL LESION,67412,HCPCS,,,LT,Outpatient,,,10768.5,2692.125,1078.11,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7064.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7537.95,Percent of Total Billed Charges, ,,85,,9153.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7322.58,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6030.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6461.1,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67412 - ORBITOTOMY W-O BONE FLAP W-REMOVAL LESION,67412,HCPCS,,,50,Outpatient,,,12587,3146.75,1078.11,10698.95,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8257.07,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8810.9,Percent of Total Billed Charges, ,,85,,10698.95,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8559.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7048.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7552.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67414 - ORBITOTOMY W-O BONE FLAP W-RMVL BONE DCMPRN,67414,HCPCS,,,50,Outpatient,,,22592,5648,1078.11,19203.2,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14820.35,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15814.4,Percent of Total Billed Charges, ,,85,,19203.2,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,15362.56,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12651.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13555.2,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67500 - RETROBULBAR INJECTION MEDICATION SPX,67500,HCPCS,,,XU,Outpatient,,,4498.83,1124.7075,284.2,3824.01,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2951.23,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3149.18,Percent of Total Billed Charges, ,,85,,3824.01,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3059.2,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2519.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2699.3,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67500 - RETROBULBAR INJECTION MEDICATION SPX,67500,HCPCS,,,LT,Outpatient,,,4853,1213.25,284.2,4125.05,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3183.57,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3397.1,Percent of Total Billed Charges, ,,85,,4125.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3300.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2717.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2911.8,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67550 - ORBITAL IMPLANT INSERTION,67550,HCPCS,,,RT,Outpatient,,,8501.5,2125.375,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5576.98,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5951.05,Percent of Total Billed Charges, ,,85,,7226.28,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5781.02,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4760.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5100.9,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID,67700,HCPCS,,,RT,Outpatient,,,6040.5,1510.125,284.2,5134.43,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3962.57,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4228.35,Percent of Total Billed Charges, ,,85,,5134.43,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4107.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3382.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3624.3,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID,67700,HCPCS,,,E4,Outpatient,,,8581,2145.25,284.2,7293.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5835.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID,67700,HCPCS,,,E3,Outpatient,,,8581,2145.25,284.2,7293.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5835.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID,67700,HCPCS,,,E1,Outpatient,,,9331,2332.75,284.2,7931.35,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6121.14,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6531.7,Percent of Total Billed Charges, ,,85,,7931.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6345.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5225.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5598.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67800 - EXCISION CHALAZION SINGLE,67800,HCPCS,,,E3,Outpatient,,,8643.5,2160.875,284.2,7346.98,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5670.14,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6050.45,Percent of Total Billed Charges, ,,85,,7346.98,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5877.58,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4840.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5186.1,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67800 - EXCISION CHALAZION SINGLE,67800,HCPCS,,,E2,Outpatient,,,8581,2145.25,284.2,7293.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5835.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67800 - EXCISION CHALAZION SINGLE,67800,HCPCS,,,E1,Outpatient,,,6519.89,1629.9725,284.2,5541.91,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4277.05,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4563.92,Percent of Total Billed Charges, ,,85,,5541.91,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4433.53,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3651.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3911.93,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67800 - EXCISION CHALAZION SINGLE,67800,HCPCS,,,50,Outpatient,,,8581,2145.25,284.2,7293.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5835.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67805 - EXCISION CHALAZION MULTIPLE DIFFERENT LIDS,67805,HCPCS,,,50,Outpatient,,,10289.33,2572.3325,284.2,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6749.8,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7202.53,Percent of Total Billed Charges, ,,85,,8745.93,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6996.74,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5762.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6173.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67808 - EXC CHALAZION ANES REQ HOSPIZATION SINGLE-MULT,67808,HCPCS,,,LT,Outpatient,,,8581,2145.25,742.5,7293.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67808 - EXC CHALAZION ANES REQ HOSPIZATION SINGLE-MULT,67808,HCPCS,,,E3,Outpatient,,,9456,2364,742.5,8037.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6203.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6619.2,Percent of Total Billed Charges, ,,85,,8037.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6430.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5295.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5673.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67808 - EXC CHALAZION ANES REQ HOSPIZATION SINGLE-MULT,67808,HCPCS,,,E2,Outpatient,,,8581,2145.25,742.5,7293.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67808 - EXC CHALAZION ANES REQ HOSPIZATION SINGLE-MULT,67808,HCPCS,,,E1,Outpatient,,,8581,2145.25,742.5,7293.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67825 - CORRECTION TRICHIASIS EPILATION OTH-THAN FORCEPS,67825,HCPCS,,,LT,Outpatient,,,7655.5,1913.875,284.2,6507.18,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5022.01,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5358.85,Percent of Total Billed Charges, ,,85,,6507.18,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5205.74,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4287.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4593.3,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67825 - CORRECTION TRICHIASIS EPILATION OTH-THAN FORCEPS,67825,HCPCS,,,E4,Outpatient,,,8581,2145.25,284.2,7293.85,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5835.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67825 - CORRECTION TRICHIASIS EPILATION OTH-THAN FORCEPS,67825,HCPCS,,,E2,Outpatient,,,7454.75,1863.6875,284.2,6336.54,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4890.32,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5218.33,Percent of Total Billed Charges, ,,85,,6336.54,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5069.23,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4174.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4472.85,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67825 - CORRECTION TRICHIASIS EPILATION OTH-THAN FORCEPS,67825,HCPCS,,,E1,Outpatient,,,10281,2570.25,284.2,8738.85,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6744.34,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7196.7,Percent of Total Billed Charges, ,,85,,8738.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6991.08,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5757.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6168.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67825 - CORRECTION TRICHIASIS EPILATION OTH-THAN FORCEPS,67825,HCPCS,,,50,Outpatient,,,8914.33,2228.5825,284.2,7577.18,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5847.8,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6240.03,Percent of Total Billed Charges, ,,85,,7577.18,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6061.74,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4992.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5348.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67830 - CORRECTION TRICHIASIS INCCISION LID MARGIN,67830,HCPCS,,,E2,Outpatient,,,6328.5,1582.125,920.83,5379.23,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4151.5,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4429.95,Percent of Total Billed Charges, ,,85,,5379.23,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4303.38,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3543.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3797.1,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67840 - EXC LESION EYELID W-O CLSR-W-SIMPLE DIR CLOSURE,67840,HCPCS,,,XU,Outpatient,,,4943.66,1235.915,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3243.04,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3460.56,Percent of Total Billed Charges, ,,85,,4202.11,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3361.69,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2768.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2966.2,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67840 - EXC LESION EYELID W-O CLSR-W-SIMPLE DIR CLOSURE,67840,HCPCS,,,RT,Outpatient,,,4790.5,1197.625,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3142.57,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3353.35,Percent of Total Billed Charges, ,,85,,4071.93,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3257.54,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2682.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2874.3,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67840 - EXC LESION EYELID W-O CLSR-W-SIMPLE DIR CLOSURE,67840,HCPCS,,,LT,Outpatient,,,5290.5,1322.625,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3470.57,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3703.35,Percent of Total Billed Charges, ,,85,,4496.93,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3597.54,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2962.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3174.3,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67840 - EXC LESION EYELID W-O CLSR-W-SIMPLE DIR CLOSURE,67840,HCPCS,,,E3,Outpatient,,,4152,1038,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2723.71,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2906.4,Percent of Total Billed Charges, ,,85,,3529.2,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2823.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2325.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2491.2,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67840 - EXC LESION EYELID W-O CLSR-W-SIMPLE DIR CLOSURE,67840,HCPCS,,,E2,Outpatient,,,8535.22,2133.805,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5599.1,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5974.65,Percent of Total Billed Charges, ,,85,,7254.94,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5803.95,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4779.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5121.13,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67840 - EXC LESION EYELID W-O CLSR-W-SIMPLE DIR CLOSURE,67840,HCPCS,,,E1,Outpatient,,,5415.5,1353.875,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3552.57,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3790.85,Percent of Total Billed Charges, ,,85,,4603.18,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3682.54,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3032.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3249.3,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67840 - EXC LESION EYELID W-O CLSR-W-SIMPLE DIR CLOSURE,67840,HCPCS,,,50,Outpatient,,,11643.5,2910.875,742.5,9896.98,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7638.14,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8150.45,Percent of Total Billed Charges, ,,85,,9896.98,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7917.58,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6520.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6986.1,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67875 - TEMPORARY CLOSURE EYELIDS SUTURE,67875,HCPCS,,,RT,Outpatient,,,4818.83,1204.7075,742.5,4096.01,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3161.15,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3373.18,Percent of Total Billed Charges, ,,85,,4096.01,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3276.8,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2698.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2891.3,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67875 - TEMPORARY CLOSURE EYELIDS SUTURE,67875,HCPCS,,,LT,Outpatient,,,6771.42,1692.855,742.5,5755.71,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4442.05,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4739.99,Percent of Total Billed Charges, ,,85,,5755.71,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4604.57,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3792,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4062.85,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67875 - TEMPORARY CLOSURE EYELIDS SUTURE,67875,HCPCS,,,E4,Outpatient,,,3568.66,892.165,742.5,3033.36,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2341.04,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2498.06,Percent of Total Billed Charges, ,,85,,3033.36,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2426.69,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1998.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2141.2,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67875 - TEMPORARY CLOSURE EYELIDS SUTURE,67875,HCPCS,,,E2,Outpatient,,,3860.33,965.0825,742.5,3281.28,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1430.4,,,1430.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2532.38,Percent of Total Billed Charges, ,1415.56,,,1415.56,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2702.23,Percent of Total Billed Charges, ,,85,,3281.28,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2625.02,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2161.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2316.2,Percent of Total Billed Charges, ,1415.78,,,1415.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1371.19,,,1371.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,953.06,,,953.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,962.27,,,962.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,920.83,,,920.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.04,,,930.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,948.45,,,948.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,964.57,,,964.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67880 - CONSTJ INTERMARGIN ADHES-TARSORRH-CANTHORRHAPY,67880,HCPCS,,,RT,Outpatient,,,9110.4,2277.6,742.5,7743.84,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5976.42,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6377.28,Percent of Total Billed Charges, ,,85,,7743.84,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6195.07,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5101.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5466.24,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67880 - CONSTJ INTERMARGIN ADHES-TARSORRH-CANTHORRHAPY,67880,HCPCS,,,LT,Outpatient,,,11372.67,2843.1675,742.5,9666.77,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7460.47,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7960.87,Percent of Total Billed Charges, ,,85,,9666.77,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7733.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6368.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6823.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67880 - CONSTJ INTERMARGIN ADHES-TARSORRH-CANTHORRHAPY,67880,HCPCS,,,E2,Outpatient,,,4073.16,1018.29,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2671.99,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2851.21,Percent of Total Billed Charges, ,,85,,3462.19,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2769.75,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2280.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2443.9,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67900 - REPAIR BROW PTOSIS,67900,HCPCS,,,RT,Outpatient,,,8278.63,2069.6575,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5430.78,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5795.04,Percent of Total Billed Charges, ,,85,,7036.84,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5629.47,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4636.03,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4967.18,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67900 - REPAIR BROW PTOSIS,67900,HCPCS,,,LT,Outpatient,,,11483,2870.75,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7532.85,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8038.1,Percent of Total Billed Charges, ,,85,,9760.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7808.44,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6430.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6889.8,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67900 - REPAIR BROW PTOSIS,67900,HCPCS,,,50,Outpatient,,,14699.63,3674.9075,742.5,12494.69,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9642.96,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10289.74,Percent of Total Billed Charges, ,,85,,12494.69,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9995.75,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8231.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8819.78,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67903 - RPR BLEPHAROPTOSIS LEVATOR RESCJ-ADVMNT INTERNAL,67903,HCPCS,,,LT,Outpatient,,,8956,2239,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5875.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6269.2,Percent of Total Billed Charges, ,,85,,7612.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6090.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5015.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5373.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67903 - RPR BLEPHAROPTOSIS LEVATOR RESCJ-ADVMNT INTERNAL,67903,HCPCS,,,E3,Outpatient,,,8872.67,2218.1675,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5820.47,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6210.87,Percent of Total Billed Charges, ,,85,,7541.77,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6033.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4968.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5323.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67903 - RPR BLEPHAROPTOSIS LEVATOR RESCJ-ADVMNT INTERNAL,67903,HCPCS,,,E1,Outpatient,,,9077.3,2269.325,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5954.71,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6354.11,Percent of Total Billed Charges, ,,85,,7715.71,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6172.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5083.29,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5446.38,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67903 - RPR BLEPHAROPTOSIS LEVATOR RESCJ-ADVMNT INTERNAL,67903,HCPCS,,,50,Outpatient,,,10345.59,2586.3975,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6786.71,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7241.91,Percent of Total Billed Charges, ,,85,,8793.75,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7035,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5793.53,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6207.35,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67904 - RPR BLEPHAROPTOSIS LEVATOR RESCJ-ADVMNT XTRNL,67904,HCPCS,,,RT,Outpatient,,,10268.5,2567.125,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6736.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7187.95,Percent of Total Billed Charges, ,,85,,8728.23,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6982.58,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5750.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6161.1,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67904 - RPR BLEPHAROPTOSIS LEVATOR RESCJ-ADVMNT XTRNL,67904,HCPCS,,,LT,Outpatient,,,8672.9,2168.225,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5689.42,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6071.03,Percent of Total Billed Charges, ,,85,,7371.97,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5897.57,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4856.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5203.74,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67904 - RPR BLEPHAROPTOSIS LEVATOR RESCJ-ADVMNT XTRNL,67904,HCPCS,,,E3,Outpatient,,,10997.67,2749.4175,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7214.47,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7698.37,Percent of Total Billed Charges, ,,85,,9348.02,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7478.42,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6158.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6598.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67904 - RPR BLEPHAROPTOSIS LEVATOR RESCJ-ADVMNT XTRNL,67904,HCPCS,,,E1,Outpatient,,,12356,3089,950.4,10502.6,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8105.54,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8649.2,Percent of Total Billed Charges, ,,85,,10502.6,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8402.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6919.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7413.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67904 - RPR BLEPHAROPTOSIS LEVATOR RESCJ-ADVMNT XTRNL,67904,HCPCS,,,50,Outpatient,,,10495.08,2623.77,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6884.77,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7346.56,Percent of Total Billed Charges, ,,85,,8920.82,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7136.65,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5877.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6297.05,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67908 - RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ,67908,HCPCS,,,RT,Outpatient,,,13415,3353.75,742.5,11402.75,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8800.24,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9390.5,Percent of Total Billed Charges, ,,85,,11402.75,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9122.2,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7512.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8049,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67908 - RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ,67908,HCPCS,,,E3,Outpatient,,,8831,2207.75,742.5,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5793.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6181.7,Percent of Total Billed Charges, ,,85,,7506.35,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6005.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4945.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5298.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67911 - CORRECTION LID RETRACTION,67911,HCPCS,,,E3,Outpatient,,,8956,2239,742.5,7612.6,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5875.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6269.2,Percent of Total Billed Charges, ,,85,,7612.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6090.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5015.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5373.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67911 - CORRECTION LID RETRACTION,67911,HCPCS,,,E1,Outpatient,,,10956,2739,742.5,9312.6,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7187.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7669.2,Percent of Total Billed Charges, ,,85,,9312.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7450.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6135.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6573.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67911 - CORRECTION LID RETRACTION,67911,HCPCS,,,50,Outpatient,,,14105,3526.25,742.5,11989.25,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9252.88,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9873.5,Percent of Total Billed Charges, ,,85,,11989.25,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9591.4,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7898.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8463,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD,67912,HCPCS,,,LT,Outpatient,,,6540.5,1635.125,742.5,5559.43,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4290.57,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4578.35,Percent of Total Billed Charges, ,,85,,5559.43,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4447.54,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3662.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3924.3,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67912 - CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD,67912,HCPCS,,,E3,Outpatient,,,6976.25,1744.0625,742.5,5929.81,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4576.42,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4883.38,Percent of Total Billed Charges, ,,85,,5929.81,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4743.85,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3906.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4185.75,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67916 - REPAIR ECTROPION EXCISION TARSAL WEDGE,67916,HCPCS,,,E2,Outpatient,,,8565,2141.25,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5618.64,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5995.5,Percent of Total Billed Charges, ,,85,,7280.25,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5824.2,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4796.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5139,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67917 - REPAIR ECTROPION EXTENSIVE,67917,HCPCS,,,RT,Outpatient,,,9706,2426.5,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6367.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6794.2,Percent of Total Billed Charges, ,,85,,8250.1,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6600.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5435.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5823.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67917 - REPAIR ECTROPION EXTENSIVE,67917,HCPCS,,,E4,Outpatient,,,6381.51,1595.3775,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4186.27,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4467.06,Percent of Total Billed Charges, ,,85,,5424.28,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4339.43,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3573.65,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3828.91,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67917 - REPAIR ECTROPION EXTENSIVE,67917,HCPCS,,,E2,Outpatient,,,7017.32,1754.33,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4603.36,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4912.12,Percent of Total Billed Charges, ,,85,,5964.72,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4771.78,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3929.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4210.39,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67917 - REPAIR ECTROPION EXTENSIVE,67917,HCPCS,,,50,Outpatient,,,9661.13,2415.2825,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6337.7,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6762.79,Percent of Total Billed Charges, ,,85,,8211.96,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6569.57,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5410.23,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5796.68,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67924 - REPAIR ENTROPION EXTENSIVE,67924,HCPCS,,,RT,Outpatient,,,8609.17,2152.2925,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5647.62,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6026.42,Percent of Total Billed Charges, ,,85,,7317.79,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5854.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4821.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5165.5,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67924 - REPAIR ENTROPION EXTENSIVE,67924,HCPCS,,,E4,Outpatient,,,9802.23,2450.5575,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6430.26,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6861.56,Percent of Total Billed Charges, ,,85,,8331.9,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6665.52,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5489.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5881.34,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67924 - REPAIR ENTROPION EXTENSIVE,67924,HCPCS,,,E2,Outpatient,,,9563.14,2390.785,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6273.42,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6694.2,Percent of Total Billed Charges, ,,85,,8128.67,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6502.94,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5355.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5737.88,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67924 - REPAIR ENTROPION EXTENSIVE,67924,HCPCS,,,50,Outpatient,,,11252.25,2813.0625,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7381.48,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7876.58,Percent of Total Billed Charges, ,,85,,9564.41,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7651.53,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6301.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6751.35,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67950 - CANTHOPLASTY,67950,HCPCS,,,XU,Outpatient,,,4498.25,1124.5625,882.09,3823.51,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2950.85,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3148.78,Percent of Total Billed Charges, ,,85,,3823.51,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3058.81,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2519.02,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2698.95,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67950 - CANTHOPLASTY,67950,HCPCS,,,RT,Outpatient,,,6809.28,1702.32,882.09,5787.89,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4466.89,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4766.5,Percent of Total Billed Charges, ,,85,,5787.89,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4630.31,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3813.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4085.57,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67950 - CANTHOPLASTY,67950,HCPCS,,,LT,Outpatient,,,6776.5,1694.125,882.09,5760.03,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4445.38,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4743.55,Percent of Total Billed Charges, ,,85,,5760.03,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4608.02,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3794.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4065.9,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67950 - CANTHOPLASTY,67950,HCPCS,,,E4,Outpatient,,,8404.5,2101.125,882.09,7143.83,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5513.35,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5883.15,Percent of Total Billed Charges, ,,85,,7143.83,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5715.06,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4706.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5042.7,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67950 - CANTHOPLASTY,67950,HCPCS,,,E2,Outpatient,,,6538.43,1634.6075,882.09,5557.67,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4289.21,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4576.9,Percent of Total Billed Charges, ,,85,,5557.67,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4446.13,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3661.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3923.06,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67950 - CANTHOPLASTY,67950,HCPCS,,,E1,Outpatient,,,5672.5,1418.125,882.09,4821.63,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3721.16,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3970.75,Percent of Total Billed Charges, ,,85,,4821.63,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3857.3,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3176.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3403.5,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67950 - CANTHOPLASTY,67950,HCPCS,,,50,Outpatient,,,13592,3398,882.09,11553.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8916.35,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9514.4,Percent of Total Billed Charges, ,,85,,11553.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9242.56,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7611.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8155.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67961 - EXCISION AND REPAIR EYELID LESS THAN ONE-FOURTH LID MARGIN,67961,HCPCS,,,LT,Outpatient,,,10451.66,2612.915,950.4,8883.91,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6856.29,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7316.16,Percent of Total Billed Charges, ,,85,,8883.91,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7107.13,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5852.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6271,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67961 - EXCISION AND REPAIR EYELID LESS THAN ONE-FOURTH LID MARGIN,67961,HCPCS,,,E4,Outpatient,,,9185.13,2296.2825,950.4,7807.36,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6025.45,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6429.59,Percent of Total Billed Charges, ,,85,,7807.36,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6245.89,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5143.67,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5511.08,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67961 - EXCISION AND REPAIR EYELID LESS THAN ONE-FOURTH LID MARGIN,67961,HCPCS,,,E3,Outpatient,,,10172.17,2543.0425,950.4,8646.34,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6672.94,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7120.52,Percent of Total Billed Charges, ,,85,,8646.34,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6917.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5696.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6103.3,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67961 - EXCISION AND REPAIR EYELID LESS THAN ONE-FOURTH LID MARGIN,67961,HCPCS,,,E2,Outpatient,,,8838.08,2209.52,950.4,7512.37,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5797.78,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6186.66,Percent of Total Billed Charges, ,,85,,7512.37,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6009.89,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4949.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5302.85,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67961 - EXCISION AND REPAIR EYELID LESS THAN ONE-FOURTH LID MARGIN,67961,HCPCS,,,E1,Outpatient,,,10456,2614,950.4,8887.6,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6859.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7319.2,Percent of Total Billed Charges, ,,85,,8887.6,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7110.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5855.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6273.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67966 - EXCISION AND REPAIR EYELID ONE-FOURTH LID MARGIN,67966,HCPCS,,,RT,Outpatient,,,11572,2893,742.5,9836.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7591.23,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8100.4,Percent of Total Billed Charges, ,,85,,9836.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7868.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6480.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6943.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67966 - EXCISION AND REPAIR EYELID ONE-FOURTH LID MARGIN,67966,HCPCS,,,E4,Outpatient,,,10081.13,2520.2825,742.5,8568.96,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6613.22,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7056.79,Percent of Total Billed Charges, ,,85,,8568.96,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6855.17,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5645.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6048.68,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67966 - EXCISION AND REPAIR EYELID ONE-FOURTH LID MARGIN,67966,HCPCS,,,E3,Outpatient,,,11784.5,2946.125,742.5,10016.83,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7730.63,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8249.15,Percent of Total Billed Charges, ,,85,,10016.83,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8013.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6599.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7070.7,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67966 - EXCISION AND REPAIR EYELID ONE-FOURTH LID MARGIN,67966,HCPCS,,,E2,Outpatient,,,10931,2732.75,742.5,9291.35,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7170.74,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7651.7,Percent of Total Billed Charges, ,,85,,9291.35,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7433.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6121.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6558.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67966 - EXCISION AND REPAIR EYELID ONE-FOURTH LID MARGIN,67966,HCPCS,,,E1,Outpatient,,,7762.33,1940.5825,742.5,6597.98,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5092.09,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5433.63,Percent of Total Billed Charges, ,,85,,6597.98,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5278.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4346.9,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4657.4,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67966 - EXCISION AND REPAIR EYELID ONE-FOURTH LID MARGIN,67966,HCPCS,,,50,Outpatient,,,17279,4319.75,742.5,14687.15,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11335.02,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12095.3,Percent of Total Billed Charges, ,,85,,14687.15,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11749.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9676.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10367.4,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67971 - RCNSTJ EYELID FULL THICKNESS LESS THAN TWO-THIRDS 1 STG,67971,HCPCS,,,RT,Outpatient,,,4959.38,1239.845,950.4,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3253.35,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3471.57,Percent of Total Billed Charges, ,,85,,4215.47,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3372.38,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2777.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2975.63,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67971 - RCNSTJ EYELID FULL THICKNESS LESS THAN TWO-THIRDS 1 STG,67971,HCPCS,,,E4,Outpatient,,,7882.92,1970.73,950.4,6700.48,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5171.2,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5518.04,Percent of Total Billed Charges, ,,85,,6700.48,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5360.39,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4414.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4729.75,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67971 - RCNSTJ EYELID FULL THICKNESS LESS THAN TWO-THIRDS 1 STG,67971,HCPCS,,,E3,Outpatient,,,10706,2676.5,950.4,9100.1,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7023.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7494.2,Percent of Total Billed Charges, ,,85,,9100.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7280.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5995.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6423.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67971 - RCNSTJ EYELID FULL THICKNESS LESS THAN TWO-THIRDS 1 STG,67971,HCPCS,,,E2,Outpatient,,,10048.42,2512.105,950.4,8541.16,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6591.76,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7033.89,Percent of Total Billed Charges, ,,85,,8541.16,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6832.93,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5627.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6029.05,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67971 - RCNSTJ EYELID FULL THICKNESS LESS THAN TWO-THIRDS 1 STG,67971,HCPCS,,,E1,Outpatient,,,13415,3353.75,950.4,11402.75,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8800.24,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9390.5,Percent of Total Billed Charges, ,,85,,11402.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9122.2,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7512.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8049,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67973 - RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG,67973,HCPCS,,,RT,Outpatient,,,4595.75,1148.9375,950.4,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3014.81,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3217.03,Percent of Total Billed Charges, ,,85,,3906.39,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3125.11,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2573.62,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2757.45,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67973 - RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG,67973,HCPCS,,,E4,Outpatient,,,4425.67,1106.4175,950.4,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2903.24,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3097.97,Percent of Total Billed Charges, ,,85,,3761.82,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3009.46,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2478.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2655.4,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67975 - RCNSTJ EYELID FULL THICKNESS SECOND STAGE,67975,HCPCS,,,E4,Outpatient,,,8581,2145.25,950.4,7293.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67975 - RCNSTJ EYELID FULL THICKNESS SECOND STAGE,67975,HCPCS,,,E3,Outpatient,,,8581,2145.25,950.4,7293.85,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5835.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67975 - RCNSTJ EYELID FULL THICKNESS SECOND STAGE,67975,HCPCS,,,E2,Outpatient,,,8255.63,2063.9075,950.4,7017.29,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5415.69,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5778.94,Percent of Total Billed Charges, ,,85,,7017.29,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5613.83,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4623.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4953.38,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67999 - UNLISTED PROCEDURE EYELIDS,67999,HCPCS,,,RT,Outpatient,,,4977.66,1244.415,0.01,6015,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3265.34,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3484.36,Percent of Total Billed Charges, ,,85,,4231.01,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3384.81,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2787.49,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2986.6,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67999 - UNLISTED PROCEDURE EYELIDS,67999,HCPCS,,,LT,Outpatient,,,6256.58,1564.145,0.01,6015,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4104.32,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4379.61,Percent of Total Billed Charges, ,,85,,5318.09,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4254.47,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3503.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3753.95,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67999 - UNLISTED PROCEDURE EYELIDS,67999,HCPCS,,,50,Outpatient,,,17125.38,4281.345,0.01,14556.57,,,,,,,Service Paid at Rev Code level,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11234.25,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11987.77,Percent of Total Billed Charges, ,,85,,14556.57,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11645.26,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9590.21,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10275.23,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68110 - EXCISION LESION CONJUNCTIVA LESS THAN 1 CM,68110,HCPCS,,,RT,Outpatient,,,6902.5,1725.625,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4528.04,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4831.75,Percent of Total Billed Charges, ,,85,,5867.13,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4693.7,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3865.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4141.5,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68110 - EXCISION LESION CONJUNCTIVA LESS THAN 1 CM,68110,HCPCS,,,LT,Outpatient,,,9610.67,2402.6675,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6304.6,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6727.47,Percent of Total Billed Charges, ,,85,,8169.07,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6535.26,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5381.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5766.4,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68115 - EXCISION LESION CONJUNCTIVA GREATER THAN 1 CM,68115,HCPCS,,,XU,Outpatient,,,2985.34,746.335,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1958.38,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2089.74,Percent of Total Billed Charges, ,,85,,2537.54,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2030.03,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1671.79,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1791.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68115 - EXCISION LESION CONJUNCTIVA GREATER THAN 1 CM,68115,HCPCS,,,RT,Outpatient,,,11572,2893,742.5,9836.2,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7591.23,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8100.4,Percent of Total Billed Charges, ,,85,,9836.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7868.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6480.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6943.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68115 - EXCISION LESION CONJUNCTIVA GREATER THAN 1 CM,68115,HCPCS,,,LT,Outpatient,,,12606.75,3151.6875,742.5,10715.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8270.03,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8824.73,Percent of Total Billed Charges, ,,85,,10715.74,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8572.59,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7059.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7564.05,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68115 - EXCISION LESION CONJUNCTIVA GREATER THAN 1 CM,68115,HCPCS,,,50,Outpatient,,,9956,2489,742.5,8462.6,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6531.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6969.2,Percent of Total Billed Charges, ,,85,,8462.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6770.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5575.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5973.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68135 - DESTRUCTION LESION CONJUNCTIVA,68135,HCPCS,,,XU,Outpatient,,,4424.42,1106.105,0.01,3760.76,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2902.42,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3097.09,Percent of Total Billed Charges, ,,85,,3760.76,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3008.61,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2477.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2654.65,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68135 - DESTRUCTION LESION CONJUNCTIVA,68135,HCPCS,,,RT,Outpatient,,,11572,2893,0.01,9836.2,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7591.23,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8100.4,Percent of Total Billed Charges, ,,85,,9836.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7868.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6480.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6943.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68135 - DESTRUCTION LESION CONJUNCTIVA,68135,HCPCS,,,LT,Outpatient,,,11572,2893,0.01,9836.2,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7591.23,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8100.4,Percent of Total Billed Charges, ,,85,,9836.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7868.96,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6480.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6943.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68135 - DESTRUCTION LESION CONJUNCTIVA,68135,HCPCS,,,50,Outpatient,,,8581,2145.25,0.01,7293.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5629.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6006.7,Percent of Total Billed Charges, ,,85,,7293.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,5835.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4805.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5148.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68320 - CONJUNCTIVOPLASTY W-GRF-XTNSV REARRANGEMENT,68320,HCPCS,,,XU,Outpatient,,,6976.25,1744.0625,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4576.42,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4883.38,Percent of Total Billed Charges, ,,85,,5929.81,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4743.85,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3906.7,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4185.75,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68320 - CONJUNCTIVOPLASTY W-GRF-XTNSV REARRANGEMENT,68320,HCPCS,,,RT,Outpatient,,,5826.06,1456.515,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3821.9,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4078.24,Percent of Total Billed Charges, ,,85,,4952.15,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3961.72,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3262.59,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3495.64,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68320 - CONJUNCTIVOPLASTY W-GRF-XTNSV REARRANGEMENT,68320,HCPCS,,,E4,Outpatient,,,19081,4770.25,882.09,16218.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12517.14,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13356.7,Percent of Total Billed Charges, ,,85,,16218.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12975.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10685.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11448.6,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68320 - CONJUNCTIVOPLASTY W-GRF-XTNSV REARRANGEMENT,68320,HCPCS,,,E2,Outpatient,,,5777,1444.25,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3789.71,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4043.9,Percent of Total Billed Charges, ,,85,,4910.45,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3928.36,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3235.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3466.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68320 - CONJUNCTIVOPLASTY W-GRF-XTNSV REARRANGEMENT,68320,HCPCS,,,50,Outpatient,,,7603,1900.75,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4987.57,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5322.1,Percent of Total Billed Charges, ,,85,,6462.55,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5170.04,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4257.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4561.8,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68325 - CONJUNCTIVOPLASTY W-BUCCAL MUC MEMB GRAFT,68325,HCPCS,,,LT,Outpatient,,,10165.5,2541.375,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6668.57,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7115.85,Percent of Total Billed Charges, ,,85,,8640.68,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6912.54,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5692.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6099.3,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68362 - CONJUNCTIVAL FLAP TOTAL,68362,HCPCS,,,LT,Outpatient,,,15091.5,3772.875,882.09,12827.78,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9900.02,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10564.05,Percent of Total Billed Charges, ,,85,,12827.78,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10262.22,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8451.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9054.9,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68420 - INCISIONANDDRAINAGE LACRIMAL SAC,68420,HCPCS,,,LT,Outpatient,,,4902,1225.5,882.09,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3215.71,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3431.4,Percent of Total Billed Charges, ,,85,,4166.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3333.36,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2745.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2941.2,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68440 - SNIP INCISION LACRIMAL PUNCTUM,68440,HCPCS,,,XU,Outpatient,,,2463,615.75,284.2,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1615.73,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1724.1,Percent of Total Billed Charges, ,,85,,2093.55,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1674.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1379.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1477.8,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68440 - SNIP INCISION LACRIMAL PUNCTUM,68440,HCPCS,,,50,Outpatient,,,4853,1213.25,284.2,4125.05,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3183.57,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3397.1,Percent of Total Billed Charges, ,,85,,4125.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3300.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2717.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2911.8,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68510 - BIOPSY LACRIMAL GLAND,68510,HCPCS,,,50,Outpatient,,,7723.5,1930.875,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5066.62,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5406.45,Percent of Total Billed Charges, ,,85,,6564.98,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5251.98,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4325.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4634.1,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68530 - RMVL FB-DACRYOLITH LACRIMAL PASSAGES,68530,HCPCS,,,LT,Outpatient,,,5256.5,1314.125,284.2,4468.03,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3448.26,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3679.55,Percent of Total Billed Charges, ,,85,,4468.03,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3574.42,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2943.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3153.9,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68530 - RMVL FB-DACRYOLITH LACRIMAL PASSAGES,68530,HCPCS,,,50,Outpatient,,,5665.5,1416.375,284.2,4815.68,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3716.57,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3965.85,Percent of Total Billed Charges, ,,85,,4815.68,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3852.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3172.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3399.3,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68700 - PLASTIC REPAIR CANALICULI,68700,HCPCS,,,RT,Outpatient,,,4768.25,1192.0625,742.5,4053.01,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3127.97,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3337.78,Percent of Total Billed Charges, ,,85,,4053.01,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3242.41,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2670.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2860.95,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68700 - PLASTIC REPAIR CANALICULI,68700,HCPCS,,,LT,Outpatient,,,5592.72,1398.18,742.5,4753.81,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3668.82,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3914.9,Percent of Total Billed Charges, ,,85,,4753.81,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3803.05,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3131.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3355.63,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68700 - PLASTIC REPAIR CANALICULI,68700,HCPCS,,,E4,Outpatient,,,5575.66,1393.915,742.5,4739.31,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3657.63,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3902.96,Percent of Total Billed Charges, ,,85,,4739.31,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3791.45,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3122.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3345.4,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68705 - CORRECTION EVERTED PUNCTUM CAUTERY,68705,HCPCS,,,50,Outpatient,,,6228,1557,284.2,5293.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4085.57,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4359.6,Percent of Total Billed Charges, ,,85,,5293.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4235.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3487.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3736.8,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68720 - DACRYOCSTORHINOSTOMY,68720,HCPCS,,,RT,Outpatient,,,9125,2281.25,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5986,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6387.5,Percent of Total Billed Charges, ,,85,,7756.25,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6205,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5110,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5475,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68720 - DACRYOCSTORHINOSTOMY,68720,HCPCS,,,LT,Outpatient,,,6787.8,1696.95,882.09,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4452.8,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4751.46,Percent of Total Billed Charges, ,,85,,5769.63,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4615.7,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3801.17,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4072.68,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68750 - CONJUNCTIVORHINOSTOMY INSJ TUBE-STENT,68750,HCPCS,,,RT,Outpatient,,,6693,1673.25,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4390.61,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4685.1,Percent of Total Billed Charges, ,,85,,5689.05,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4551.24,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3748.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4015.8,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68750 - CONJUNCTIVORHINOSTOMY INSJ TUBE-STENT,68750,HCPCS,,,LT,Outpatient,,,10165.5,2541.375,950.4,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5569.23,,,5569.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6668.57,Percent of Total Billed Charges, ,5670.27,,,5670.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7115.85,Percent of Total Billed Charges, ,,85,,8640.68,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6912.54,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5692.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6099.3,Percent of Total Billed Charges, ,5512.31,,,5512.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5492.52,,,5492.52,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3710.72,,,3710.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3746.58,,,3746.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3585.24,,,3585.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3621.09,,,3621.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3692.8,,,3692.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3755.54,,,3755.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68801 - DILATION LACRIMAL PUNCTUM W-WO IRRGATION,68801,HCPCS,,,LT,Outpatient,,,2463,615.75,379.38,2093.55,,,,,,,Service Paid at Rev Code level,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,589.32,,,589.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1615.73,Percent of Total Billed Charges, ,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1724.1,Percent of Total Billed Charges, ,,85,,2093.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1674.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1379.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1477.8,Percent of Total Billed Charges, ,583.3,,,583.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.28,,,593.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.66,,,392.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.45,,,396.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.38,,,379.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,390.76,,,390.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.4,,,397.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68801 - DILATION LACRIMAL PUNCTUM W-WO IRRGATION,68801,HCPCS,,,50,Outpatient,,,4790.5,1197.625,379.38,4071.93,,,,,,,Service Paid at Rev Code level,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,589.32,,,589.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3142.57,Percent of Total Billed Charges, ,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3353.35,Percent of Total Billed Charges, ,,85,,4071.93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3257.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2682.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2874.3,Percent of Total Billed Charges, ,583.3,,,583.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.28,,,593.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.66,,,392.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.45,,,396.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.38,,,379.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,390.76,,,390.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.4,,,397.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68811 - PROBE NASOLACRIMAL DUCT W-WO IRRIG REQ GEN ANES,68811,HCPCS,,,LT,Outpatient,,,6035.66,1508.915,742.5,5130.31,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3959.39,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4224.96,Percent of Total Billed Charges, ,,85,,5130.31,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4104.25,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3379.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3621.4,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68815 - PROBE NASOLACRIMAL DUCT W-WO IRRG INSJ TUBE-STNT,68815,HCPCS,,,RT,Outpatient,,,6357.43,1589.3575,742.5,5403.82,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4170.47,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4450.2,Percent of Total Billed Charges, ,,85,,5403.82,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4323.05,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3560.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3814.46,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68815 - PROBE NASOLACRIMAL DUCT W-WO IRRG INSJ TUBE-STNT,68815,HCPCS,,,LT,Outpatient,,,7770.31,1942.5775,742.5,6604.76,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5097.32,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5439.22,Percent of Total Billed Charges, ,,85,,6604.76,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5283.81,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4351.37,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4662.19,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68815 - PROBE NASOLACRIMAL DUCT W-WO IRRG INSJ TUBE-STNT,68815,HCPCS,,,50,Outpatient,,,6353.25,1588.3125,742.5,5400.26,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4167.73,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4447.28,Percent of Total Billed Charges, ,,85,,5400.26,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4320.21,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3557.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3811.95,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68816 - PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION,68816,HCPCS,,,RT,Outpatient,,,8708,2177,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5712.45,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6095.6,Percent of Total Billed Charges, ,,85,,7401.8,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5921.44,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4876.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5224.8,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68816 - PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION,68816,HCPCS,,,LT,Outpatient,,,2463,615.75,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1615.73,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1724.1,Percent of Total Billed Charges, ,,85,,2093.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1674.84,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1379.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1477.8,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68816 - PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION,68816,HCPCS,,,50,Outpatient,,,7980.6,1995.15,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5235.27,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5586.42,Percent of Total Billed Charges, ,,85,,6783.51,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5426.81,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4469.14,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4788.36,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
68840 - PROBE LACRIMAL CANALICULI W-WO IRRIGATION,68840,HCPCS,,,LT,Outpatient,,,7040.5,1760.125,284.2,5984.43,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4618.57,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4928.35,Percent of Total Billed Charges, ,,85,,5984.43,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4787.54,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3942.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4224.3,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69110 - EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR,69110,HCPCS,,,RT,Outpatient,,,9851.33,2462.8325,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6462.47,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6895.93,Percent of Total Billed Charges, ,,85,,8373.63,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6698.9,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5516.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5910.8,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69110 - EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR,69110,HCPCS,,,LT,Outpatient,,,8760.84,2190.21,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4226.84,,,4226.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5747.11,Percent of Total Billed Charges, ,4190.48,,,4190.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6132.59,Percent of Total Billed Charges, ,,85,,7446.71,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5957.37,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4906.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5256.5,Percent of Total Billed Charges, ,4183.65,,,4183.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4059.12,,,4059.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2816.31,,,2816.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2843.52,,,2843.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2721.07,,,2721.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2748.28,,,2748.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2802.7,,,2802.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2850.32,,,2850.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69120 - EXCISION EXTERNAL EAR COMPLETE AMPUTATION,69120,HCPCS,,,LT,Outpatient,,,16481,4120.25,950.4,14008.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10811.54,Percent of Total Billed Charges, ,8661.84,,,8661.84,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11536.7,Percent of Total Billed Charges, ,,85,,14008.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11207.08,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9229.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9888.6,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8390.31,,,8390.31,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69210 - REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,69210,HCPCS,,,50,Outpatient,,,4775.5,1193.875,56.47,4059.18,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3132.73,Percent of Total Billed Charges, ,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3342.85,Percent of Total Billed Charges, ,,85,,4059.18,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3247.34,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2674.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2865.3,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.32,,,90.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69300 - OTOPLASTY PROTRUDING EAR W-WO SIZE RDCTJ,69300,HCPCS,,,50,Outpatient,,,19348.22,4837.055,882.09,16445.99,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12692.43,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13543.75,Percent of Total Billed Charges, ,,85,,16445.99,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13156.79,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,10835,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11608.93,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69421 - MYRINGOTOMY ASPIRAND-EUSTACHIAN TUBE NFLTJ ANES,69421,HCPCS,,,50,Outpatient,,,4775.5,1193.875,742.5,4789.54,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3132.73,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3342.85,Percent of Total Billed Charges, ,,85,,4059.18,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3247.34,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2674.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2865.3,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69424 - VENTILATING TUBE RMVL REQUIRING GENERAL ANES,69424,HCPCS,,,RT,Outpatient,,,7212,1803,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4731.07,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5048.4,Percent of Total Billed Charges, ,,85,,6130.2,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4904.16,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4038.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4327.2,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69436 - TYMPANOSTOMY GENERAL ANESTHESIA,69436,HCPCS,,,RT,Outpatient,,,8448,2112,742.5,7180.8,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2187.63,,,2187.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5541.89,Percent of Total Billed Charges, ,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5913.6,Percent of Total Billed Charges, ,,85,,7180.8,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5744.64,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4730.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5068.8,Percent of Total Billed Charges, ,2165.28,,,2165.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2181.22,,,2181.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1457.6,,,1457.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1471.68,,,1471.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1408.31,,,1408.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1450.56,,,1450.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1475.2,,,1475.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69436 - TYMPANOSTOMY GENERAL ANESTHESIA,69436,HCPCS,,,LT,Outpatient,,,7212,1803,742.5,6130.2,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2187.63,,,2187.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4731.07,Percent of Total Billed Charges, ,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5048.4,Percent of Total Billed Charges, ,,85,,6130.2,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4904.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4038.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4327.2,Percent of Total Billed Charges, ,2165.28,,,2165.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2181.22,,,2181.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1457.6,,,1457.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1471.68,,,1471.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1408.31,,,1408.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1450.56,,,1450.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1475.2,,,1475.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69436 - TYMPANOSTOMY GENERAL ANESTHESIA,69436,HCPCS,,,50,Outpatient,,,7566.53,1891.6325,742.5,6431.55,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2187.63,,,2187.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4963.64,Percent of Total Billed Charges, ,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5296.57,Percent of Total Billed Charges, ,,85,,6431.55,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5145.24,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4237.26,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4539.92,Percent of Total Billed Charges, ,2165.28,,,2165.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2181.22,,,2181.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1457.6,,,1457.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1471.68,,,1471.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1408.31,,,1408.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1450.56,,,1450.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1475.2,,,1475.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69610 - TYMPANIC MEMB RPR W-WO PREPJ PERFOR PATCH,69610,HCPCS,,,LT,Outpatient,,,7212,1803,742.5,9153,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2187.63,,,2187.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4731.07,Percent of Total Billed Charges, ,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5048.4,Percent of Total Billed Charges, ,,85,,6130.2,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4904.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4038.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4327.2,Percent of Total Billed Charges, ,2165.28,,,2165.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2181.22,,,2181.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1457.6,,,1457.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1471.68,,,1471.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1408.31,,,1408.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1450.56,,,1450.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1475.2,,,1475.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69620 - MYRINGOPLASTY,69620,HCPCS,,,RT,Outpatient,,,12587,3146.75,1078.11,10698.95,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4789.54,,,4789.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8257.07,Percent of Total Billed Charges, ,4615.12,,,4615.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8810.9,Percent of Total Billed Charges, ,,85,,10698.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8559.16,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7048.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,7552.2,Percent of Total Billed Charges, ,4740.6,,,4740.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4470.44,,,4470.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3191.24,,,3191.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3222.07,,,3222.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3083.32,,,3083.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3114.15,,,3114.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3175.82,,,3175.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3229.78,,,3229.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69705 - SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI,69705,HCPCS,,,XU,Outpatient,,,5084.2,1271.05,0.01,8736.57,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8736.57,,,8736.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3335.24,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3558.94,Percent of Total Billed Charges, ,,85,,4321.57,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3457.26,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2847.15,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3050.52,Percent of Total Billed Charges, ,8647.28,,,8647.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5821.1,,,5821.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5877.34,,,5877.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5624.25,,,5624.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5680.49,,,5680.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5792.98,,,5792.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5891.4,,,5891.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
69726 - REMOVAL ENTIRE OI IMPLT SKL PERQ ATTACHMENT ESP,69726,HCPCS,,,RT,Outpatient,,,19679.5,4919.875,1078.11,16727.58,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12909.75,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13775.65,Percent of Total Billed Charges, ,,85,,16727.58,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13382.06,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11020.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11807.7,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69930 - COCHLEAR DEVICE IMPLANTATION W-WO MASTOIDECTOMY,69930,HCPCS,,,RT,Outpatient,,,19679.5,4919.875,1078.11,54078.28,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54078.28,,,54078.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46975.56,,,46975.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12909.75,Percent of Total Billed Charges, ,54078.28,,,54078.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13775.65,Percent of Total Billed Charges, ,,85,,16727.58,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,13382.06,Percent of Total Billed Charges,0,21967,,,21967,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11020.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,11807.7,Percent of Total Billed Charges, ,46495.49,,,46495.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52383.04,,,52383.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31299.4,,,31299.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31601.81,,,31601.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30543.38,,,30543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30240.97,,,30240.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30543.38,,,30543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31148.2,,,31148.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31677.42,,,31677.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92018 - COMPL OPH XMANDEVAL GENERAL ANES W-WO MNPJ GLOBE,92018,HCPCS,,,XU,Outpatient,,,5103,1275.75,742.5,4337.55,,,,,,,Service Paid at Rev Code level,2930.06,,,2930.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3347.57,Percent of Total Billed Charges, ,2930.06,,,2930.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3572.1,Percent of Total Billed Charges, ,,85,,4337.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3470.04,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2857.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3061.8,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2837.74,,,2837.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92018 - COMPL OPH XMANDEVAL GENERAL ANES W-WO MNPJ GLOBE,92018,HCPCS,,,RT,Outpatient,,,4190.75,1047.6875,742.5,3562.14,,,,,,,Service Paid at Rev Code level,2930.06,,,2930.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2749.13,Percent of Total Billed Charges, ,2930.06,,,2930.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2933.53,Percent of Total Billed Charges, ,,85,,3562.14,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2849.71,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2346.82,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2514.45,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2837.74,,,2837.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92018 - COMPL OPH XMANDEVAL GENERAL ANES W-WO MNPJ GLOBE,92018,HCPCS,,,50,Outpatient,,,5910,1477.5,742.5,5023.5,,,,,,,Service Paid at Rev Code level,2930.06,,,2930.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3876.96,Percent of Total Billed Charges, ,2930.06,,,2930.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4137,Percent of Total Billed Charges, ,,85,,5023.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4018.8,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3309.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3546,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2837.74,,,2837.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92019 - LMTD OPH XMANDEVAL GENERAL ANES W-WO MNPJ GLOBE,92019,HCPCS,,,50,Outpatient,,,5910,1477.5,742.5,5023.5,,,,,,,Service Paid at Rev Code level,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,3445.45,,,3445.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3876.96,Percent of Total Billed Charges, ,3429.63,,,3429.63,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4137,Percent of Total Billed Charges, ,,85,,5023.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4018.8,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3309.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3546,Percent of Total Billed Charges, ,3410.24,,,3410.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3322.12,,,3322.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2295.67,,,2295.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2317.85,,,2317.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2218.04,,,2218.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2240.22,,,2240.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2284.58,,,2284.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2323.4,,,2323.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97598 - DEBRIDEMENT OPN WND EA ADDL 20 SQ CM-PRT THEREOF,97598,HCPCS,,,XU,Outpatient,,,1638.5,409.625,0.01,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1074.86,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1146.95,Percent of Total Billed Charges, ,,85,,1392.73,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1114.18,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,917.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,983.1,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9765 - REVASC INTRA LITHOTRIP-STENT,C9765,HCPCS,,,RT,Outpatient,,,4929.5,1232.375,0.01,26519.48,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,2267.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3233.75,Percent of Total Billed Charges, ,,46,,2267.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3450.65,Percent of Total Billed Charges, ,,85,,4190.08,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3352.06,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2760.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2957.7,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,1281.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9781 - ARTHRO-SHOUL SURG; W-SPACER,C9781,HCPCS,,,RT,Outpatient,,,5628.33,1407.0825,1463.37,19002.44,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,2589.03,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,19002.44,,,19002.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3692.18,Percent of Total Billed Charges, ,,46,,2589.03,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3939.83,Percent of Total Billed Charges, ,,85,,4784.08,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3827.26,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3151.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3377,Percent of Total Billed Charges, ,18808.24,,,18808.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,1463.37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12661.16,,,12661.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12783.49,,,12783.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12233,,,12233,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12355.33,,,12355.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12599.99,,,12599.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12814.07,,,12814.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,0360,RC,,,,Outpatient,,,11510.23,2877.5575,1442,9783.7,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,7550.71,Percent of Total Billed Charges, ,,,,,,,,70,,8057.16,Percent of Total Billed Charges, ,,85,,9783.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7826.96,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6906.14,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
10030 - IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ,10030,HCPCS,,,XU,Outpatient,,,1410,352.5,668.93,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,924.96,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,987,Percent of Total Billed Charges, ,,85,,1198.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,958.8,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,789.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,846,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10030 - IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ,10030,HCPCS,,,RT,Outpatient,,,1410,352.5,668.93,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,924.96,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,987,Percent of Total Billed Charges, ,,85,,1198.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,958.8,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,789.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,846,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA-CYST,10160,HCPCS,,,73,Outpatient,,,775,193.75,379.85,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,XU,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,XS,Outpatient,,,1800,450,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19000 - PUNCTURE ASPIRATION CYST OF BREAST,19000,HCPCS,,,RT,Outpatient,,,1800,450,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19000 - PUNCTURE ASPIRATION CYST OF BREAST,19000,HCPCS,,,LT,Outpatient,,,1800,450,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19001 - PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST,19001,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19081 - BX BREAST W-DEVICE 1ST LESION STEREOTACTIC GUID,19081,HCPCS,,,RT,Outpatient,,,9462,2365.5,742.5,8042.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19081 - BX BREAST W-DEVICE 1ST LESION STEREOTACTIC GUID,19081,HCPCS,,,LT,Outpatient,,,9462,2365.5,742.5,8042.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19081 - BX BREAST W-DEVICE 1ST LESION STEREOTACTIC GUID,19081,HCPCS,,,73,Outpatient,,,9462,2365.5,742.5,8042.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19082 - BX BREAST W-DEVICE ADDL LESION STEREOTACT GUID,19082,HCPCS,,,RT,Outpatient,,,1085,271.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,711.76,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,759.5,Percent of Total Billed Charges, ,,85,,922.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,737.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,607.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,651,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
19082 - BX BREAST W-DEVICE ADDL LESION STEREOTACT GUID,19082,HCPCS,,,LT,Outpatient,,,1085,271.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,711.76,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,759.5,Percent of Total Billed Charges, ,,85,,922.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,737.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,607.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,651,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
19083 - BX BREAST W-DEVICE 1ST LESION ULTRASOUND GUID,19083,HCPCS,,,RT,Outpatient,,,9438.18,2359.545,742.5,8022.45,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6191.45,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6606.73,Percent of Total Billed Charges, ,,85,,8022.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6417.96,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5285.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5662.91,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19083 - BX BREAST W-DEVICE 1ST LESION ULTRASOUND GUID,19083,HCPCS,,,LT,Outpatient,,,9412.72,2353.18,742.5,8000.81,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6174.74,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6588.9,Percent of Total Billed Charges, ,,85,,8000.81,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6400.65,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5271.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5647.63,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19083 - BX BREAST W-DEVICE 1ST LESION ULTRASOUND GUID,19083,HCPCS,,,GA,Outpatient,,,9462,2365.5,742.5,8042.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19083 - BX BREAST W-DEVICE 1ST LESION ULTRASOUND GUID,19083,HCPCS,,,74,Outpatient,,,9462,2365.5,742.5,8042.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19083 - BX BREAST W-DEVICE 1ST LESION ULTRASOUND GUID,19083,HCPCS,,,73,Outpatient,,,9462,2365.5,742.5,8042.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19083 - BX BREAST W-DEVICE 1ST LESION ULTRASOUND GUID,19083,HCPCS,,,50,Outpatient,,,9462,2365.5,742.5,8042.7,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19084 - BX BREAST W-DEVICE ADDL LESION ULTRASOUND GUID,19084,HCPCS,,,RT,Outpatient,,,1085,271.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,711.76,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,759.5,Percent of Total Billed Charges, ,,85,,922.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,737.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,607.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,651,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
19084 - BX BREAST W-DEVICE ADDL LESION ULTRASOUND GUID,19084,HCPCS,,,LT,Outpatient,,,1085,271.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,711.76,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,759.5,Percent of Total Billed Charges, ,,85,,922.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,737.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,607.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,651,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
19085 - BX BREAST W-DEVICE 1ST LESION MAGNETIC RES GUID,19085,HCPCS,,,RT,Outpatient,,,4608,1152,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3133.44,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2580.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2764.8,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19085 - BX BREAST W-DEVICE 1ST LESION MAGNETIC RES GUID,19085,HCPCS,,,LT,Outpatient,,,4608,1152,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3133.44,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2580.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2764.8,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19281 - PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W-GDNCE,19281,HCPCS,,,RT,Outpatient,,,953,238.25,533.68,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,625.17,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,667.1,Percent of Total Billed Charges, ,,85,,810.05,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,648.04,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,533.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,571.8,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE,19283,HCPCS,,,XU,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE,19283,HCPCS,,,XS,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE,19283,HCPCS,,,RT,Outpatient,,,1780.8,445.2,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1168.2,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1246.56,Percent of Total Billed Charges, ,,85,,1513.68,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1210.94,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,997.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1068.48,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE,19283,HCPCS,,,LT,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19283 - PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE,19283,HCPCS,,,CG,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19284 - PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC,19284,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG,19285,HCPCS,,,XU,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG,19285,HCPCS,,,XP,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG,19285,HCPCS,,,RT,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG,19285,HCPCS,,,LT,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19285 - PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG,19285,HCPCS,,,CG,Outpatient,,,1766.41,441.6025,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1158.76,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1236.49,Percent of Total Billed Charges, ,,85,,1501.45,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1201.16,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,989.19,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1059.85,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19303 - MASTECTOMY SIMPLE COMPLETE,19303,HCPCS,,,XU,Outpatient,,,241.68,60.42,135.34,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9631.25,,,9631.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,158.54,Percent of Total Billed Charges, ,9640.8,,,9640.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,169.18,Percent of Total Billed Charges, ,,85,,205.43,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,164.34,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,135.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,145.01,Percent of Total Billed Charges, ,9532.82,,,9532.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9338.58,,,9338.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6417.22,,,6417.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6479.22,,,6479.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6200.21,,,6200.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6262.21,,,6262.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6386.22,,,6386.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6494.72,,,6494.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
19357 - TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION,19357,HCPCS,,,50,Outpatient,,,241.66,60.415,135.33,27063.88,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27063.88,,,27063.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25694.85,,,25694.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,158.53,Percent of Total Billed Charges, ,27063.88,,,27063.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,169.16,Percent of Total Billed Charges, ,,85,,205.41,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,164.33,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,135.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,145,Percent of Total Billed Charges, ,25432.26,,,25432.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26215.48,,,26215.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17120.26,,,17120.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17285.67,,,17285.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16706.72,,,16706.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16541.31,,,16541.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16706.72,,,16706.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17037.55,,,17037.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17327.02,,,17327.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE,20206,HCPCS,,,RT,Outpatient,,,2684,671,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1760.7,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1878.8,Percent of Total Billed Charges, ,,85,,2281.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1825.12,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1503.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1610.4,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE,20206,HCPCS,,,LT,Outpatient,,,2684,671,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1760.7,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1878.8,Percent of Total Billed Charges, ,,85,,2281.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1825.12,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1503.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1610.4,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20526 - INJECTION THERAPEUTIC CARPAL TUNNEL,20526,HCPCS,,,LT,Outpatient,,,900,225,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20605 - ARTHROCENTESIS ASPIRAND-INJ INTERM JT-BURS W-O US,20605,HCPCS,,,LT,Outpatient,,,387.5,96.875,217,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,254.2,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,271.25,Percent of Total Billed Charges, ,,85,,329.38,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,263.5,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,217,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,232.5,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,RT,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,LT,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,52,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,50,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20611 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-US,20611,HCPCS,,,RT,Outpatient,,,775,193.75,280.65,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20611 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-US,20611,HCPCS,,,LT,Outpatient,,,775,193.75,280.65,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23350 - INJECTION SHOULDER ARTHROGRAPHY- CT-MRI ARTHG,23350,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23350 - INJECTION SHOULDER ARTHROGRAPHY- CT-MRI ARTHG,23350,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25000 - INCISION EXTENSOR TENDON SHEATH WRIST,25000,HCPCS,,,RT,Outpatient,,,1800,450,742.5,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25075 - EXC TUMOR SOFT TISSUE FOREARM AND-WRIST SUBQ LESS THAN 3CM,25075,HCPCS,,,RT,Outpatient,,,1800,450,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25111 - EXCISION GANGLION WRIST DORSAL-VOLAR PRIMARY,25111,HCPCS,,,LT,Outpatient,,,900,225,504,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25115 - RAD EXC BURSA SYNVA WRST-F-ARM TDN SHTHS FLXRS,25115,HCPCS,,,XS,Outpatient,,,900,225,504,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25210 - CARPECTOMY 1 BONE,25210,HCPCS,,,XU,Outpatient,,,1800,450,882.09,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25310 - TDN TRNSPLJ-TR FLXR-XTNSR F-ARMAND-WRST 1 EA TDN,25310,HCPCS,,,RT,Outpatient,,,1800,450,1008,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25310 - TDN TRNSPLJ-TR FLXR-XTNSR F-ARMAND-WRST 1 EA TDN,25310,HCPCS,,,LT,Outpatient,,,900,225,504,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25447 - ARTHRP INTERCARPAL-CARP-MTCRPL JT INTERPOSITION,25447,HCPCS,,,RT,Outpatient,,,1800,450,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25447 - ARTHRP INTERCARPAL-CARP-MTCRPL JT INTERPOSITION,25447,HCPCS,,,LT,Outpatient,,,1800,450,882.09,10028,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25825 - ARTHRODESIS WRIST WITH AUTOGRAFT,25825,HCPCS,,,LT,Outpatient,,,900,225,504,10730.04,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F9,Outpatient,,,900,225,504,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26055 - TENDON SHEATH INCISION,26055,HCPCS,,,F8,Outpatient,,,1800,450,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26340 - MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,26340,HCPCS,,,XU,Outpatient,,,360,90,201.6,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,236.16,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,252,Percent of Total Billed Charges, ,,85,,306,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,244.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,201.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,216,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,F4,Outpatient,,,900,225,504,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26445 - TENOLYSIS EXTENSOR TENDON HAND-FINGER EACH,26445,HCPCS,,,F2,Outpatient,,,900,225,504,4828.64,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26471 - TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH,26471,HCPCS,,,F4,Outpatient,,,600,150,336,4828.64,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,393.6,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,420,Percent of Total Billed Charges, ,,85,,510,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,408,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,336,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,360,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26480 - TR-TRNSPL TDN CARP-MTCRPL HAND W-O FR GRF EA TDN,26480,HCPCS,,,RT,Outpatient,,,1800,450,1008,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26480 - TR-TRNSPL TDN CARP-MTCRPL HAND W-O FR GRF EA TDN,26480,HCPCS,,,LT,Outpatient,,,900,225,504,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26510 - CROSS INTRINSIC TRANSFER EACH TENDON,26510,HCPCS,,,F2,Outpatient,,,900,225,504,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26525 - CAPSULECTOMY-CAPSULOTOMY IPHAL JOINT EACH,26525,HCPCS,,,F3,Outpatient,,,600,150,336,4478,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,393.6,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,420,Percent of Total Billed Charges, ,,85,,510,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,408,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,336,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,360,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26852 - ARTHRODESIS MTCRPL JT W-WO INT FIXJ W-AUTOGRAFT,26852,HCPCS,,,LT,Outpatient,,,1800,450,742.5,10730.04,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10550.25,,,10550.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,10730.04,,,10730.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,10442.44,,,10442.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10393.68,,,10393.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7029.54,,,7029.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7097.46,,,7097.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6791.83,,,6791.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6859.75,,,6859.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6995.58,,,6995.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7114.44,,,7114.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27093 - INJECTION HIP ARTHROGRAPHY W-O ANESTHESIA,27093,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27093 - INJECTION HIP ARTHROGRAPHY W-O ANESTHESIA,27093,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27093 - INJECTION HIP ARTHROGRAPHY W-O ANESTHESIA,27093,HCPCS,,,50,Outpatient,,,1496.33,374.0825,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,981.59,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1047.43,Percent of Total Billed Charges, ,,85,,1271.88,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1017.5,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,837.94,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,897.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27095 - INJECTION HIP ARTHROGRAPHY W-ANESTHESIA,27095,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W-ANKLE FOOT,29581,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,9153,,,,,,,Service Paid at Rev Code level,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29882 - ARTHROSCOPY KNEE W-MENISCUS RPR MEDIAL-LATERAL,29882,HCPCS,,,RT,Outpatient,,,362.5,90.625,203,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,237.8,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,253.75,Percent of Total Billed Charges, ,,85,,308.13,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,246.5,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,217.5,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,RT,Outpatient,,,988,247,553.28,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,648.13,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,691.6,Percent of Total Billed Charges, ,,85,,839.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,671.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,553.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,592.8,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31628 - BRONCHOSCOPY W-TRANSBRONCHIAL LUNG BX 1 LOBE,31628,HCPCS,,,RT,Outpatient,,,988,247,553.28,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,648.13,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,691.6,Percent of Total Billed Charges, ,,85,,839.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,671.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,553.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,592.8,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32408 - CORE NEEDLE BX LUNG-MEDIASTINUM PERQ W-IMG,32408,HCPCS,,,RT,Outpatient,,,3151,787.75,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2067.06,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2205.7,Percent of Total Billed Charges, ,,85,,2678.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2142.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1764.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1890.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32408 - CORE NEEDLE BX LUNG-MEDIASTINUM PERQ W-IMG,32408,HCPCS,,,LT,Outpatient,,,3151,787.75,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2067.06,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2205.7,Percent of Total Billed Charges, ,,85,,2678.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2142.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1764.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1890.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,LT,Outpatient,,,3831,957.75,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2513.14,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2681.7,Percent of Total Billed Charges, ,,85,,3256.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2605.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2145.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2298.6,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,52,Outpatient,,,3831,957.75,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2513.14,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2681.7,Percent of Total Billed Charges, ,,85,,3256.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2605.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2145.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2298.6,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36002 - INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM,36002,HCPCS,,,RT,Outpatient,,,1800,450,587.8,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36005 - NJX PX XTR VNGRPH W-INTRO NDL-INTRACATH,36005,HCPCS,,,XU,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36005 - NJX PX XTR VNGRPH W-INTRO NDL-INTRACATH,36005,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36005 - NJX PX XTR VNGRPH W-INTRO NDL-INTRACATH,36005,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36010 - INTRO CATHETER SUPERIOR-INFERIOR VENA CAVA,36010,HCPCS,,,XU,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36010 - INTRO CATHETER SUPERIOR-INFERIOR VENA CAVA,36010,HCPCS,,,50,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36014 - SLCTV CATHETER PLMT LEFT-RIGHT PULMONARY ARTERY,36014,HCPCS,,,50,Outpatient,,,1636,409,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1073.22,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1145.2,Percent of Total Billed Charges, ,,85,,1390.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1112.48,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,916.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,981.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36140 - INTRO OF NEEDLE OR INTRACATHETER UPR-LXTR ARTERY,36140,HCPCS,,,XU,Outpatient,,,1700,425,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1115.2,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1190,Percent of Total Billed Charges, ,,85,,1445,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1156,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,952,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1020,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36140 - INTRO OF NEEDLE OR INTRACATHETER UPR-LXTR ARTERY,36140,HCPCS,,,RT,Outpatient,,,1700,425,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1115.2,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1190,Percent of Total Billed Charges, ,,85,,1445,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1156,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,952,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1020,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36140 - INTRO OF NEEDLE OR INTRACATHETER UPR-LXTR ARTERY,36140,HCPCS,,,LT,Outpatient,,,1700,425,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1115.2,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1190,Percent of Total Billed Charges, ,,85,,1445,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1156,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,952,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1020,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36200 - INTRODUCTION CATHETER AORTA,36200,HCPCS,,,XU,Outpatient,,,1478,369.5,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,969.57,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1034.6,Percent of Total Billed Charges, ,,85,,1256.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1005.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,827.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,886.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36200 - INTRODUCTION CATHETER AORTA,36200,HCPCS,,,LT,Outpatient,,,1478,369.5,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,969.57,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1034.6,Percent of Total Billed Charges, ,,85,,1256.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1005.04,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,827.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,886.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36215 - SLCTV CATHJ EA 1ST ORD THRC-BRCH-CPHLC BRNCH,36215,HCPCS,,,XU,Outpatient,,,6634,1658.5,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4351.9,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4643.8,Percent of Total Billed Charges, ,,85,,5638.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,4511.12,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3715.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3980.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36215 - SLCTV CATHJ EA 1ST ORD THRC-BRCH-CPHLC BRNCH,36215,HCPCS,,,RT,Outpatient,,,3432,858,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2251.39,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2402.4,Percent of Total Billed Charges, ,,85,,2917.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2333.76,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1921.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2059.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36215 - SLCTV CATHJ EA 1ST ORD THRC-BRCH-CPHLC BRNCH,36215,HCPCS,,,LT,Outpatient,,,3549.24,887.31,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2328.3,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2484.47,Percent of Total Billed Charges, ,,85,,3016.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2413.48,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1987.57,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2129.54,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36216 - SLCTV CATHJ 1ST 2ND ORD THRC-BRCH-CPHLC BRNCH,36216,HCPCS,,,XU,Outpatient,,,3549,887.25,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2328.14,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2484.3,Percent of Total Billed Charges, ,,85,,3016.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2413.32,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1987.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2129.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36216 - SLCTV CATHJ 1ST 2ND ORD THRC-BRCH-CPHLC BRNCH,36216,HCPCS,,,RT,Outpatient,,,3718,929.5,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2439.01,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2602.6,Percent of Total Billed Charges, ,,85,,3160.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2528.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2082.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2230.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36216 - SLCTV CATHJ 1ST 2ND ORD THRC-BRCH-CPHLC BRNCH,36216,HCPCS,,,LT,Outpatient,,,3380,845,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2217.28,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2366,Percent of Total Billed Charges, ,,85,,2873,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2298.4,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1892.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2028,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36245 - SLCTV CATHJ EA 1ST ORD ABDL PEL-LXTR ART BRNCH,36245,HCPCS,,,XU,Outpatient,,,3872.33,968.0825,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2540.25,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2710.63,Percent of Total Billed Charges, ,,85,,3291.48,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2633.18,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2168.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2323.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36245 - SLCTV CATHJ EA 1ST ORD ABDL PEL-LXTR ART BRNCH,36245,HCPCS,,,RT,Outpatient,,,1743,435.75,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1143.41,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1220.1,Percent of Total Billed Charges, ,,85,,1481.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1185.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,976.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1045.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36245 - SLCTV CATHJ EA 1ST ORD ABDL PEL-LXTR ART BRNCH,36245,HCPCS,,,LT,Outpatient,,,1736.07,434.0175,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1138.86,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1215.25,Percent of Total Billed Charges, ,,85,,1475.66,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1180.53,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,972.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1041.64,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36245 - SLCTV CATHJ EA 1ST ORD ABDL PEL-LXTR ART BRNCH,36245,HCPCS,,,50,Outpatient,,,2812.45,703.1125,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1844.97,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1968.72,Percent of Total Billed Charges, ,,85,,2390.58,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1912.47,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1574.97,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1687.47,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36248 - SLCTV CATHJ EA 2ND+ ORD ABDL PEL-LXTR ART BRNCH,36248,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36251 - SLCTV CATH 1STORD W-WO ART PUNCT-FLUORO-SANDI UN,36251,HCPCS,,,XU,Outpatient,,,5747,1436.75,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3770.03,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4022.9,Percent of Total Billed Charges, ,,85,,4884.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3907.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3218.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3448.2,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36251 - SLCTV CATH 1STORD W-WO ART PUNCT-FLUORO-SANDI UN,36251,HCPCS,,,RT,Outpatient,,,5747,1436.75,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3770.03,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4022.9,Percent of Total Billed Charges, ,,85,,4884.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3907.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3218.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3448.2,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36251 - SLCTV CATH 1STORD W-WO ART PUNCT-FLUORO-SANDI UN,36251,HCPCS,,,LT,Outpatient,,,5747,1436.75,1078.11,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3770.03,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4022.9,Percent of Total Billed Charges, ,,85,,4884.95,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3907.96,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3218.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3448.2,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36253 - SUPSLCTV CATH 2ND+ORD RENALANDACCESSORY ARTERY-SANDI,36253,HCPCS,,,XU,Outpatient,,,9859,2464.75,1078.11,10452,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6467.5,Percent of Total Billed Charges, ,8337.54,,,8337.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6901.3,Percent of Total Billed Charges, ,,85,,8380.15,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6704.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5521.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5915.4,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8076.18,,,8076.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36589 - RMVL TUN CVC W-O SUBQ PORT-PMP,36589,HCPCS,,,LT,Outpatient,,,1800,450,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37224 - REVSC OPN-PRG FEM-POP W-ANGIOPLASTY UNI,37224,HCPCS,,,XU,Outpatient,,,850,212.5,476,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,557.6,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,595,Percent of Total Billed Charges, ,,85,,722.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,578,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,476,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,510,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37224 - REVSC OPN-PRG FEM-POP W-ANGIOPLASTY UNI,37224,HCPCS,,,LT,Outpatient,,,850,212.5,476,10452,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,557.6,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,595,Percent of Total Billed Charges, ,,85,,722.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,578,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,476,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,510,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37226 - REVSC OPN-PRQ FEM-POP W-STNT-ANGIOP SM VSL,37226,HCPCS,,,RT,Outpatient,,,845.5,211.375,473.48,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,554.65,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,591.85,Percent of Total Billed Charges, ,,85,,718.68,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,574.94,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,473.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,507.3,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37765 - STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS,37765,HCPCS,,,RT,Outpatient,,,6353,1588.25,882.09,9153,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4167.57,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4447.1,Percent of Total Billed Charges, ,,85,,5400.05,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4320.04,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3557.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3811.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
38525 - BX-EXC LYMPH NODE OPEN DEEP AXILLARY NODE,38525,HCPCS,,,RT,Outpatient,,,1262.5,315.625,707,5655.3,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5655.3,,,5655.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,828.2,Percent of Total Billed Charges, ,5576.68,,,5576.68,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,883.75,Percent of Total Billed Charges, ,,85,,1073.13,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,858.5,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,707,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,757.5,Percent of Total Billed Charges, ,5597.5,,,5597.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5401.86,,,5401.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3768.07,,,3768.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3804.48,,,3804.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3640.65,,,3640.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3677.06,,,3677.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3749.87,,,3749.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3813.58,,,3813.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42400 - BIOPSY SALIVARY GLAND NEEDLE,42400,HCPCS,,,RT,Outpatient,,,1388,347,668.93,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,910.53,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,971.6,Percent of Total Billed Charges, ,,85,,1179.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,943.84,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,777.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,832.8,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
47000 - BIOPSY LIVER NEEDLE PERCUTANEOUS,47000,HCPCS,,,XU,Outpatient,,,2270,567.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1489.12,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1589,Percent of Total Billed Charges, ,,85,,1929.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1543.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1271.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1362,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
47000 - BIOPSY LIVER NEEDLE PERCUTANEOUS,47000,HCPCS,,,74,Outpatient,,,2270,567.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1489.12,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1589,Percent of Total Billed Charges, ,,85,,1929.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1543.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1271.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1362,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
47000 - BIOPSY LIVER NEEDLE PERCUTANEOUS,47000,HCPCS,,,73,Outpatient,,,2270,567.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1489.12,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1589,Percent of Total Billed Charges, ,,85,,1929.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1543.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1271.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1362,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
47000 - BIOPSY LIVER NEEDLE PERCUTANEOUS,47000,HCPCS,,,52,Outpatient,,,2270,567.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1489.12,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1589,Percent of Total Billed Charges, ,,85,,1929.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1543.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1271.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1362,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49423 - EXCHNG ABSC-CST DRG CATH RAD GID SPX,49423,HCPCS,,,XU,Outpatient,,,577,144.25,323.12,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,378.51,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,403.9,Percent of Total Billed Charges, ,,85,,490.45,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,392.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,323.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,346.2,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49424 - CNTRST NJX ASSMT ABSC-CST VIA DRG CATH-TUBE SPX,49424,HCPCS,,,XU,Outpatient,,,1129.96,282.49,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,741.25,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,790.97,Percent of Total Billed Charges, ,,85,,960.47,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,768.37,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,632.78,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,677.98,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49424 - CNTRST NJX ASSMT ABSC-CST VIA DRG CATH-TUBE SPX,49424,HCPCS,,,59,Outpatient,,,1041.75,260.4375,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,683.39,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,729.23,Percent of Total Billed Charges, ,,85,,885.49,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,708.39,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,583.38,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,625.05,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50382 - RMVL AND RPLCMT INTLY DWELLING URETERAL STENT PRQ,50382,HCPCS,,,LT,Outpatient,,,4800.5,1200.125,882.09,4080.43,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3149.13,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3360.35,Percent of Total Billed Charges, ,,85,,4080.43,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3264.34,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2688.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2880.3,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50390 - ASPIR AND-NJX RENAL CYST-PELVIS NEEDLE PRQ,50390,HCPCS,,,RT,Outpatient,,,387.5,96.875,217,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,254.2,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,271.25,Percent of Total Billed Charges, ,,85,,329.38,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,263.5,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,217,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,232.5,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50543 - LAPAROSCOPY SURG PARTIAL NEPHRECTOMY,50543,HCPCS,,,LT,Outpatient,,,725,181.25,406,15375.87,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15375.87,,,15375.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,14741.13,,,14741.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,15218.73,,,15218.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14279.03,,,14279.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10244.8,,,10244.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10343.79,,,10343.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9898.36,,,9898.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9997.34,,,9997.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10195.31,,,10195.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10368.53,,,10368.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50693 - PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT,50693,HCPCS,,,LT,Outpatient,,,4800.5,1200.125,742.5,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3149.13,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3360.35,Percent of Total Billed Charges, ,,85,,4080.43,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3264.34,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2688.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2880.3,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50694 - PLMT URTRL STNT PRQ NEW ACESS W-O SEP NFROS CATH,50694,HCPCS,,,RT,Outpatient,,,9601,2400.25,742.5,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50695 - PLMT URTRL STENT PRQ NEW ACCESS W-SEP NFROS CATH,50695,HCPCS,,,RT,Outpatient,,,9201,2300.25,742.5,10028,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6035.86,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6440.7,Percent of Total Billed Charges, ,,85,,7820.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6256.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5152.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5520.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,RT,Outpatient,,,725,181.25,406,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62322 - NJX DX-THER SBST INTRLMNR LMBR-SAC W-O IMG GDN,62322,HCPCS,,,XP,Outpatient,,,1793.67,448.4175,846.43,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1176.65,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1255.57,Percent of Total Billed Charges, ,,85,,1524.62,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1219.7,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1004.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1076.2,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62328 - DIAGNOSTIC LUMBAR SPINAL PUNCTURE W-FLUOR OR CT,62328,HCPCS,,,59,Outpatient,,,1800,450,658.41,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64417 - INJECTION AAAND-STRD AXILLARY NERVE W-IMG GDN,64417,HCPCS,,,XP,Outpatient,,,1696.92,424.23,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1113.18,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1187.84,Percent of Total Billed Charges, ,,85,,1442.38,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1153.91,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,950.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1018.15,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,XP,Outpatient,,,725,181.25,406,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64454 - INJECTION AAAND-STRD GENICULAR NRV BRANCHES W-IMG,64454,HCPCS,,,XP,Outpatient,,,1287.5,321.875,658.41,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,844.6,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,901.25,Percent of Total Billed Charges, ,,85,,1094.38,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,875.5,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,721,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,772.5,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE,64640,HCPCS,,,LT,Outpatient,,,1800,450,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64708 - NEURP MAJOR PRPH NRV ARM-LEG OPN OTH-THN SPEC,64708,HCPCS,,,XU,Outpatient,,,900,225,504,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64719 - NEUROPLASTY AND-TRANSPOSITION ULNAR NERVE WRIST,64719,HCPCS,,,RT,Outpatient,,,1800,450,950.4,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64721 - NEUROPLASTY AND-TRANSPOS MEDIAN NRV CARPAL TUNNE,64721,HCPCS,,,RT,Outpatient,,,1800,450,950.4,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64721 - NEUROPLASTY AND-TRANSPOS MEDIAN NRV CARPAL TUNNE,64721,HCPCS,,,LT,Outpatient,,,1800,450,950.4,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64772 - TRANSECTION-AVULSION OTH SPINAL NRV XDRL,64772,HCPCS,,,XP,Outpatient,,,900,225,504,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64772 - TRANSECTION-AVULSION OTH SPINAL NRV XDRL,64772,HCPCS,,,LT,Outpatient,,,900,225,504,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2883.96,,,2883.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,590.4,Percent of Total Billed Charges, ,2915.9,,,2915.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,630,Percent of Total Billed Charges, ,,85,,765,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,612,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,504,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,540,Percent of Total Billed Charges, ,2854.49,,,2854.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2824.49,,,2824.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1921.56,,,1921.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1940.13,,,1940.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1856.58,,,1856.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1875.15,,,1875.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1912.28,,,1912.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1944.77,,,1944.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64999 - UNLISTED PROCEDURE NERVOUS SYSTEM,64999,HCPCS,,,XU,Outpatient,,,1450,362.5,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,951.2,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1015,Percent of Total Billed Charges, ,,85,,1232.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,986,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,812,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,870,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64999 - UNLISTED PROCEDURE NERVOUS SYSTEM,64999,HCPCS,,,XP,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64999 - UNLISTED PROCEDURE NERVOUS SYSTEM,64999,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64999 - UNLISTED PROCEDURE NERVOUS SYSTEM,64999,HCPCS,,,50,Outpatient,,,993.75,248.4375,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,651.9,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,695.63,Percent of Total Billed Charges, ,,85,,844.69,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,675.75,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,556.5,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,596.25,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97597 - DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM-LESS THAN,97597,HCPCS,,,GO,Outpatient,,,725,181.25,71.46,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,253.93,,,253.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0361 - OPERATING ROOM SERVICES - MINOR SURGERY,0361,RC,,,,Outpatient,,,6421.37,1605.3425,1442,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,4212.42,Percent of Total Billed Charges, ,,,,,,,,70,,4494.96,Percent of Total Billed Charges, ,,85,,5458.16,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4366.53,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3852.82,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
99151 - MOD SED SAME PHYS-QHP INITIAL 15 MINS LESS THAN 5 YRS,99151,HCPCS,,,59,Outpatient,,,265,66.25,0.01,225.25,,,46,,121.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,123.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,173.84,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,185.5,Percent of Total Billed Charges, ,,85,,225.25,Percent of Total Billed Charges, ,,50,,132.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,180.2,Percent of Total Billed Charges,0,,50,,132.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,148.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,159,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99152 - MOD SED SAME PHYS-QHP INITIAL 15 MINS 5-GREATER THAN YRS,99152,HCPCS,,,59,Outpatient,,,292,73,0.01,248.2,,,46,,134.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,135.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,191.55,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,204.4,Percent of Total Billed Charges, ,,85,,248.2,Percent of Total Billed Charges, ,,50,,146,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.56,Percent of Total Billed Charges,0,,50,,146,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,163.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,175.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99153 - MOD SED SAME PHYS-QHP EACH ADDL 15 MINS,99153,HCPCS,,,59,Outpatient,,,292,73,0.01,248.2,,,46,,134.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,135.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,191.55,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,204.4,Percent of Total Billed Charges, ,,85,,248.2,Percent of Total Billed Charges, ,,50,,146,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.56,Percent of Total Billed Charges,0,,50,,146,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,163.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,175.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0370 - ANESTHESIA - GENERAL CLASSIFICATION,0370,RC,,,,Outpatient,,,289.3,72.325,173.58,245.91,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,189.78,Percent of Total Billed Charges, ,,,,,,,,70,,202.51,Percent of Total Billed Charges, ,,85,,245.91,Percent of Total Billed Charges, ,,,,,,,,68,,196.72,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,173.58,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
P9016 - RBC LEUKOCYTES REDUCED,P9016,HCPCS,,,XU,Outpatient,,,332,83,152.72,282.2,,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,218.99,,,218.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,154.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,268.79,,,268.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,217.79,Percent of Total Billed Charges, ,218.99,,,218.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,232.4,Percent of Total Billed Charges, ,,85,,282.2,Percent of Total Billed Charges, ,,50,,166,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,225.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,185.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.2,Percent of Total Billed Charges, ,266.03,,,266.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,212.16,,,212.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,179.09,,,179.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,180.82,,,180.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.76,,,174.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,173.03,,,173.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.76,,,174.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,178.22,,,178.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.25,,,181.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
P9016 - RBC LEUKOCYTES REDUCED,P9016,HCPCS,,,59,Outpatient,,,332,83,152.72,282.2,,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,218.99,,,218.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,154.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,268.79,,,268.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,217.79,Percent of Total Billed Charges, ,218.99,,,218.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,232.4,Percent of Total Billed Charges, ,,85,,282.2,Percent of Total Billed Charges, ,,50,,166,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,225.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,185.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.2,Percent of Total Billed Charges, ,266.03,,,266.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,212.16,,,212.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,179.09,,,179.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,180.82,,,180.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.76,,,174.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,173.03,,,173.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.76,,,174.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,178.22,,,178.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.25,,,181.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
P9073 - PLATELETS PHERESIS PATH REDU,P9073,HCPCS,,,XU,Outpatient,,,1864,466,558.35,1584.4,,,46,,857.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,668.83,,,668.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,866.76,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,867.33,,,867.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1222.78,Percent of Total Billed Charges, ,668.83,,,668.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1304.8,Percent of Total Billed Charges, ,,85,,1584.4,Percent of Total Billed Charges, ,,50,,932,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1267.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,1043.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1118.4,Percent of Total Billed Charges, ,858.46,,,858.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,647.98,,,647.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,577.89,,,577.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,583.48,,,583.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,563.93,,,563.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,558.35,,,558.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,563.93,,,563.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,575.1,,,575.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,584.87,,,584.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0390 - ADMINISTRATION PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION,0390,RC,,,,Outpatient,,,471.27,117.8175,282.76,1419,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,309.15,Percent of Total Billed Charges, ,,,,,,,,70,,329.89,Percent of Total Billed Charges, ,,85,,400.58,Percent of Total Billed Charges, ,,,,,,,,68,,320.46,Percent of Total Billed Charges,0,1419,,,1419,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,282.76,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
36430 - TRANSFUSION BLOOD-BLOOD COMPONENTS,36430,HCPCS,,,XU,Outpatient,,,1800,450,415.64,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,661.45,,,661.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,645.65,,,645.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,661.45,,,661.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,639.05,,,639.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.71,,,640.71,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,430.19,,,430.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,434.34,,,434.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,419.8,,,419.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.64,,,415.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,419.8,,,419.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,428.11,,,428.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,435.38,,,435.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0391 - ADMINISTRATION PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - ADMINISTRATION (E.G. TRANSFUSIONS),0391,RC,,,,Outpatient,,,1800,450,1080,1530,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,1180.8,Percent of Total Billed Charges, ,,,,,,,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,,,,,,,68,,1224,Percent of Total Billed Charges,0,1419,,,1419,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1080,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,77061,HCPCS,,,XU,Outpatient,,,283,70.75,0.01,240.55,,,34.4,,97.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,185.65,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.1,Percent of Total Billed Charges, ,,85,,240.55,Percent of Total Billed Charges, ,,50,,141.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,192.44,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,158.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,169.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,77061,HCPCS,,,XP,Outpatient,,,283,70.75,0.01,240.55,,,34.4,,97.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,185.65,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.1,Percent of Total Billed Charges, ,,85,,240.55,Percent of Total Billed Charges, ,,50,,141.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,192.44,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,158.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,169.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,77061,HCPCS,,,TC,Outpatient,,,283,70.75,0.01,240.55,,,34.4,,97.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,185.65,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.1,Percent of Total Billed Charges, ,,85,,240.55,Percent of Total Billed Charges, ,,50,,141.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,192.44,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,158.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,169.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,77061,HCPCS,,,RT,Outpatient,,,283,70.75,0.01,240.55,,,34.4,,97.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,185.65,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.1,Percent of Total Billed Charges, ,,85,,240.55,Percent of Total Billed Charges, ,,50,,141.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,192.44,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,158.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,169.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77061 - DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,77061,HCPCS,,,LT,Outpatient,,,283,70.75,0.01,240.55,,,34.4,,97.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,185.65,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.1,Percent of Total Billed Charges, ,,85,,240.55,Percent of Total Billed Charges, ,,50,,141.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,192.44,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,158.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,169.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,186.58,,,186.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77062 - DIGITAL BREAST TOMOSYNTHESIS BILATERAL,77062,HCPCS,,,GA,Outpatient,,,375,93.75,0.01,318.75,,,34.4,,129,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,173.05,,,173.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,246,Percent of Total Billed Charges, ,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,262.5,Percent of Total Billed Charges, ,,85,,318.75,Percent of Total Billed Charges, ,,50,,187.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,255,Percent of Total Billed Charges,0,143.77,,,143.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,210,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,225,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.7,,,121.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,245.53,,,245.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,245.53,,,245.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,245.53,,,245.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,245.53,,,245.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77065 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI,77065,HCPCS,,,XU,Outpatient,,,538,134.5,82.88,457.3,,,34.4,,185.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,131.78,,,131.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,352.93,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,376.6,Percent of Total Billed Charges, ,,85,,457.3,Percent of Total Billed Charges, ,,50,,269,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,365.84,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,301.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,322.8,Percent of Total Billed Charges, ,127.43,,,127.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,85.78,,,85.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.61,,,86.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.88,,,82.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.37,,,85.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77065 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI,77065,HCPCS,,,RT,Outpatient,,,538,134.5,82.88,457.3,,,34.4,,185.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,131.78,,,131.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,352.93,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,376.6,Percent of Total Billed Charges, ,,85,,457.3,Percent of Total Billed Charges, ,,50,,269,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,365.84,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,301.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,322.8,Percent of Total Billed Charges, ,127.43,,,127.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,85.78,,,85.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.61,,,86.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.88,,,82.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.37,,,85.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77065 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI,77065,HCPCS,,,LT,Outpatient,,,538,134.5,82.88,457.3,,,34.4,,185.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,131.78,,,131.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,352.93,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,376.6,Percent of Total Billed Charges, ,,85,,457.3,Percent of Total Billed Charges, ,,50,,269,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,365.84,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,301.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,322.8,Percent of Total Billed Charges, ,127.43,,,127.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,85.78,,,85.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.61,,,86.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.88,,,82.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.37,,,85.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77065 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI,77065,HCPCS,,,GG,Outpatient,,,538,134.5,82.88,457.3,,,34.4,,185.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,131.78,,,131.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,352.93,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,376.6,Percent of Total Billed Charges, ,,85,,457.3,Percent of Total Billed Charges, ,,50,,269,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,365.84,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,301.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,322.8,Percent of Total Billed Charges, ,127.43,,,127.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,85.78,,,85.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.61,,,86.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.88,,,82.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.37,,,85.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77065 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI,77065,HCPCS,,,GA,Outpatient,,,538,134.5,82.88,457.3,,,34.4,,185.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,131.78,,,131.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,352.93,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,376.6,Percent of Total Billed Charges, ,,85,,457.3,Percent of Total Billed Charges, ,,50,,269,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,365.84,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,301.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,322.8,Percent of Total Billed Charges, ,127.43,,,127.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,85.78,,,85.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.61,,,86.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.88,,,82.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.37,,,85.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77065 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI,77065,HCPCS,,,76,Outpatient,,,538,134.5,82.88,457.3,,,34.4,,185.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.69,,,135.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,131.78,,,131.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,352.93,Percent of Total Billed Charges, ,98.51,,,98.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,376.6,Percent of Total Billed Charges, ,,85,,457.3,Percent of Total Billed Charges, ,,50,,269,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,365.84,Percent of Total Billed Charges,0,112.45,,,112.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,301.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,322.8,Percent of Total Billed Charges, ,127.43,,,127.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.44,,,95.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,85.78,,,85.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.61,,,86.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.88,,,82.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.37,,,85.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,310.19,,,310.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77066 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI,77066,HCPCS,,,LT,Outpatient,,,940,235,105.58,799,,,34.4,,323.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,173.05,,,173.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,167.87,,,167.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,616.64,Percent of Total Billed Charges, ,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,658,Percent of Total Billed Charges, ,,85,,799,Percent of Total Billed Charges, ,,50,,470,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,639.2,Percent of Total Billed Charges,0,143.77,,,143.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,526.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,564,Percent of Total Billed Charges, ,162.33,,,162.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.7,,,121.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,109.28,,,109.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,110.33,,,110.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.64,,,106.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.58,,,105.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.64,,,106.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,108.75,,,108.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,110.6,,,110.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77066 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI,77066,HCPCS,,,GG,Outpatient,,,940,235,105.58,799,,,34.4,,323.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,173.05,,,173.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,167.87,,,167.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,616.64,Percent of Total Billed Charges, ,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,658,Percent of Total Billed Charges, ,,85,,799,Percent of Total Billed Charges, ,,50,,470,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,639.2,Percent of Total Billed Charges,0,143.77,,,143.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,526.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,564,Percent of Total Billed Charges, ,162.33,,,162.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.7,,,121.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,109.28,,,109.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,110.33,,,110.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.64,,,106.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.58,,,105.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.64,,,106.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,108.75,,,108.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,110.6,,,110.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77066 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI,77066,HCPCS,,,GA,Outpatient,,,940,235,105.58,799,,,34.4,,323.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,173.05,,,173.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,167.87,,,167.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,616.64,Percent of Total Billed Charges, ,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,658,Percent of Total Billed Charges, ,,85,,799,Percent of Total Billed Charges, ,,50,,470,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,639.2,Percent of Total Billed Charges,0,143.77,,,143.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,526.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,564,Percent of Total Billed Charges, ,162.33,,,162.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.7,,,121.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,109.28,,,109.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,110.33,,,110.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.64,,,106.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.58,,,105.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.64,,,106.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,108.75,,,108.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,110.6,,,110.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,375.65,,,375.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
G0279 - TOMOSYNTHESIS MAMMO,G0279,HCPCS,,,RT,Outpatient,,,283,70.75,14.82,240.55,,,46,,130.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.56,,,23.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,185.65,Percent of Total Billed Charges, ,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.1,Percent of Total Billed Charges, ,,85,,240.55,Percent of Total Billed Charges, ,,50,,141.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,192.44,Percent of Total Billed Charges,0,31.33,,,31.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,158.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,169.8,Percent of Total Billed Charges, ,22.79,,,22.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.26,,,46.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.34,,,15.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.49,,,15.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.97,,,14.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.82,,,14.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.97,,,14.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.26,,,15.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.52,,,15.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0279 - TOMOSYNTHESIS MAMMO,G0279,HCPCS,,,LT,Outpatient,,,283.1,70.775,14.82,240.64,,,46,,130.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.56,,,23.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,185.71,Percent of Total Billed Charges, ,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.17,Percent of Total Billed Charges, ,,85,,240.64,Percent of Total Billed Charges, ,,50,,141.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,192.51,Percent of Total Billed Charges,0,31.33,,,31.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,158.54,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,169.86,Percent of Total Billed Charges, ,22.79,,,22.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.26,,,46.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.34,,,15.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.49,,,15.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.97,,,14.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.82,,,14.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.97,,,14.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.26,,,15.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.52,,,15.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0279 - TOMOSYNTHESIS MAMMO,G0279,HCPCS,,,GA,Outpatient,,,362.57,90.6425,14.82,308.18,,,46,,166.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.56,,,23.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,237.85,Percent of Total Billed Charges, ,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,253.8,Percent of Total Billed Charges, ,,85,,308.18,Percent of Total Billed Charges, ,,50,,181.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,246.55,Percent of Total Billed Charges,0,31.33,,,31.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,217.54,Percent of Total Billed Charges, ,22.79,,,22.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.26,,,46.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.34,,,15.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.49,,,15.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.97,,,14.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.82,,,14.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.97,,,14.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.26,,,15.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.52,,,15.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY,0401,RC,,,,Outpatient,,,434.58,108.645,260.75,369.39,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,285.08,Percent of Total Billed Charges, ,,,,,,,,70,,304.21,Percent of Total Billed Charges, ,,85,,369.39,Percent of Total Billed Charges, ,,,,,,,,68,,295.51,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,260.75,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
76536 - US SOFT TISSUE HEAD AND NECK REAL TIME IMGE DOCM,76536,HCPCS,,,PO,Outpatient,,,583,145.75,101.1,495.55,,,34.4,,200.55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,382.45,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,408.1,Percent of Total Billed Charges, ,,85,,495.55,Percent of Total Billed Charges, ,,50,,291.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,396.44,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,326.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,349.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,160.38,,,160.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,160.38,,,160.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,160.38,,,160.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,160.38,,,160.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76604 - US CHEST REAL TIME W-IMAGE DOCUMENTATION,76604,HCPCS,,,XU,Outpatient,,,576,144,68.31,489.6,,,34.4,,198.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,377.86,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,403.2,Percent of Total Billed Charges, ,,85,,489.6,Percent of Total Billed Charges, ,,50,,288,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,391.68,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,322.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,345.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76604 - US CHEST REAL TIME W-IMAGE DOCUMENTATION,76604,HCPCS,,,RT,Outpatient,,,576,144,68.31,489.6,,,34.4,,198.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,377.86,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,403.2,Percent of Total Billed Charges, ,,85,,489.6,Percent of Total Billed Charges, ,,50,,288,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,391.68,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,322.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,345.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76604 - US CHEST REAL TIME W-IMAGE DOCUMENTATION,76604,HCPCS,,,PO,Outpatient,,,576,144,68.31,489.6,,,34.4,,198.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,377.86,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,403.2,Percent of Total Billed Charges, ,,85,,489.6,Percent of Total Billed Charges, ,,50,,288,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,391.68,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,322.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,345.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76604 - US CHEST REAL TIME W-IMAGE DOCUMENTATION,76604,HCPCS,,,LT,Outpatient,,,576,144,68.31,489.6,,,34.4,,198.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,377.86,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,403.2,Percent of Total Billed Charges, ,,85,,489.6,Percent of Total Billed Charges, ,,50,,288,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,391.68,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,322.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,345.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76604 - US CHEST REAL TIME W-IMAGE DOCUMENTATION,76604,HCPCS,,,52,Outpatient,,,576,144,68.31,489.6,,,34.4,,198.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,377.86,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,403.2,Percent of Total Billed Charges, ,,85,,489.6,Percent of Total Billed Charges, ,,50,,288,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,391.68,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,322.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,345.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.31,,,68.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76641 - US BREAST UNI REAL TIME WITH IMAGE COMPLETE,76641,HCPCS,,,RT,Outpatient,,,275,68.75,94.6,233.75,,,34.4,,94.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,180.4,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,192.5,Percent of Total Billed Charges, ,,85,,233.75,Percent of Total Billed Charges, ,,50,,137.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,187,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,154,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,165,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76641 - US BREAST UNI REAL TIME WITH IMAGE COMPLETE,76641,HCPCS,,,LT,Outpatient,,,275,68.75,94.6,233.75,,,34.4,,94.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,180.4,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,192.5,Percent of Total Billed Charges, ,,85,,233.75,Percent of Total Billed Charges, ,,50,,137.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,187,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,154,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,165,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76641 - US BREAST UNI REAL TIME WITH IMAGE COMPLETE,76641,HCPCS,,,50,Outpatient,,,284,71,97.7,241.4,,,34.4,,97.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.3,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.8,Percent of Total Billed Charges, ,,85,,241.4,Percent of Total Billed Charges, ,,50,,142,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,193.12,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,159.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,170.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.3,,,188.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED,76642,HCPCS,,,XU,Outpatient,,,206.53,51.6325,71.05,175.55,,,34.4,,71.05,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,135.48,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,144.57,Percent of Total Billed Charges, ,,85,,175.55,Percent of Total Billed Charges, ,,50,,103.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,140.44,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,115.66,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,123.92,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED,76642,HCPCS,,,RT,Outpatient,,,200,50,68.8,170,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,50,,100,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED,76642,HCPCS,,,LT,Outpatient,,,200,50,68.8,170,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,50,,100,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76642 - US BREAST UNI REAL TIME WITH IMAGE LIMITED,76642,HCPCS,,,50,Outpatient,,,258,64.5,83.36,219.3,,,34.4,,88.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.45,,,130.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,169.25,Percent of Total Billed Charges, ,86.04,,,86.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,180.6,Percent of Total Billed Charges, ,,85,,219.3,Percent of Total Billed Charges, ,,50,,129,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,175.44,Percent of Total Billed Charges,0,99.51,,,99.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,144.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,154.8,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.36,,,83.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,144.05,,,144.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76700 - US ABDOMINAL REAL TIME W-IMAGE DOCUMENTATION,76700,HCPCS,,,XU,Outpatient,,,1442,360.5,101.1,3030,,,34.4,,496.05,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,945.95,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1009.4,Percent of Total Billed Charges, ,,85,,1225.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,980.56,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,807.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,865.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76700 - US ABDOMINAL REAL TIME W-IMAGE DOCUMENTATION,76700,HCPCS,,,XP,Outpatient,,,1442,360.5,101.1,3030,,,34.4,,496.05,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,945.95,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1009.4,Percent of Total Billed Charges, ,,85,,1225.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,980.56,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,807.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,865.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76700 - US ABDOMINAL REAL TIME W-IMAGE DOCUMENTATION,76700,HCPCS,,,PO,Outpatient,,,1442,360.5,101.1,3030,,,34.4,,496.05,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,945.95,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1009.4,Percent of Total Billed Charges, ,,85,,1225.7,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,980.56,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,807.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,865.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,166.32,,,166.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76705 - US ABDOMINAL REAL TIME W-IMAGE LIMITED,76705,HCPCS,,,XU,Outpatient,,,236,59,59.4,3030,,,34.4,,81.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.82,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,165.2,Percent of Total Billed Charges, ,,85,,200.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,160.48,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,132.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76705 - US ABDOMINAL REAL TIME W-IMAGE LIMITED,76705,HCPCS,,,PO,Outpatient,,,236,59,59.4,3030,,,34.4,,81.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.82,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,165.2,Percent of Total Billed Charges, ,,85,,200.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,160.48,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,132.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76705 - US ABDOMINAL REAL TIME W-IMAGE LIMITED,76705,HCPCS,,,76,Outpatient,,,236,59,59.4,3030,,,34.4,,81.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.82,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,165.2,Percent of Total Billed Charges, ,,85,,200.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,160.48,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,132.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76706 - US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA,76706,HCPCS,,,XU,Outpatient,,,207,51.75,71.21,213.93,,,34.4,,71.21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,135.79,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,144.9,Percent of Total Billed Charges, ,,85,,175.95,Percent of Total Billed Charges, ,,50,,103.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,140.76,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,115.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,124.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,213.93,,,213.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,213.93,,,213.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,213.93,,,213.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,213.93,,,213.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76706 - US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA,76706,HCPCS,,,PO,Outpatient,,,207,51.75,71.21,213.93,,,34.4,,71.21,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,135.79,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,144.9,Percent of Total Billed Charges, ,,85,,175.95,Percent of Total Billed Charges, ,,50,,103.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,140.76,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,115.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,124.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,213.93,,,213.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,213.93,,,213.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,213.93,,,213.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,213.93,,,213.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76775 - US RETROPERITONEAL REAL TIME W-IMAGE LIMITED,76775,HCPCS,,,XU,Outpatient,,,200,50,44.55,175.57,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,50,,100,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76775 - US RETROPERITONEAL REAL TIME W-IMAGE LIMITED,76775,HCPCS,,,XP,Outpatient,,,200,50,44.55,175.57,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,50,,100,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76775 - US RETROPERITONEAL REAL TIME W-IMAGE LIMITED,76775,HCPCS,,,PO,Outpatient,,,200,50,44.55,175.57,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,50,,100,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,44.55,,,44.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76819 - FETAL BIOPHYSICAL PROFILE W-O NON-STRESS TESTING,76819,HCPCS,,,59,Outpatient,,,371,92.75,101.1,315.35,,,34.4,,127.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,243.38,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,259.7,Percent of Total Billed Charges, ,,85,,315.35,Percent of Total Billed Charges, ,,50,,185.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,252.28,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,207.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,222.6,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,187.14,,,187.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,187.14,,,187.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,187.14,,,187.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,187.14,,,187.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76830 - US TRANSVAGINAL,76830,HCPCS,,,PO,Outpatient,,,632,158,101.1,3030,,,34.4,,217.41,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,414.59,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,442.4,Percent of Total Billed Charges, ,,85,,537.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,429.76,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,353.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,379.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.96,,,201.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,201.96,,,201.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,201.96,,,201.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,201.96,,,201.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,76856,HCPCS,,,XU,Outpatient,,,648,162,101.1,3030,,,34.4,,222.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,425.09,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,453.6,Percent of Total Billed Charges, ,,85,,550.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,440.64,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,362.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,388.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,76856,HCPCS,,,PO,Outpatient,,,648,162,101.1,3030,,,34.4,,222.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,425.09,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,453.6,Percent of Total Billed Charges, ,,85,,550.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,440.64,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,362.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,388.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76856 - US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,76856,HCPCS,,,59,Outpatient,,,648,162,101.1,3030,,,34.4,,222.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,425.09,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,453.6,Percent of Total Billed Charges, ,,85,,550.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,440.64,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,362.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,388.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,118.8,,,118.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76857 - US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED-F-U,76857,HCPCS,,,PO,Outpatient,,,452,113,71.28,3030,,,34.4,,155.49,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,296.51,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,316.4,Percent of Total Billed Charges, ,,85,,384.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,307.36,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,253.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,271.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76870 - US SCROTUM AND CONTENTS,76870,HCPCS,,,PO,Outpatient,,,669,167.25,92.07,568.65,,,34.4,,230.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,438.86,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,468.3,Percent of Total Billed Charges, ,,85,,568.65,Percent of Total Billed Charges, ,,50,,334.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,454.92,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,374.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,401.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.07,,,92.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,92.07,,,92.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,92.07,,,92.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,92.07,,,92.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76881 - US COMPL JOINT R-T W-IMAGE DOCUMENTATION,76881,HCPCS,,,XS,Outpatient,,,249,62.25,85.66,3030,,,34.4,,85.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,163.34,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,174.3,Percent of Total Billed Charges, ,,85,,211.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,169.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,139.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,149.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76881 - US COMPL JOINT R-T W-IMAGE DOCUMENTATION,76881,HCPCS,,,RT,Outpatient,,,249,62.25,85.66,3030,,,34.4,,85.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,163.34,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,174.3,Percent of Total Billed Charges, ,,85,,211.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,169.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,139.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,149.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76881 - US COMPL JOINT R-T W-IMAGE DOCUMENTATION,76881,HCPCS,,,LT,Outpatient,,,249,62.25,85.66,3030,,,34.4,,85.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,163.34,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,174.3,Percent of Total Billed Charges, ,,85,,211.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,169.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,139.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,149.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76881 - US COMPL JOINT R-T W-IMAGE DOCUMENTATION,76881,HCPCS,,,76,Outpatient,,,249,62.25,85.66,3030,,,34.4,,85.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,163.34,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,174.3,Percent of Total Billed Charges, ,,85,,211.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,169.32,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,139.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,149.4,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,303.95,,,303.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76882 - US LMTD JT-FCL EVAL NONVASC XTR STRUX R-T W-IMG,76882,HCPCS,,,XU,Outpatient,,,403,100.75,35.61,342.55,,,34.4,,138.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,264.37,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.1,Percent of Total Billed Charges, ,,85,,342.55,Percent of Total Billed Charges, ,,50,,201.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,225.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,241.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76882 - US LMTD JT-FCL EVAL NONVASC XTR STRUX R-T W-IMG,76882,HCPCS,,,XP,Outpatient,,,403,100.75,35.61,342.55,,,34.4,,138.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,264.37,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.1,Percent of Total Billed Charges, ,,85,,342.55,Percent of Total Billed Charges, ,,50,,201.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,225.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,241.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76882 - US LMTD JT-FCL EVAL NONVASC XTR STRUX R-T W-IMG,76882,HCPCS,,,RT,Outpatient,,,403,100.75,35.61,342.55,,,34.4,,138.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,264.37,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.1,Percent of Total Billed Charges, ,,85,,342.55,Percent of Total Billed Charges, ,,50,,201.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,225.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,241.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76882 - US LMTD JT-FCL EVAL NONVASC XTR STRUX R-T W-IMG,76882,HCPCS,,,LT,Outpatient,,,403,100.75,35.61,342.55,,,34.4,,138.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,264.37,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.1,Percent of Total Billed Charges, ,,85,,342.55,Percent of Total Billed Charges, ,,50,,201.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,225.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,241.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76882 - US LMTD JT-FCL EVAL NONVASC XTR STRUX R-T W-IMG,76882,HCPCS,,,76,Outpatient,,,403,100.75,35.61,342.55,,,34.4,,138.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,264.37,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.1,Percent of Total Billed Charges, ,,85,,342.55,Percent of Total Billed Charges, ,,50,,201.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,274.04,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,225.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,241.8,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.61,,,35.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76936 - US CMPRN RPR ARTL PSEUDOARYSM-ARVEN FSTL,76936,HCPCS,,,PO,Outpatient,,,463,115.75,50.46,3030,,,34.4,,159.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,272.87,,,272.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,426.8,,,426.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,303.73,Percent of Total Billed Charges, ,272.87,,,272.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,324.1,Percent of Total Billed Charges, ,,85,,393.55,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,314.84,Percent of Total Billed Charges,0,325.27,,,325.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,259.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,277.8,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.36,,,264.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.46,,,50.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.46,,,50.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.46,,,50.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.46,,,50.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76936 - US CMPRN RPR ARTL PSEUDOARYSM-ARVEN FSTL,76936,HCPCS,,,LT,Outpatient,,,463,115.75,50.46,3030,,,34.4,,159.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,272.87,,,272.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,426.8,,,426.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,303.73,Percent of Total Billed Charges, ,272.87,,,272.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,324.1,Percent of Total Billed Charges, ,,85,,393.55,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,314.84,Percent of Total Billed Charges,0,325.27,,,325.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,259.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,277.8,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.36,,,264.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.46,,,50.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.46,,,50.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.46,,,50.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.46,,,50.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76937 - US VASC ACCESS SITS VSL PATENCY NDL ENTRY,76937,HCPCS,,,XU,Outpatient,,,548,137,0.01,465.8,,,34.4,,188.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.35,,,23.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,254.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,359.49,Percent of Total Billed Charges, ,23.35,,,23.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,383.6,Percent of Total Billed Charges, ,,85,,465.8,Percent of Total Billed Charges, ,,50,,274,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,372.64,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,306.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,328.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.62,,,22.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76937 - US VASC ACCESS SITS VSL PATENCY NDL ENTRY,76937,HCPCS,,,RT,Outpatient,,,548,137,0.01,465.8,,,34.4,,188.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.35,,,23.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,254.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,359.49,Percent of Total Billed Charges, ,23.35,,,23.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,383.6,Percent of Total Billed Charges, ,,85,,465.8,Percent of Total Billed Charges, ,,50,,274,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,372.64,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,306.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,328.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.62,,,22.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76937 - US VASC ACCESS SITS VSL PATENCY NDL ENTRY,76937,HCPCS,,,LT,Outpatient,,,548,137,0.01,465.8,,,34.4,,188.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.35,,,23.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,254.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,359.49,Percent of Total Billed Charges, ,23.35,,,23.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,383.6,Percent of Total Billed Charges, ,,85,,465.8,Percent of Total Billed Charges, ,,50,,274,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,372.64,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,306.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,328.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.62,,,22.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.36,,,52.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76942 - US GUIDANCE NEEDLE PLACEMENT IMG SANDI,76942,HCPCS,,,XU,Outpatient,,,509,127.25,0.01,432.65,,,34.4,,175.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,236.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,346.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.12,,,26.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76942 - US GUIDANCE NEEDLE PLACEMENT IMG SANDI,76942,HCPCS,,,RT,Outpatient,,,509,127.25,0.01,432.65,,,34.4,,175.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,236.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,346.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.12,,,26.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76942 - US GUIDANCE NEEDLE PLACEMENT IMG SANDI,76942,HCPCS,,,LT,Outpatient,,,509,127.25,0.01,432.65,,,34.4,,175.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,236.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,346.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.12,,,26.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76942 - US GUIDANCE NEEDLE PLACEMENT IMG SANDI,76942,HCPCS,,,76,Outpatient,,,509,127.25,0.01,432.65,,,34.4,,175.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,236.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,346.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.12,,,26.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76942 - US GUIDANCE NEEDLE PLACEMENT IMG SANDI,76942,HCPCS,,,52,Outpatient,,,509,127.25,0.01,432.65,,,34.4,,175.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,236.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,346.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.12,,,26.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76942 - US GUIDANCE NEEDLE PLACEMENT IMG SANDI,76942,HCPCS,,,50,Outpatient,,,509,127.25,0.01,432.65,,,34.4,,175.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,236.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,26.96,,,26.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,346.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.12,,,26.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76981 - ULTRASOUND ELASTOGRAPHY PARENCHYMA,76981,HCPCS,,,XU,Outpatient,,,200,50,68.8,3030,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76981 - ULTRASOUND ELASTOGRAPHY PARENCHYMA,76981,HCPCS,,,XP,Outpatient,,,200,50,68.8,3030,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76981 - ULTRASOUND ELASTOGRAPHY PARENCHYMA,76981,HCPCS,,,PO,Outpatient,,,200,50,68.8,3030,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76982 - ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION,76982,HCPCS,,,XU,Outpatient,,,200,50,68.8,3030,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,120.83,,,120.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,134.03,,,134.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.07,,,117.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
76983 - ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION,76983,HCPCS,,,XU,Outpatient,,,200,50,0.01,170,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,50,,100,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0402 - OTHER IMAGING SERVICES - ULTRASOUND,0402,RC,,,,Outpatient,,,269.91,67.4775,161.95,229.42,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,177.06,Percent of Total Billed Charges, ,,,,,,,,70,,188.94,Percent of Total Billed Charges, ,,85,,229.42,Percent of Total Billed Charges, ,,,,,,,,68,,183.54,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,161.95,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI,77063,HCPCS,,,XU,Outpatient,,,224,56,22.71,190.4,,,34.4,,77.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.11,,,36.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,146.94,Percent of Total Billed Charges, ,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,156.8,Percent of Total Billed Charges, ,,85,,190.4,Percent of Total Billed Charges, ,,50,,112,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,152.32,Percent of Total Billed Charges,0,31.33,,,31.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,125.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,134.4,Percent of Total Billed Charges, ,34.92,,,34.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.26,,,46.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.5,,,23.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.73,,,23.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.94,,,22.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.71,,,22.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.94,,,22.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.39,,,23.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.79,,,23.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI,77063,HCPCS,,,XP,Outpatient,,,224,56,22.71,190.4,,,34.4,,77.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.11,,,36.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,146.94,Percent of Total Billed Charges, ,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,156.8,Percent of Total Billed Charges, ,,85,,190.4,Percent of Total Billed Charges, ,,50,,112,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,152.32,Percent of Total Billed Charges,0,31.33,,,31.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,125.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,134.4,Percent of Total Billed Charges, ,34.92,,,34.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.26,,,46.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.5,,,23.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.73,,,23.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.94,,,22.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.71,,,22.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.94,,,22.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.39,,,23.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.79,,,23.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI,77063,HCPCS,,,GA,Outpatient,,,224,56,22.71,190.4,,,34.4,,77.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.11,,,36.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,146.94,Percent of Total Billed Charges, ,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,156.8,Percent of Total Billed Charges, ,,85,,190.4,Percent of Total Billed Charges, ,,50,,112,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,152.32,Percent of Total Billed Charges,0,31.33,,,31.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,125.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,134.4,Percent of Total Billed Charges, ,34.92,,,34.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.26,,,46.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.5,,,23.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.73,,,23.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.94,,,22.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.71,,,22.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.94,,,22.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.39,,,23.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.79,,,23.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77063 - SCREENING DIGITAL BREAST TOMOSYNTHESIS BI,77063,HCPCS,,,50,Outpatient,,,224,56,22.71,190.4,,,34.4,,77.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.11,,,36.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,146.94,Percent of Total Billed Charges, ,47.75,,,47.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,156.8,Percent of Total Billed Charges, ,,85,,190.4,Percent of Total Billed Charges, ,,50,,112,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,152.32,Percent of Total Billed Charges,0,31.33,,,31.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,125.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,134.4,Percent of Total Billed Charges, ,34.92,,,34.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.26,,,46.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.5,,,23.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.73,,,23.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.94,,,22.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.71,,,22.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.94,,,22.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.39,,,23.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.79,,,23.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.81,,,67.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77067 - SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD,77067,HCPCS,,,XU,Outpatient,,,423,105.75,87.33,359.55,,,34.4,,145.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.16,,,104.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,142.96,,,142.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,138.85,,,138.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,277.49,Percent of Total Billed Charges, ,104.16,,,104.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,296.1,Percent of Total Billed Charges, ,,85,,359.55,Percent of Total Billed Charges, ,,50,,211.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,287.64,Percent of Total Billed Charges,0,118.88,,,118.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,236.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,253.8,Percent of Total Billed Charges, ,134.27,,,134.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.91,,,100.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,90.39,,,90.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.26,,,91.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.2,,,88.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.33,,,87.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.2,,,88.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.95,,,89.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.48,,,91.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77067 - SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD,77067,HCPCS,,,XP,Outpatient,,,423,105.75,87.33,359.55,,,34.4,,145.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.16,,,104.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,142.96,,,142.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,138.85,,,138.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,277.49,Percent of Total Billed Charges, ,104.16,,,104.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,296.1,Percent of Total Billed Charges, ,,85,,359.55,Percent of Total Billed Charges, ,,50,,211.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,287.64,Percent of Total Billed Charges,0,118.88,,,118.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,236.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,253.8,Percent of Total Billed Charges, ,134.27,,,134.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.91,,,100.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,90.39,,,90.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.26,,,91.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.2,,,88.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.33,,,87.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.2,,,88.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.95,,,89.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.48,,,91.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77067 - SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD,77067,HCPCS,,,GA,Outpatient,,,423,105.75,87.33,359.55,,,34.4,,145.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.16,,,104.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,142.96,,,142.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,138.85,,,138.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,277.49,Percent of Total Billed Charges, ,104.16,,,104.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,296.1,Percent of Total Billed Charges, ,,85,,359.55,Percent of Total Billed Charges, ,,50,,211.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,287.64,Percent of Total Billed Charges,0,118.88,,,118.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,236.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,253.8,Percent of Total Billed Charges, ,134.27,,,134.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.91,,,100.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,90.39,,,90.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.26,,,91.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.2,,,88.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.33,,,87.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.2,,,88.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.95,,,89.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.48,,,91.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
77067 - SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD,77067,HCPCS,,,50,Outpatient,,,423,105.75,87.33,359.55,,,34.4,,145.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.16,,,104.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,142.96,,,142.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,138.85,,,138.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,277.49,Percent of Total Billed Charges, ,104.16,,,104.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,296.1,Percent of Total Billed Charges, ,,85,,359.55,Percent of Total Billed Charges, ,,50,,211.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,287.64,Percent of Total Billed Charges,0,118.88,,,118.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,236.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,253.8,Percent of Total Billed Charges, ,134.27,,,134.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.91,,,100.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,90.39,,,90.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.26,,,91.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.2,,,88.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.33,,,87.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.2,,,88.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.95,,,89.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.48,,,91.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.55,,,293.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY,0403,RC,,,,Outpatient,,,328.39,82.0975,197.03,279.13,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,215.42,Percent of Total Billed Charges, ,,,,,,,,70,,229.87,Percent of Total Billed Charges, ,,85,,279.13,Percent of Total Billed Charges, ,,,,,,,,68,,223.31,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,197.03,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
78814 - PET IMAGING CT FOR ATTENUATION LIMITED AREA,78814,HCPCS,,,PS,Outpatient,,,4051,1012.75,1386.74,4395.6,,,34.4,,1393.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2154.13,,,2154.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2657.46,Percent of Total Billed Charges, ,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2835.7,Percent of Total Billed Charges, ,,85,,3443.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2754.68,Percent of Total Billed Charges,0,1820.82,,,1820.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2268.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2430.6,Percent of Total Billed Charges, ,2132.11,,,2132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1507.41,,,1507.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1435.28,,,1435.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1449.14,,,1449.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1386.74,,,1386.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1428.34,,,1428.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1452.61,,,1452.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78814 - PET IMAGING CT FOR ATTENUATION LIMITED AREA,78814,HCPCS,,,PI,Outpatient,,,4051,1012.75,1386.74,4395.6,,,34.4,,1393.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2154.13,,,2154.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2657.46,Percent of Total Billed Charges, ,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2835.7,Percent of Total Billed Charges, ,,85,,3443.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2754.68,Percent of Total Billed Charges,0,1820.82,,,1820.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2268.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2430.6,Percent of Total Billed Charges, ,2132.11,,,2132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1507.41,,,1507.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1435.28,,,1435.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1449.14,,,1449.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1386.74,,,1386.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1428.34,,,1428.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1452.61,,,1452.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78815 - PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,78815,HCPCS,,,PS,Outpatient,,,4051,1012.75,1386.74,4395.6,,,34.4,,1393.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2154.13,,,2154.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2657.46,Percent of Total Billed Charges, ,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2835.7,Percent of Total Billed Charges, ,,85,,3443.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2754.68,Percent of Total Billed Charges,0,1820.82,,,1820.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2268.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2430.6,Percent of Total Billed Charges, ,2132.11,,,2132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1507.41,,,1507.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1435.28,,,1435.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1449.14,,,1449.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1386.74,,,1386.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1428.34,,,1428.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1452.61,,,1452.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78815 - PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,78815,HCPCS,,,PI,Outpatient,,,4051,1012.75,1386.74,4395.6,,,34.4,,1393.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2154.13,,,2154.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2657.46,Percent of Total Billed Charges, ,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2835.7,Percent of Total Billed Charges, ,,85,,3443.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2754.68,Percent of Total Billed Charges,0,1820.82,,,1820.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2268.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2430.6,Percent of Total Billed Charges, ,2132.11,,,2132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1507.41,,,1507.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1435.28,,,1435.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1449.14,,,1449.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1386.74,,,1386.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1428.34,,,1428.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1452.61,,,1452.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78815 - PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,78815,HCPCS,,,KX,Outpatient,,,4051,1012.75,1386.74,4395.6,,,34.4,,1393.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2154.13,,,2154.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2657.46,Percent of Total Billed Charges, ,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2835.7,Percent of Total Billed Charges, ,,85,,3443.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2754.68,Percent of Total Billed Charges,0,1820.82,,,1820.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2268.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2430.6,Percent of Total Billed Charges, ,2132.11,,,2132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1507.41,,,1507.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1435.28,,,1435.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1449.14,,,1449.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1386.74,,,1386.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1428.34,,,1428.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1452.61,,,1452.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78815 - PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,78815,HCPCS,,,JZ,Outpatient,,,4051,1012.75,1386.74,4395.6,,,34.4,,1393.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2154.13,,,2154.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2657.46,Percent of Total Billed Charges, ,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2835.7,Percent of Total Billed Charges, ,,85,,3443.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2754.68,Percent of Total Billed Charges,0,1820.82,,,1820.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2268.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2430.6,Percent of Total Billed Charges, ,2132.11,,,2132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1507.41,,,1507.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1435.28,,,1435.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1449.14,,,1449.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1386.74,,,1386.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1428.34,,,1428.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1452.61,,,1452.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78816 - PET IMAGING FOR CT ATTENUATION WHOLE BODY,78816,HCPCS,,,PS,Outpatient,,,9731,2432.75,1386.74,8271.35,,,34.4,,3347.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2154.13,,,2154.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6383.54,Percent of Total Billed Charges, ,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6811.7,Percent of Total Billed Charges, ,,85,,8271.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6617.08,Percent of Total Billed Charges,0,1820.82,,,1820.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5449.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5838.6,Percent of Total Billed Charges, ,2132.11,,,2132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1507.41,,,1507.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1435.28,,,1435.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1449.14,,,1449.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1386.74,,,1386.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1428.34,,,1428.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1452.61,,,1452.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78816 - PET IMAGING FOR CT ATTENUATION WHOLE BODY,78816,HCPCS,,,PI,Outpatient,,,9435.95,2358.9875,1386.74,8020.56,,,34.4,,3245.97,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2154.13,,,2154.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6189.98,Percent of Total Billed Charges, ,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6605.17,Percent of Total Billed Charges, ,,85,,8020.56,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6416.45,Percent of Total Billed Charges,0,1820.82,,,1820.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5284.13,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5661.57,Percent of Total Billed Charges, ,2132.11,,,2132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1507.41,,,1507.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1435.28,,,1435.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1449.14,,,1449.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1386.74,,,1386.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1428.34,,,1428.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1452.61,,,1452.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
78816 - PET IMAGING FOR CT ATTENUATION WHOLE BODY,78816,HCPCS,,,KX,Outpatient,,,9731,2432.75,1386.74,8271.35,,,34.4,,3347.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,2154.13,,,2154.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6383.54,Percent of Total Billed Charges, ,1555.91,,,1555.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6811.7,Percent of Total Billed Charges, ,,85,,8271.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6617.08,Percent of Total Billed Charges,0,1820.82,,,1820.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5449.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5838.6,Percent of Total Billed Charges, ,2132.11,,,2132.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1507.41,,,1507.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1435.28,,,1435.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1449.14,,,1449.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1386.74,,,1386.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1400.61,,,1400.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1428.34,,,1428.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1452.61,,,1452.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4395.6,,,4395.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY,0404,RC,,,,Outpatient,,,4542.81,1135.7025,1150,3861.39,,,,,,,,,,,,,,1150,,,1150,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,2980.08,Percent of Total Billed Charges, ,,,,,,,,70,,3179.97,Percent of Total Billed Charges, ,,85,,3861.39,Percent of Total Billed Charges, ,,,,,,,,68,,3089.11,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,2725.69,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,36600,HCPCS,,,XU,Outpatient,,,833.71,208.4275,122.55,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,546.91,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,583.6,Percent of Total Billed Charges, ,,85,,708.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,566.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,466.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,500.23,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,36600,HCPCS,,,91,Outpatient,,,775,193.75,122.55,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36600 - ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,36600,HCPCS,,,59,Outpatient,,,775,193.75,122.55,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
94640 - PRESSURIZED-NONPRESSURIZED INHALATION TREATMENT,94640,HCPCS,,,XU,Outpatient,,,300,75,17.82,300.38,,,46,,138,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,265.4,,,265.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,300.38,,,300.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,196.8,Percent of Total Billed Charges, ,265.4,,,265.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,210,Percent of Total Billed Charges, ,,85,,255,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,204,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,168,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,180,Percent of Total Billed Charges, ,297.31,,,297.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,257.04,,,257.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.14,,,200.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.07,,,202.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.3,,,195.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.37,,,193.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.3,,,195.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.17,,,199.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.56,,,202.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94640 - PRESSURIZED-NONPRESSURIZED INHALATION TREATMENT,94640,HCPCS,,,76,Outpatient,,,300,75,17.82,300.38,,,46,,138,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,265.4,,,265.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,300.38,,,300.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,196.8,Percent of Total Billed Charges, ,265.4,,,265.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,210,Percent of Total Billed Charges, ,,85,,255,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,204,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,168,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,180,Percent of Total Billed Charges, ,297.31,,,297.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,257.04,,,257.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.14,,,200.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.07,,,202.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.3,,,195.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.37,,,193.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.3,,,195.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.17,,,199.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.56,,,202.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94660 - CPAP VENTILATION CPAP INITIATIONANDMGMT,94660,HCPCS,,,XU,Outpatient,,,331,82.75,152.26,300.38,,,46,,152.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,265.4,,,265.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,300.38,,,300.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,217.14,Percent of Total Billed Charges, ,265.4,,,265.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,231.7,Percent of Total Billed Charges, ,,85,,281.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,225.08,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,185.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,198.6,Percent of Total Billed Charges, ,297.31,,,297.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,257.04,,,257.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.14,,,200.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.07,,,202.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.3,,,195.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.37,,,193.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.3,,,195.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.17,,,199.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.56,,,202.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
94664 - DEMOAND-EVAL OF PT UTILIZ AERSL GEN-NEB-INHLR-IP,94664,HCPCS,,,XU,Outpatient,,,335,83.75,17.82,300.38,,,46,,154.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,265.4,,,265.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,300.38,,,300.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,219.76,Percent of Total Billed Charges, ,265.4,,,265.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,234.5,Percent of Total Billed Charges, ,,85,,284.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,227.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,187.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,201,Percent of Total Billed Charges, ,297.31,,,297.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,257.04,,,257.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.14,,,200.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.07,,,202.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.3,,,195.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.37,,,193.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.3,,,195.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.17,,,199.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.56,,,202.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.82,,,17.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94667 - MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMOAND-EVAL,94667,HCPCS,,,XU,Outpatient,,,264,66,121.44,224.4,,,46,,121.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,160.92,,,160.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,173.18,Percent of Total Billed Charges, ,160.92,,,160.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,184.8,Percent of Total Billed Charges, ,,85,,224.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,179.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,147.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,158.4,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.85,,,155.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0238 - OTH RESP PROC INDIV,G0238,HCPCS,,,KX,Outpatient,,,71,17.75,23.28,60.35,,,46,,32.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.24,,,36.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,36.17,,,36.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,46.58,Percent of Total Billed Charges, ,36.24,,,36.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,49.7,Percent of Total Billed Charges, ,,85,,60.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,48.28,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,39.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,42.6,Percent of Total Billed Charges, ,35.79,,,35.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.1,,,35.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.09,,,24.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.33,,,24.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.51,,,23.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.28,,,23.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.51,,,23.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.98,,,23.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.39,,,24.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,0410,RC,,,,Outpatient,,,298.93,74.7325,179.36,442,,,,,,,,,,,,,,205,,,205,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,196.1,Percent of Total Billed Charges, ,,,,,,,,70,,209.25,Percent of Total Billed Charges, ,,85,,254.09,Percent of Total Billed Charges, ,241,,,241,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,203.27,Percent of Total Billed Charges,0,442,,,442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,179.36,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
95992 - CANALITH REPOSITIONING PROCEDURE,95992,HCPCS,,,GP,Outpatient,,,150,37.5,40.09,127.5,,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.9,,,54.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,63.74,,,63.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,54.9,,,54.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,53.17,,,53.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,41.49,,,41.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.89,,,41.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.49,,,40.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.09,,,40.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.49,,,40.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.29,,,41.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.99,,,41.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96112 - DEVELOPMENTAL TST ADMIN PHYS-QHP 1ST HOUR,96112,HCPCS,,,GP,Outpatient,,,405,101.25,148.75,388.13,,,46,,186.3,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.68,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,283.5,Percent of Total Billed Charges, ,,85,,344.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,275.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,226.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,243,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97012 - APPL MODALITY 1-GREATER THAN AREAS TRACTION MECHANICAL,97012,HCPCS,,,XU,Outpatient,,,150,37.5,13.89,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,22.09,,,22.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,21.08,,,21.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.38,,,14.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.89,,,13.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.31,,,14.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.55,,,14.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97012 - APPL MODALITY 1-GREATER THAN AREAS TRACTION MECHANICAL,97012,HCPCS,,,GP,Outpatient,,,149.98,37.495,13.89,127.48,,,34.4,,51.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,22.09,,,22.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.39,Percent of Total Billed Charges, ,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,104.99,Percent of Total Billed Charges, ,,85,,127.48,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,101.99,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,83.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,89.99,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,21.08,,,21.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.38,,,14.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.89,,,13.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.31,,,14.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.55,,,14.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97016 - APPL MODALITY 1-GREATER THAN AREAS VASOPNEUMATIC DEVICES,97016,HCPCS,,,GP,Outpatient,,,150,37.5,11.35,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.49,,,17.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,18.05,,,18.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,17.49,,,17.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,16.94,,,16.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.75,,,11.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.86,,,11.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.46,,,11.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.35,,,11.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.46,,,11.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.69,,,11.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.89,,,11.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97022 - APPLICATION MODALITY 1-GREATER THAN AREAS WHIRLPOOL,97022,HCPCS,,,GP,Outpatient,,,150,37.5,15.13,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.85,,,24.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,24.06,,,24.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,24.85,,,24.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,24.07,,,24.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.66,,,15.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.81,,,15.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.28,,,15.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.13,,,15.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.28,,,15.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.58,,,15.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.85,,,15.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97032 - APPL MODALITY 1+ AREAS ESTIM EA 15 MIN,97032,HCPCS,,,GP,Outpatient,,,150,37.5,13.89,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,22.09,,,22.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,21.08,,,21.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.38,,,14.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.89,,,13.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.31,,,14.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.55,,,14.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97032 - APPL MODALITY 1+ AREAS ESTIM EA 15 MIN,97032,HCPCS,,,59,Outpatient,,,150,37.5,13.89,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,22.09,,,22.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,21.08,,,21.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.38,,,14.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.89,,,13.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.31,,,14.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.55,,,14.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97033 - APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN,97033,HCPCS,,,GP,Outpatient,,,150,37.5,18.31,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.27,,,29.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,29.11,,,29.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,29.27,,,29.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,28.35,,,28.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.95,,,18.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.13,,,19.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.49,,,18.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.31,,,18.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.49,,,18.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.86,,,18.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.18,,,19.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97035 - APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN,97035,HCPCS,,,GP,Outpatient,,,150,37.5,13.56,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.45,,,21.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,21.56,,,21.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,21.45,,,21.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,20.77,,,20.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.17,,,14.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.7,,,13.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.56,,,13.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.7,,,13.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.97,,,13.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.2,,,14.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97110 - THERAPEUTIC PX 1-GREATER THAN AREAS EACH 15 MIN EXERCISES,97110,HCPCS,,,XU,Outpatient,,,250,62.5,28.12,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97110 - THERAPEUTIC PX 1-GREATER THAN AREAS EACH 15 MIN EXERCISES,97110,HCPCS,,,KX,Outpatient,,,250,62.5,28.12,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97110 - THERAPEUTIC PX 1-GREATER THAN AREAS EACH 15 MIN EXERCISES,97110,HCPCS,,,GP,Outpatient,,,250,62.5,28.12,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97110 - THERAPEUTIC PX 1-GREATER THAN AREAS EACH 15 MIN EXERCISES,97110,HCPCS,,,GO,Outpatient,,,250,62.5,28.12,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97110 - THERAPEUTIC PX 1-GREATER THAN AREAS EACH 15 MIN EXERCISES,97110,HCPCS,,,59,Outpatient,,,250,62.5,28.12,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97112 - THER PX 1-GREATER THAN AREAS EACH 15 MIN NEUROMUSC REEDUCA,97112,HCPCS,,,XU,Outpatient,,,155,38.75,31.28,131.75,,,34.4,,53.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.74,,,49.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.68,Percent of Total Billed Charges, ,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,108.5,Percent of Total Billed Charges, ,,85,,131.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,105.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,86.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,49.09,,,49.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.37,,,32.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.69,,,32.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.28,,,31.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.22,,,32.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.77,,,32.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97112 - THER PX 1-GREATER THAN AREAS EACH 15 MIN NEUROMUSC REEDUCA,97112,HCPCS,,,KX,Outpatient,,,155,38.75,31.28,131.75,,,34.4,,53.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.74,,,49.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.68,Percent of Total Billed Charges, ,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,108.5,Percent of Total Billed Charges, ,,85,,131.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,105.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,86.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,49.09,,,49.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.37,,,32.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.69,,,32.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.28,,,31.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.22,,,32.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.77,,,32.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97112 - THER PX 1-GREATER THAN AREAS EACH 15 MIN NEUROMUSC REEDUCA,97112,HCPCS,,,GP,Outpatient,,,155,38.75,31.28,131.75,,,34.4,,53.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.74,,,49.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.68,Percent of Total Billed Charges, ,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,108.5,Percent of Total Billed Charges, ,,85,,131.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,105.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,86.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,49.09,,,49.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.37,,,32.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.69,,,32.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.28,,,31.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.22,,,32.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.77,,,32.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97112 - THER PX 1-GREATER THAN AREAS EACH 15 MIN NEUROMUSC REEDUCA,97112,HCPCS,,,59,Outpatient,,,155,38.75,31.28,131.75,,,34.4,,53.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.74,,,49.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.68,Percent of Total Billed Charges, ,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,108.5,Percent of Total Billed Charges, ,,85,,131.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,105.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,86.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,49.09,,,49.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.37,,,32.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.69,,,32.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.28,,,31.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.22,,,32.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.77,,,32.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97116 - THER PX 1-GREATER THAN AREAS EA 15 MIN GAIT TRAING W-STAIR,97116,HCPCS,,,XU,Outpatient,,,150,37.5,28.12,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97116 - THER PX 1-GREATER THAN AREAS EA 15 MIN GAIT TRAING W-STAIR,97116,HCPCS,,,GP,Outpatient,,,149.99,37.4975,28.12,127.49,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.39,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,104.99,Percent of Total Billed Charges, ,,85,,127.49,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,101.99,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,83.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,89.99,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97116 - THER PX 1-GREATER THAN AREAS EA 15 MIN GAIT TRAING W-STAIR,97116,HCPCS,,,59,Outpatient,,,150,37.5,28.12,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97124 - THER PX 1-GREATER THAN AREAS EACH 15 MINUTES MASSAGE,97124,HCPCS,,,XU,Outpatient,,,150,37.5,29.05,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,46.19,,,46.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.99,,,42.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.07,,,30.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.36,,,30.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.05,,,29.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.92,,,29.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.43,,,30.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97124 - THER PX 1-GREATER THAN AREAS EACH 15 MINUTES MASSAGE,97124,HCPCS,,,GP,Outpatient,,,150,37.5,29.05,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,46.19,,,46.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.99,,,42.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.07,,,30.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.36,,,30.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.05,,,29.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.92,,,29.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.43,,,30.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97124 - THER PX 1-GREATER THAN AREAS EACH 15 MINUTES MASSAGE,97124,HCPCS,,,59,Outpatient,,,150,37.5,29.05,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,46.19,,,46.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.99,,,42.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.07,,,30.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.36,,,30.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.05,,,29.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.92,,,29.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.43,,,30.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97140 - MANUAL THERAPY TQS 1-GREATER THAN REGIONS EACH 15 MINUTES,97140,HCPCS,,,XU,Outpatient,,,150,37.5,26.54,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,42.2,,,42.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,39.55,,,39.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.54,,,26.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.34,,,27.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.8,,,27.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97140 - MANUAL THERAPY TQS 1-GREATER THAN REGIONS EACH 15 MINUTES,97140,HCPCS,,,GP,Outpatient,,,149.99,37.4975,26.54,127.49,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,42.2,,,42.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.39,Percent of Total Billed Charges, ,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,104.99,Percent of Total Billed Charges, ,,85,,127.49,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,101.99,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,83.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,89.99,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,39.55,,,39.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.54,,,26.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.34,,,27.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.8,,,27.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97140 - MANUAL THERAPY TQS 1-GREATER THAN REGIONS EACH 15 MINUTES,97140,HCPCS,,,59,Outpatient,,,150,37.5,26.54,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,42.2,,,42.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,39.55,,,39.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.54,,,26.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.34,,,27.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.8,,,27.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97150 - THERAPEUTIC PROCEDURES GROUP 2-GREATER THAN INDIVIDUALS,97150,HCPCS,,,XU,Outpatient,,,150,37.5,17.05,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.72,,,26.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,27.11,,,27.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,26.72,,,26.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,25.88,,,25.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.65,,,17.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.05,,,17.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.56,,,17.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.86,,,17.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97150 - THERAPEUTIC PROCEDURES GROUP 2-GREATER THAN INDIVIDUALS,97150,HCPCS,,,GP,Outpatient,,,150,37.5,17.05,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.72,,,26.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,27.11,,,27.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,26.72,,,26.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,25.88,,,25.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.65,,,17.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.05,,,17.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.56,,,17.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.86,,,17.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,97530,HCPCS,,,XU,Outpatient,,,157,39.25,33.8,133.45,,,34.4,,54.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,53.74,,,53.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,102.99,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,109.9,Percent of Total Billed Charges, ,,85,,133.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,106.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,87.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,94.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,53.12,,,53.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.98,,,34.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.32,,,35.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.8,,,33.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.81,,,34.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.41,,,35.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,97530,HCPCS,,,GP,Outpatient,,,157,39.25,33.8,133.45,,,34.4,,54.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,53.74,,,53.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,102.99,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,109.9,Percent of Total Billed Charges, ,,85,,133.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,106.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,87.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,94.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,53.12,,,53.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.98,,,34.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.32,,,35.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.8,,,33.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.81,,,34.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.41,,,35.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,97530,HCPCS,,,GO,Outpatient,,,157,39.25,33.8,133.45,,,34.4,,54.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,53.74,,,53.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,102.99,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,109.9,Percent of Total Billed Charges, ,,85,,133.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,106.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,87.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,94.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,53.12,,,53.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.98,,,34.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.32,,,35.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.8,,,33.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.81,,,34.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.41,,,35.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,97530,HCPCS,,,59,Outpatient,,,157,39.25,33.8,133.45,,,34.4,,54.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,53.74,,,53.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,102.99,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,109.9,Percent of Total Billed Charges, ,,85,,133.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,106.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,87.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,94.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,53.12,,,53.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.98,,,34.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.32,,,35.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.8,,,33.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.81,,,34.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.41,,,35.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97535 - SELF-CARE-HOME MGMT TRAINING EACH 15 MINUTES,97535,HCPCS,,,GP,Outpatient,,,181,45.25,31.27,153.85,,,34.4,,62.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.72,,,49.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,118.74,Percent of Total Billed Charges, ,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,126.7,Percent of Total Billed Charges, ,,85,,153.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,123.08,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,101.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,108.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,47.37,,,47.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.36,,,32.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.68,,,32.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.27,,,31.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.21,,,32.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.76,,,32.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97535 - SELF-CARE-HOME MGMT TRAINING EACH 15 MINUTES,97535,HCPCS,,,GO,Outpatient,,,181,45.25,31.27,153.85,,,34.4,,62.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.72,,,49.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,118.74,Percent of Total Billed Charges, ,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,126.7,Percent of Total Billed Charges, ,,85,,153.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,123.08,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,101.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,108.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,47.37,,,47.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.36,,,32.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.68,,,32.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.27,,,31.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.21,,,32.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.76,,,32.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97535 - SELF-CARE-HOME MGMT TRAINING EACH 15 MINUTES,97535,HCPCS,,,59,Outpatient,,,181,45.25,31.27,153.85,,,34.4,,62.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.72,,,49.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,118.74,Percent of Total Billed Charges, ,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,126.7,Percent of Total Billed Charges, ,,85,,153.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,123.08,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,101.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,108.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,47.37,,,47.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.36,,,32.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.68,,,32.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.27,,,31.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.21,,,32.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.76,,,32.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97542 - WHEELCHAIR MGMT EA 15 MIN,97542,HCPCS,,,GP,Outpatient,,,284,71,30.02,241.4,,,34.4,,97.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.74,,,47.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,47.73,,,47.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.3,Percent of Total Billed Charges, ,47.74,,,47.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.8,Percent of Total Billed Charges, ,,85,,241.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,193.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,159.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,170.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,46.24,,,46.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.07,,,31.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.37,,,31.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.32,,,30.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.02,,,30.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.32,,,30.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.92,,,30.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.45,,,31.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97760 - ORTHOTICS MGMT AND TRAING INITIAL ENCTR EA 15 MINS,97760,HCPCS,,,GP,Outpatient,,,150,37.5,44.85,127.5,,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,71.12,,,71.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,71.31,,,71.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,71.12,,,71.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,68.88,,,68.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.42,,,46.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.87,,,46.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.3,,,45.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.85,,,44.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.3,,,45.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.2,,,46.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.98,,,46.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97763 - ORTHOTICS-PROSTH MGMT AND-TRAING SBSQ ENCTR 15 MIN,97763,HCPCS,,,GP,Outpatient,,,150,37.5,48.94,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,77.45,,,77.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,77.81,,,77.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,77.45,,,77.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,75.01,,,75.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.65,,,50.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.14,,,51.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.43,,,49.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.94,,,48.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.43,,,49.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.41,,,50.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.26,,,51.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99368 - TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN,99368,HCPCS,,,GP,Outpatient,,,150,37.5,0.01,127.5,,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
S8990 - PT OR MANIP FOR MAINT,S8990,HCPCS,,,GP,Outpatient,,,20,5,5.2,17,,,46,,9.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,9.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,,,,65.6,,13.12,Percent of Total Billed Charges, ,,46,,9.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14,Percent of Total Billed Charges, ,,85,,17,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13.6,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,11.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,5.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,0420,RC,,,,Outpatient,,,211.94,52.985,127.16,243,,,,,,,,,,,,,,205,,,205,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,139.03,Percent of Total Billed Charges, ,,,,,,,,70,,148.36,Percent of Total Billed Charges, ,,85,,180.15,Percent of Total Billed Charges, ,241,,,241,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,144.12,Percent of Total Billed Charges,0,243,,,243,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,127.16,Percent of Total Billed Charges, ,175,,,175,Case Rate,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
97161 - PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS,97161,HCPCS,,,XU,Outpatient,,,250,62.5,86,293.67,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,152.18,,,152.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,146.05,,,146.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,99.06,,,99.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.02,,,100.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.67,,,96.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.71,,,95.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.67,,,96.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.58,,,98.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.26,,,100.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97161 - PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS,97161,HCPCS,,,GP,Outpatient,,,249.99,62.4975,86,293.67,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,152.18,,,152.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,163.99,Percent of Total Billed Charges, ,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,174.99,Percent of Total Billed Charges, ,,85,,212.49,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,169.99,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,139.99,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,149.99,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,146.05,,,146.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,99.06,,,99.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.02,,,100.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.67,,,96.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.71,,,95.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.67,,,96.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.58,,,98.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.26,,,100.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97162 - PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS,97162,HCPCS,,,GP,Outpatient,,,353,88.25,95.71,440.51,,,34.4,,121.43,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,152.18,,,152.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,231.57,Percent of Total Billed Charges, ,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,247.1,Percent of Total Billed Charges, ,,85,,300.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,240.04,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,197.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,211.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,146.05,,,146.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,99.06,,,99.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.02,,,100.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.67,,,96.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.71,,,95.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.67,,,96.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.58,,,98.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.26,,,100.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,440.51,,,440.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,440.51,,,440.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,440.51,,,440.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,440.51,,,440.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97163 - PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS,97163,HCPCS,,,GP,Outpatient,,,471,117.75,95.71,587.35,,,34.4,,162.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,152.18,,,152.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,308.98,Percent of Total Billed Charges, ,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,329.7,Percent of Total Billed Charges, ,,85,,400.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,320.28,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,263.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,282.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,146.05,,,146.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,99.06,,,99.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.02,,,100.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.67,,,96.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.71,,,95.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.67,,,96.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.58,,,98.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.26,,,100.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.35,,,587.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,587.35,,,587.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,587.35,,,587.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,587.35,,,587.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97164 - PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS,97164,HCPCS,,,XU,Outpatient,,,235,58.75,66.03,293.67,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,104.99,,,104.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,159.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,100.2,,,100.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69,,,69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.03,,,66.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.01,,,68.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.17,,,69.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97164 - PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS,97164,HCPCS,,,XP,Outpatient,,,235,58.75,66.03,293.67,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,104.99,,,104.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,159.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,100.2,,,100.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69,,,69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.03,,,66.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.01,,,68.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.17,,,69.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97164 - PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS,97164,HCPCS,,,GP,Outpatient,,,235,58.75,66.03,293.67,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,104.99,,,104.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,159.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,100.2,,,100.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69,,,69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.03,,,66.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.01,,,68.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.17,,,69.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97164 - PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS,97164,HCPCS,,,59,Outpatient,,,235,58.75,66.03,293.67,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,104.99,,,104.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,159.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,100.2,,,100.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69,,,69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.03,,,66.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.01,,,68.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.17,,,69.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97164 - PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS,97164,HCPCS,,,57,Outpatient,,,235,58.75,66.03,293.67,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,104.99,,,104.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,103.46,,,103.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,159.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,100.2,,,100.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69,,,69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.03,,,66.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.69,,,66.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.01,,,68.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.17,,,69.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION,0424,RC,,,,Outpatient,,,282.91,70.7275,169.75,243,,,,,,,,,,,,,,205,,,205,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,185.59,Percent of Total Billed Charges, ,,,,,,,,70,,198.04,Percent of Total Billed Charges, ,,85,,240.47,Percent of Total Billed Charges, ,241,,,241,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,192.38,Percent of Total Billed Charges,0,243,,,243,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,169.75,Percent of Total Billed Charges, ,175,,,175,Case Rate,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
97012 - APPL MODALITY 1-GREATER THAN AREAS TRACTION MECHANICAL,97012,HCPCS,,,GO,Outpatient,,,150,37.5,13.89,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,22.09,,,22.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,21.08,,,21.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.38,,,14.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.89,,,13.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.31,,,14.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.55,,,14.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97018 - APPL MODALITY 1-GREATER THAN AREAS PARAFFIN BATH,97018,HCPCS,,,GO,Outpatient,,,150,37.5,5.97,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.18,,,8.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,9.49,,,9.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,8.18,,,8.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,7.92,,,7.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.18,,,6.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.24,,,6.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.03,,,6.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.97,,,5.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.03,,,6.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.25,,,6.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97022 - APPLICATION MODALITY 1-GREATER THAN AREAS WHIRLPOOL,97022,HCPCS,,,XU,Outpatient,,,150,37.5,15.13,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.85,,,24.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,24.06,,,24.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,24.85,,,24.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,24.07,,,24.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.66,,,15.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.81,,,15.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.28,,,15.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.13,,,15.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.28,,,15.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.58,,,15.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.85,,,15.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97022 - APPLICATION MODALITY 1-GREATER THAN AREAS WHIRLPOOL,97022,HCPCS,,,GO,Outpatient,,,150,37.5,15.13,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.85,,,24.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,24.06,,,24.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,24.85,,,24.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,24.07,,,24.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.66,,,15.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.81,,,15.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.28,,,15.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.13,,,15.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.28,,,15.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.58,,,15.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.85,,,15.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97032 - APPL MODALITY 1+ AREAS ESTIM EA 15 MIN,97032,HCPCS,,,GO,Outpatient,,,150,37.5,13.89,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,22.09,,,22.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,21.77,,,21.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,21.08,,,21.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.38,,,14.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.89,,,13.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.31,,,14.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.55,,,14.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97033 - APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN,97033,HCPCS,,,GO,Outpatient,,,150,37.5,18.31,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.27,,,29.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,29.11,,,29.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,29.27,,,29.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,28.35,,,28.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.95,,,18.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.13,,,19.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.49,,,18.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.31,,,18.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.49,,,18.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.86,,,18.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.18,,,19.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97035 - APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN,97035,HCPCS,,,GO,Outpatient,,,150,37.5,13.56,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.45,,,21.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,21.56,,,21.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,21.45,,,21.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,20.77,,,20.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.17,,,14.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.7,,,13.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.56,,,13.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.7,,,13.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.97,,,13.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.2,,,14.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97110 - THERAPEUTIC PX 1-GREATER THAN AREAS EACH 15 MIN EXERCISES,97110,HCPCS,,,XU,Outpatient,,,200,50,28.12,170,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,136,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97110 - THERAPEUTIC PX 1-GREATER THAN AREAS EACH 15 MIN EXERCISES,97110,HCPCS,,,GP,Outpatient,,,200,50,28.12,170,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,136,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97110 - THERAPEUTIC PX 1-GREATER THAN AREAS EACH 15 MIN EXERCISES,97110,HCPCS,,,GO,Outpatient,,,200,50,28.12,170,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,136,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97110 - THERAPEUTIC PX 1-GREATER THAN AREAS EACH 15 MIN EXERCISES,97110,HCPCS,,,59,Outpatient,,,200,50,28.12,170,,,34.4,,68.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,44.71,,,44.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,44.27,,,44.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,136,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,112,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.87,,,42.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.1,,,29.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.39,,,29.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.12,,,28.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.4,,,28.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.96,,,28.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.46,,,29.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97112 - THER PX 1-GREATER THAN AREAS EACH 15 MIN NEUROMUSC REEDUCA,97112,HCPCS,,,XU,Outpatient,,,155,38.75,31.28,131.75,,,34.4,,53.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.74,,,49.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.68,Percent of Total Billed Charges, ,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,108.5,Percent of Total Billed Charges, ,,85,,131.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,105.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,86.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,49.09,,,49.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.37,,,32.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.69,,,32.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.28,,,31.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.22,,,32.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.77,,,32.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97112 - THER PX 1-GREATER THAN AREAS EACH 15 MIN NEUROMUSC REEDUCA,97112,HCPCS,,,GO,Outpatient,,,155,38.75,31.28,131.75,,,34.4,,53.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.74,,,49.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.68,Percent of Total Billed Charges, ,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,108.5,Percent of Total Billed Charges, ,,85,,131.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,105.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,86.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,49.09,,,49.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.37,,,32.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.69,,,32.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.28,,,31.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.22,,,32.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.77,,,32.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97112 - THER PX 1-GREATER THAN AREAS EACH 15 MIN NEUROMUSC REEDUCA,97112,HCPCS,,,59,Outpatient,,,155,38.75,31.28,131.75,,,34.4,,53.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.74,,,49.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,101.68,Percent of Total Billed Charges, ,50.69,,,50.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,108.5,Percent of Total Billed Charges, ,,85,,131.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,105.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,86.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,49.09,,,49.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.37,,,32.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.69,,,32.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.28,,,31.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.59,,,31.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.22,,,32.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.77,,,32.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97124 - THER PX 1-GREATER THAN AREAS EACH 15 MINUTES MASSAGE,97124,HCPCS,,,GO,Outpatient,,,150,37.5,29.05,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,46.19,,,46.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.99,,,42.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.07,,,30.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.36,,,30.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.05,,,29.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.92,,,29.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.43,,,30.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97124 - THER PX 1-GREATER THAN AREAS EACH 15 MINUTES MASSAGE,97124,HCPCS,,,59,Outpatient,,,150,37.5,29.05,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,46.19,,,46.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,44.38,,,44.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,42.99,,,42.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.07,,,30.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.36,,,30.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.05,,,29.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.34,,,29.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.92,,,29.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.43,,,30.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97129 - THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES,97129,HCPCS,,,GO,Outpatient,,,150,37.5,21.19,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.46,,,34.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,33.69,,,33.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,34.46,,,34.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,33.37,,,33.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.93,,,21.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.14,,,22.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.4,,,21.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.19,,,21.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.4,,,21.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.83,,,21.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.2,,,22.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97130 - THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES,97130,HCPCS,,,GO,Outpatient,,,150,37.5,20.24,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.36,,,33.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,32.18,,,32.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,33.36,,,33.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,32.31,,,32.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.95,,,20.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.15,,,21.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.44,,,20.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.24,,,20.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.44,,,20.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.85,,,20.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.2,,,21.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97140 - MANUAL THERAPY TQS 1-GREATER THAN REGIONS EACH 15 MINUTES,97140,HCPCS,,,XU,Outpatient,,,150,37.5,26.54,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,42.2,,,42.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,39.55,,,39.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.54,,,26.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.34,,,27.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.8,,,27.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97140 - MANUAL THERAPY TQS 1-GREATER THAN REGIONS EACH 15 MINUTES,97140,HCPCS,,,GP,Outpatient,,,150,37.5,26.54,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,42.2,,,42.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,39.55,,,39.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.54,,,26.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.34,,,27.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.8,,,27.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97140 - MANUAL THERAPY TQS 1-GREATER THAN REGIONS EACH 15 MINUTES,97140,HCPCS,,,GO,Outpatient,,,150,37.5,26.54,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,42.2,,,42.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,39.55,,,39.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.54,,,26.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.34,,,27.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.8,,,27.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97140 - MANUAL THERAPY TQS 1-GREATER THAN REGIONS EACH 15 MINUTES,97140,HCPCS,,,59,Outpatient,,,150,37.5,26.54,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,42.2,,,42.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,40.84,,,40.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,39.55,,,39.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.47,,,27.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.73,,,27.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.54,,,26.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.81,,,26.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.34,,,27.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.8,,,27.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97150 - THERAPEUTIC PROCEDURES GROUP 2-GREATER THAN INDIVIDUALS,97150,HCPCS,,,XU,Outpatient,,,150,37.5,17.05,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.72,,,26.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,27.11,,,27.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,26.72,,,26.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,25.88,,,25.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.65,,,17.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.05,,,17.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.56,,,17.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.86,,,17.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97150 - THERAPEUTIC PROCEDURES GROUP 2-GREATER THAN INDIVIDUALS,97150,HCPCS,,,GO,Outpatient,,,150,37.5,17.05,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.72,,,26.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,27.11,,,27.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,26.72,,,26.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,25.88,,,25.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.65,,,17.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.05,,,17.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.56,,,17.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.86,,,17.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,17.64,,,17.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,97530,HCPCS,,,XU,Outpatient,,,250,62.5,33.8,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,53.74,,,53.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,53.12,,,53.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.98,,,34.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.32,,,35.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.8,,,33.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.81,,,34.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.41,,,35.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,97530,HCPCS,,,GP,Outpatient,,,250,62.5,33.8,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,53.74,,,53.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,53.12,,,53.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.98,,,34.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.32,,,35.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.8,,,33.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.81,,,34.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.41,,,35.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,97530,HCPCS,,,GO,Outpatient,,,249.84,62.46,33.8,212.36,,,34.4,,85.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,53.74,,,53.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,163.9,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,174.89,Percent of Total Billed Charges, ,,85,,212.36,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,169.89,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,139.91,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,149.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,53.12,,,53.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.98,,,34.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.32,,,35.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.8,,,33.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.81,,,34.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.41,,,35.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,97530,HCPCS,,,59,Outpatient,,,250,62.5,33.8,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,53.74,,,53.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,54.85,,,54.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,53.12,,,53.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.98,,,34.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.32,,,35.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.8,,,33.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.14,,,34.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.81,,,34.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.41,,,35.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97535 - SELF-CARE-HOME MGMT TRAINING EACH 15 MINUTES,97535,HCPCS,,,XU,Outpatient,,,250,62.5,31.27,212.5,,,34.4,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.72,,,49.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164,Percent of Total Billed Charges, ,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175,Percent of Total Billed Charges, ,,85,,212.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,170,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,140,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,150,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,47.37,,,47.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.36,,,32.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.68,,,32.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.27,,,31.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.21,,,32.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.76,,,32.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97535 - SELF-CARE-HOME MGMT TRAINING EACH 15 MINUTES,97535,HCPCS,,,GO,Outpatient,,,249.73,62.4325,31.27,212.27,,,34.4,,85.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,49.72,,,49.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,163.82,Percent of Total Billed Charges, ,48.91,,,48.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,174.81,Percent of Total Billed Charges, ,,85,,212.27,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,169.82,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,139.85,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,149.84,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,47.37,,,47.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.36,,,32.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.68,,,32.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.27,,,31.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.58,,,31.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.21,,,32.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.76,,,32.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97542 - WHEELCHAIR MGMT EA 15 MIN,97542,HCPCS,,,XU,Outpatient,,,284,71,30.02,241.4,,,34.4,,97.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.74,,,47.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,47.73,,,47.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.3,Percent of Total Billed Charges, ,47.74,,,47.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.8,Percent of Total Billed Charges, ,,85,,241.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,193.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,159.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,170.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,46.24,,,46.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.07,,,31.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.37,,,31.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.32,,,30.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.02,,,30.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.32,,,30.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.92,,,30.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.45,,,31.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97542 - WHEELCHAIR MGMT EA 15 MIN,97542,HCPCS,,,GO,Outpatient,,,284,71,30.02,241.4,,,34.4,,97.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.74,,,47.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,47.73,,,47.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.3,Percent of Total Billed Charges, ,47.74,,,47.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,198.8,Percent of Total Billed Charges, ,,85,,241.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,193.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,159.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,170.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,46.24,,,46.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.07,,,31.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.37,,,31.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.32,,,30.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.02,,,30.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.32,,,30.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.92,,,30.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.45,,,31.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97597 - DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM-LESS THAN,97597,HCPCS,,,GO,Outpatient,,,975,243.75,71.46,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,639.6,Percent of Total Billed Charges, ,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,682.5,Percent of Total Billed Charges, ,,85,,828.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,663,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,546,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,585,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,253.93,,,253.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97602 - RMVL DEVITAL TISS N-SLCTV DBRDMT W-O ANES 1 SESS,97602,HCPCS,,,GO,Outpatient,,,303,75.75,139.38,293.45,,,46,,139.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,198.77,Percent of Total Billed Charges, ,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,212.1,Percent of Total Billed Charges, ,,85,,257.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,206.04,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,169.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,181.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,253.93,,,253.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.92,,,200.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,200.92,,,200.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,200.92,,,200.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,200.92,,,200.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97605 - NEGATIVE PRESSURE WOUND THERAPY DME LESS THAN = 50 SQ CM,97605,HCPCS,,,GO,Outpatient,,,275,68.75,90.41,293.45,,,46,,126.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,180.4,Percent of Total Billed Charges, ,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,192.5,Percent of Total Billed Charges, ,,85,,233.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,187,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,154,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,165,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,253.93,,,253.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.41,,,90.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.41,,,90.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.41,,,90.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.41,,,90.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97606 - NEGATIVE PRESSURE WOUND THERAPY DME GREATER THAN 50 SQ CM,97606,HCPCS,,,GO,Outpatient,,,586,146.5,146.24,590.05,,,46,,269.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,541.65,,,541.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,384.42,Percent of Total Billed Charges, ,541.65,,,541.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,410.2,Percent of Total Billed Charges, ,,85,,498.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,398.48,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,328.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,351.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,524.58,,,524.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,146.24,,,146.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.24,,,146.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.24,,,146.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.24,,,146.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97760 - ORTHOTICS MGMT AND TRAING INITIAL ENCTR EA 15 MINS,97760,HCPCS,,,GO,Outpatient,,,150,37.5,44.85,127.5,,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,71.12,,,71.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,71.31,,,71.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,71.12,,,71.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,68.88,,,68.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.42,,,46.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.87,,,46.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.3,,,45.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.85,,,44.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.3,,,45.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.2,,,46.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.98,,,46.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97763 - ORTHOTICS-PROSTH MGMT AND-TRAING SBSQ ENCTR 15 MIN,97763,HCPCS,,,XU,Outpatient,,,150,37.5,48.94,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,77.45,,,77.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,77.81,,,77.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,77.45,,,77.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,75.01,,,75.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.65,,,50.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.14,,,51.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.43,,,49.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.94,,,48.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.43,,,49.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.41,,,50.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.26,,,51.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97763 - ORTHOTICS-PROSTH MGMT AND-TRAING SBSQ ENCTR 15 MIN,97763,HCPCS,,,GO,Outpatient,,,150,37.5,48.94,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,77.45,,,77.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,77.81,,,77.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,77.45,,,77.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,75.01,,,75.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.65,,,50.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.14,,,51.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.43,,,49.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.94,,,48.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.43,,,49.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.41,,,50.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.26,,,51.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99368 - TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN,99368,HCPCS,,,GO,Outpatient,,,150,37.5,0.01,127.5,,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION,0430,RC,,,,Outpatient,,,200.74,50.185,120.44,243,,,,,,,,,,,,,,205,,,205,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,131.69,Percent of Total Billed Charges, ,,,,,,,,70,,140.52,Percent of Total Billed Charges, ,,85,,170.63,Percent of Total Billed Charges, ,241,,,241,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136.5,Percent of Total Billed Charges,0,243,,,243,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,120.44,Percent of Total Billed Charges, ,175,,,175,Case Rate,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
97165 - OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS,97165,HCPCS,,,GO,Outpatient,,,235,58.75,80.84,293.67,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,156.2,,,156.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,159.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,146.05,,,146.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,101.68,,,101.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.66,,,102.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.22,,,99.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.24,,,98.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.22,,,99.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.19,,,101.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.91,,,102.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97166 - OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS,97166,HCPCS,,,GO,Outpatient,,,353,88.25,98.24,440.51,,,34.4,,121.43,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,156.2,,,156.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,231.57,Percent of Total Billed Charges, ,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,247.1,Percent of Total Billed Charges, ,,85,,300.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,240.04,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,197.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,211.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,146.05,,,146.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,101.68,,,101.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.66,,,102.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.22,,,99.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.24,,,98.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.22,,,99.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.19,,,101.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.91,,,102.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,440.51,,,440.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,440.51,,,440.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,440.51,,,440.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,440.51,,,440.51,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97167 - OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS,97167,HCPCS,,,GO,Outpatient,,,471,117.75,98.24,587.35,,,34.4,,162.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,156.2,,,156.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,308.98,Percent of Total Billed Charges, ,150.8,,,150.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,329.7,Percent of Total Billed Charges, ,,85,,400.35,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,320.28,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,263.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,282.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,146.05,,,146.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,101.68,,,101.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.66,,,102.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.22,,,99.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.24,,,98.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.22,,,99.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.19,,,101.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.91,,,102.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.35,,,587.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,587.35,,,587.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,587.35,,,587.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,587.35,,,587.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97168 - OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS,97168,HCPCS,,,XU,Outpatient,,,235,58.75,67.88,293.67,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,102.99,,,102.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,107.93,,,107.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,102.99,,,102.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,159.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,99.74,,,99.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.26,,,70.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.93,,,70.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.56,,,68.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.88,,,67.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.56,,,68.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.92,,,69.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.1,,,71.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97168 - OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS,97168,HCPCS,,,GO,Outpatient,,,235,58.75,67.88,293.67,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,102.99,,,102.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,107.93,,,107.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,102.99,,,102.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,159.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,99.74,,,99.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.26,,,70.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.93,,,70.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.56,,,68.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.88,,,67.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.56,,,68.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.92,,,69.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.1,,,71.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97168 - OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS,97168,HCPCS,,,59,Outpatient,,,235,58.75,67.88,293.67,,,34.4,,80.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,102.99,,,102.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,107.93,,,107.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,154.16,Percent of Total Billed Charges, ,102.99,,,102.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,164.5,Percent of Total Billed Charges, ,,85,,199.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,159.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,131.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,141,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,99.74,,,99.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.26,,,70.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.93,,,70.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.56,,,68.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.88,,,67.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.56,,,68.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.92,,,69.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.1,,,71.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,293.67,,,293.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0434 - OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION,0434,RC,,,,Outpatient,,,291.62,72.905,174.97,247.88,,,,,,,,,,,,,,205,,,205,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,191.3,Percent of Total Billed Charges, ,,,,,,,,70,,204.13,Percent of Total Billed Charges, ,,85,,247.88,Percent of Total Billed Charges, ,241,,,241,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.3,Percent of Total Billed Charges,0,243,,,243,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,174.97,Percent of Total Billed Charges, ,175,,,175,Case Rate,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
92507 - TX SPEECH LANG VOICE COMMJAND-AUD PROC DO INDIV,92507,HCPCS,,,GN,Outpatient,,,404,101,64.63,343.4,,,34.4,,138.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,115.46,,,115.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,116.56,,,116.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.02,Percent of Total Billed Charges, ,115.46,,,115.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,282.8,Percent of Total Billed Charges, ,,85,,343.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,274.72,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,226.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,242.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,111.82,,,111.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,75.88,,,75.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.61,,,76.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.04,,,74.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.31,,,73.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.04,,,74.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.51,,,75.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.79,,,76.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,64.63,,,64.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92526 - TX SWALLOWING DYSFUNCTIONAND-ORAL FUNCJ FEEDING,92526,HCPCS,,,XU,Outpatient,,,276,69,80.89,234.6,,,46,,126.96,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,127.39,,,127.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,128.62,,,128.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,181.06,Percent of Total Billed Charges, ,127.39,,,127.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,193.2,Percent of Total Billed Charges, ,,85,,234.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,187.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,154.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,165.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,123.37,,,123.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,83.72,,,83.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.53,,,84.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.7,,,81.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.89,,,80.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.7,,,81.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.32,,,83.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.73,,,84.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92526 - TX SWALLOWING DYSFUNCTIONAND-ORAL FUNCJ FEEDING,92526,HCPCS,,,GN,Outpatient,,,276,69,80.89,234.6,,,46,,126.96,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,127.39,,,127.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,128.62,,,128.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,181.06,Percent of Total Billed Charges, ,127.39,,,127.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,193.2,Percent of Total Billed Charges, ,,85,,234.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,187.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,154.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,165.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,123.37,,,123.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,83.72,,,83.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.53,,,84.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.7,,,81.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.89,,,80.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.7,,,81.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.32,,,83.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.73,,,84.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92609 - THER SP-GENRATJ DEV PRGRMGANDMODIFICAJ,92609,HCPCS,,,GN,Outpatient,,,177,44.25,0.01,156.68,,,46,,81.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,156.68,,,156.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.11,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.9,Percent of Total Billed Charges, ,,85,,150.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,120.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,99.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,106.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,101.99,,,101.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.97,,,102.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.53,,,99.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.54,,,98.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,99.53,,,99.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.5,,,101.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,103.22,,,103.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92610 - EVAL ORALANDPHARYNGEAL SWLNG FUNCJ,92610,HCPCS,,,GN,Outpatient,,,332,83,81.47,282.2,,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,129.54,,,129.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,217.79,Percent of Total Billed Charges, ,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,232.4,Percent of Total Billed Charges, ,,85,,282.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,225.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,185.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,86.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,84.32,,,84.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.14,,,85.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.28,,,82.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.47,,,81.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.28,,,82.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.91,,,83.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.34,,,85.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92611 - MOTION FLUOR EVAL SWLNG FUNCJ C-V REC,92611,HCPCS,,,GN,Outpatient,,,357,89.25,86.8,303.45,,,46,,164.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,129.71,,,129.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,138.01,,,138.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,234.19,Percent of Total Billed Charges, ,129.71,,,129.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,249.9,Percent of Total Billed Charges, ,,85,,303.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,242.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,199.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,214.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,89.84,,,89.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.71,,,90.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.67,,,87.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.8,,,86.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.67,,,87.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.4,,,89.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.92,,,90.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,139.2,,,139.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.2,,,139.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.2,,,139.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.2,,,139.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING,96125,HCPCS,,,XU,Outpatient,,,621,155.25,97.28,527.85,,,46,,285.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,154.02,,,154.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,154.68,,,154.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,407.38,Percent of Total Billed Charges, ,154.02,,,154.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,434.7,Percent of Total Billed Charges, ,,85,,527.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,422.28,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,347.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,372.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,149.16,,,149.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,100.68,,,100.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.66,,,101.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.25,,,98.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,97.28,,,97.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.25,,,98.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.2,,,100.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.9,,,101.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96125 - STANDARDIZED COGNITIVE PERFORMANCE TESTING,96125,HCPCS,,,GN,Outpatient,,,621,155.25,97.28,527.85,,,46,,285.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,154.02,,,154.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,154.68,,,154.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,407.38,Percent of Total Billed Charges, ,154.02,,,154.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,434.7,Percent of Total Billed Charges, ,,85,,527.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,422.28,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,347.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,372.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,149.16,,,149.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,100.68,,,100.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.66,,,101.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.25,,,98.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,97.28,,,97.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.25,,,98.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.2,,,100.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.9,,,101.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97129 - THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES,97129,HCPCS,,,GN,Outpatient,,,150,37.5,21.19,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.46,,,34.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,33.69,,,33.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,34.46,,,34.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,33.37,,,33.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.93,,,21.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.14,,,22.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.4,,,21.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.19,,,21.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.4,,,21.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.83,,,21.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.2,,,22.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97130 - THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES,97130,HCPCS,,,GN,Outpatient,,,150,37.5,20.24,127.5,,,34.4,,51.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.36,,,33.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,32.18,,,32.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,33.36,,,33.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,32.31,,,32.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.95,,,20.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.15,,,21.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.44,,,20.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.24,,,20.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.44,,,20.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.85,,,20.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.2,,,21.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99368 - TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN,99368,HCPCS,,,GN,Outpatient,,,150,37.5,0.01,127.5,,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,102,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0440 - SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION,0440,RC,,,,Outpatient,,,281.55,70.3875,168.93,243,,,,,,,,,,,,,,205,,,205,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,184.7,Percent of Total Billed Charges, ,,,,,,,,70,,197.09,Percent of Total Billed Charges, ,,85,,239.32,Percent of Total Billed Charges, ,241,,,241,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,191.45,Percent of Total Billed Charges,0,243,,,243,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,168.93,Percent of Total Billed Charges, ,175,,,175,Case Rate,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
92521 - EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER),92521,HCPCS,,,GN,Outpatient,,,245,61.25,84.28,208.25,,,34.4,,84.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.57,,,200.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,203,,,203,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,160.72,Percent of Total Billed Charges, ,200.57,,,200.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,171.5,Percent of Total Billed Charges, ,,85,,208.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,166.6,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,137.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,147,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,194.26,,,194.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,132.14,,,132.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,133.42,,,133.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.95,,,128.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.67,,,127.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.95,,,128.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,131.5,,,131.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,133.73,,,133.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE,92522,HCPCS,,,UA,Outpatient,,,198,49.5,68.11,168.73,,,34.4,,68.11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,167.65,,,167.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,168.73,,,168.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,129.89,Percent of Total Billed Charges, ,167.65,,,167.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,138.6,Percent of Total Billed Charges, ,,85,,168.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,134.64,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,110.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,118.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,162.37,,,162.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,109.83,,,109.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,110.9,,,110.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,107.18,,,107.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.12,,,106.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,107.18,,,107.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,109.3,,,109.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,111.16,,,111.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92522 - EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE,92522,HCPCS,,,GN,Outpatient,,,198,49.5,68.11,168.73,,,34.4,,68.11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,167.65,,,167.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,168.73,,,168.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,129.89,Percent of Total Billed Charges, ,167.65,,,167.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,138.6,Percent of Total Billed Charges, ,,85,,168.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,134.64,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,110.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,118.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,162.37,,,162.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,109.83,,,109.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,110.9,,,110.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,107.18,,,107.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.12,,,106.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,107.18,,,107.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,109.3,,,109.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,111.16,,,111.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION,92523,HCPCS,,,UA,Outpatient,,,434,108.5,146.84,368.9,,,34.4,,149.3,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,343.98,,,343.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,347.1,,,347.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,284.7,Percent of Total Billed Charges, ,343.98,,,343.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,303.8,Percent of Total Billed Charges, ,,85,,368.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,295.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,243.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,260.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,333.14,,,333.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,225.94,,,225.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.12,,,228.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,220.48,,,220.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,218.3,,,218.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,220.48,,,220.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,224.85,,,224.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.67,,,228.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION,92523,HCPCS,,,GZ,Outpatient,,,434,108.5,146.84,368.9,,,34.4,,149.3,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,343.98,,,343.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,347.1,,,347.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,284.7,Percent of Total Billed Charges, ,343.98,,,343.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,303.8,Percent of Total Billed Charges, ,,85,,368.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,295.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,243.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,260.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,333.14,,,333.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,225.94,,,225.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.12,,,228.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,220.48,,,220.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,218.3,,,218.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,220.48,,,220.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,224.85,,,224.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.67,,,228.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92523 - EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION,92523,HCPCS,,,GN,Outpatient,,,434,108.5,146.84,368.9,,,34.4,,149.3,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,343.98,,,343.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,347.1,,,347.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,284.7,Percent of Total Billed Charges, ,343.98,,,343.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,303.8,Percent of Total Billed Charges, ,,85,,368.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,295.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,243.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,260.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,333.14,,,333.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,225.94,,,225.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.12,,,228.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,220.48,,,220.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,218.3,,,218.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,220.48,,,220.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,224.85,,,224.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.67,,,228.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92524 - BEHAVIORAL AND QUALIT ANALYSIS VOICE AND RESONANCE,92524,HCPCS,,,GN,Outpatient,,,202,50.5,69.49,171.7,,,34.4,,69.49,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,165.78,,,165.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,165.77,,,165.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,132.51,Percent of Total Billed Charges, ,165.78,,,165.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,141.4,Percent of Total Billed Charges, ,,85,,171.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,137.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,113.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,121.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,160.56,,,160.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,107.91,,,107.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,108.95,,,108.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.3,,,105.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.26,,,104.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.3,,,105.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,107.39,,,107.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,109.21,,,109.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,146.84,,,146.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92610 - EVAL ORALANDPHARYNGEAL SWLNG FUNCJ,92610,HCPCS,,,XU,Outpatient,,,332,83,81.47,282.2,,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,129.54,,,129.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,217.79,Percent of Total Billed Charges, ,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,232.4,Percent of Total Billed Charges, ,,85,,282.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,225.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,185.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,86.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,84.32,,,84.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.14,,,85.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.28,,,82.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.47,,,81.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.28,,,82.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.91,,,83.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.34,,,85.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92610 - EVAL ORALANDPHARYNGEAL SWLNG FUNCJ,92610,HCPCS,,,GN,Outpatient,,,332,83,81.47,282.2,,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,129.54,,,129.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,217.79,Percent of Total Billed Charges, ,,46,,152.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,232.4,Percent of Total Billed Charges, ,,85,,282.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,225.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,185.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,199.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,86.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,84.32,,,84.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.14,,,85.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.28,,,82.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.47,,,81.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.28,,,82.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.91,,,83.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.34,,,85.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92611 - MOTION FLUOR EVAL SWLNG FUNCJ C-V REC,92611,HCPCS,,,GN,Outpatient,,,357,89.25,86.8,303.45,,,46,,164.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,129.71,,,129.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,138.01,,,138.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,234.19,Percent of Total Billed Charges, ,129.71,,,129.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,249.9,Percent of Total Billed Charges, ,,85,,303.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,242.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,199.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,214.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,125.62,,,125.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,89.84,,,89.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.71,,,90.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.67,,,87.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.8,,,86.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.67,,,87.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.4,,,89.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.92,,,90.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,139.2,,,139.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.2,,,139.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.2,,,139.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.2,,,139.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92612 - FLEXIBLE ENDOSCOPIC EVAL SWALLOW C-V REC,92612,HCPCS,,,GN,Outpatient,,,420,105,109.2,523.52,,,46,,193.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,193.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,299.99,,,299.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,275.52,Percent of Total Billed Charges, ,,46,,193.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,294,Percent of Total Billed Charges, ,,85,,357,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,285.6,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,235.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,252,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,109.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.27,,,195.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.16,,,197.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.56,,,190.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.67,,,188.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.56,,,190.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.33,,,194.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.63,,,197.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,523.52,,,523.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,523.52,,,523.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,523.52,,,523.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,523.52,,,523.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96105 - ASSESSMENT APHASIA W-INTERP AND REPORT PER HOUR,96105,HCPCS,,,XU,Outpatient,,,666,166.5,91.57,566.1,,,46,,306.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,306.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,145.6,,,145.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,436.9,Percent of Total Billed Charges, ,,46,,306.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,466.2,Percent of Total Billed Charges, ,,85,,566.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,452.88,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,372.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,399.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,173.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,94.77,,,94.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.69,,,95.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.49,,,92.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.57,,,91.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.49,,,92.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.32,,,94.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.92,,,95.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96105 - ASSESSMENT APHASIA W-INTERP AND REPORT PER HOUR,96105,HCPCS,,,GN,Outpatient,,,666,166.5,91.57,566.1,,,46,,306.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,306.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,145.6,,,145.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,436.9,Percent of Total Billed Charges, ,,46,,306.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,466.2,Percent of Total Billed Charges, ,,85,,566.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,452.88,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,372.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,399.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,26,,173.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,94.77,,,94.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.69,,,95.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.49,,,92.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.57,,,91.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.49,,,92.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.32,,,94.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.92,,,95.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION,0444,RC,,,,Outpatient,,,376.06,94.015,175,319.65,,,,,,,,,,,,,,205,,,205,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,246.7,Percent of Total Billed Charges, ,,,,,,,,70,,263.24,Percent of Total Billed Charges, ,,85,,319.65,Percent of Total Billed Charges, ,241,,,241,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,255.72,Percent of Total Billed Charges,0,243,,,243,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,225.64,Percent of Total Billed Charges, ,175,,,175,Case Rate,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
10060 - INCISION AND DRAINAGE ABSCESS SIMPLE-SINGLE,10060,HCPCS,,,T5,Outpatient,,,775,193.75,188.91,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10060 - INCISION AND DRAINAGE ABSCESS SIMPLE-SINGLE,10060,HCPCS,,,RT,Outpatient,,,775,193.75,188.91,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10060 - INCISION AND DRAINAGE ABSCESS SIMPLE-SINGLE,10060,HCPCS,,,LT,Outpatient,,,775,193.75,188.91,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10060 - INCISION AND DRAINAGE ABSCESS SIMPLE-SINGLE,10060,HCPCS,,,FA,Outpatient,,,775,193.75,188.91,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10060 - INCISION AND DRAINAGE ABSCESS SIMPLE-SINGLE,10060,HCPCS,,,F6,Outpatient,,,775,193.75,188.91,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10060 - INCISION AND DRAINAGE ABSCESS SIMPLE-SINGLE,10060,HCPCS,,,F1,Outpatient,,,775,193.75,188.91,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10060 - INCISION AND DRAINAGE ABSCESS SIMPLE-SINGLE,10060,HCPCS,,,52,Outpatient,,,775,193.75,188.91,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,T5,Outpatient,,,768,192,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,503.81,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,537.6,Percent of Total Billed Charges, ,,85,,652.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,522.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,430.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,460.8,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,RT,Outpatient,,,768,192,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,503.81,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,537.6,Percent of Total Billed Charges, ,,85,,652.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,522.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,430.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,460.8,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,LT,Outpatient,,,768,192,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,503.81,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,537.6,Percent of Total Billed Charges, ,,85,,652.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,522.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,430.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,460.8,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,FA,Outpatient,,,768,192,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,503.81,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,537.6,Percent of Total Billed Charges, ,,85,,652.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,522.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,430.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,460.8,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,F7,Outpatient,,,768,192,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,503.81,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,537.6,Percent of Total Billed Charges, ,,85,,652.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,522.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,430.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,460.8,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10120 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,10120,HCPCS,,,F1,Outpatient,,,768,192,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,503.81,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,537.6,Percent of Total Billed Charges, ,,85,,652.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,522.24,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,430.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,460.8,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10121 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS COMP,10121,HCPCS,,,F4,Outpatient,,,2626,656.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1722.66,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1838.2,Percent of Total Billed Charges, ,,85,,2232.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1785.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1470.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1575.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10121 - INCISION AND REMOVAL FOREIGN BODY SUBQ TISS COMP,10121,HCPCS,,,52,Outpatient,,,2626,656.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1722.66,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1838.2,Percent of Total Billed Charges, ,,85,,2232.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1785.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1470.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1575.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10140 - IANDD HEMATOMA SEROMA-FLUID COLLECTION,10140,HCPCS,,,LT,Outpatient,,,2156,539,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1414.34,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1509.2,Percent of Total Billed Charges, ,,85,,1832.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1466.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1207.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1293.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10140 - IANDD HEMATOMA SEROMA-FLUID COLLECTION,10140,HCPCS,,,F8,Outpatient,,,2156,539,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1414.34,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1509.2,Percent of Total Billed Charges, ,,85,,1832.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1466.08,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1207.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1293.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA-CYST,10160,HCPCS,,,F7,Outpatient,,,775,193.75,379.85,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA-CYST,10160,HCPCS,,,F2,Outpatient,,,775,193.75,379.85,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA-CYST,10160,HCPCS,,,F1,Outpatient,,,775,193.75,379.85,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA-CYST,10160,HCPCS,,,52,Outpatient,,,775,193.75,379.85,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,TA,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,T6,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,T5,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,T2,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,RT,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,LT,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,FA,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,F9,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,F8,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,F7,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11740 - EVACUATION SUBUNGUAL HEMATOMA,11740,HCPCS,,,TA,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11740 - EVACUATION SUBUNGUAL HEMATOMA,11740,HCPCS,,,FA,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11740 - EVACUATION SUBUNGUAL HEMATOMA,11740,HCPCS,,,F5,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11740 - EVACUATION SUBUNGUAL HEMATOMA,11740,HCPCS,,,F1,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL,11750,HCPCS,,,T5,Outpatient,,,1800,450,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,T4,Outpatient,,,802,200.5,449.12,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,526.11,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,561.4,Percent of Total Billed Charges, ,,85,,681.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,545.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,449.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,481.2,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,F2,Outpatient,,,802,200.5,449.12,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,526.11,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,561.4,Percent of Total Billed Charges, ,,85,,681.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,545.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,449.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,481.2,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11760 - REPAIR NAIL BED,11760,HCPCS,,,F1,Outpatient,,,802,200.5,449.12,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,526.11,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,561.4,Percent of Total Billed Charges, ,,85,,681.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,545.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,449.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,481.2,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,XU,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,XS,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,TA,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,T5,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,T4,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,T1,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,RT,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,LT,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,FA,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,F9,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,F8,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,F7,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,F6,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,F5,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,F4,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,F3,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,F2,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,F1,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12001 - SIMPLE REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.5CM-LESS THAN,12001,HCPCS,,,73,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,XU,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,TA,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,T7,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,T5,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,RT,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,LT,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,FA,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,F7,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,F6,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,F5,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,F3,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,F2,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,F1,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12002 - SMPL REPAIR SCALP-NECK-AX-GENIT-TRUNK 2.6-7.5CM,12002,HCPCS,,,50,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12004 - SIMPLE RPR SCALP-NECK-AX-GENIT-TRUNK 7.6-12.5CM,12004,HCPCS,,,XU,Outpatient,,,775,193.75,188.91,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12004 - SIMPLE RPR SCALP-NECK-AX-GENIT-TRUNK 7.6-12.5CM,12004,HCPCS,,,RT,Outpatient,,,775,193.75,188.91,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12004 - SIMPLE RPR SCALP-NECK-AX-GENIT-TRUNK 7.6-12.5CM,12004,HCPCS,,,LT,Outpatient,,,775,193.75,188.91,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12005 - SMPL RPR SCALP-NECK-AX-GENIT-TRUNK 12.6-20.0CM,12005,HCPCS,,,RT,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12005 - SMPL RPR SCALP-NECK-AX-GENIT-TRUNK 12.6-20.0CM,12005,HCPCS,,,LT,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12011 - SIMPLE REPAIR F-E-E-N-L-M 2.5CM-LESS THAN,12011,HCPCS,,,XU,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12011 - SIMPLE REPAIR F-E-E-N-L-M 2.5CM-LESS THAN,12011,HCPCS,,,RT,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12011 - SIMPLE REPAIR F-E-E-N-L-M 2.5CM-LESS THAN,12011,HCPCS,,,LT,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12013 - SIMPLE REPAIR F-E-E-N-L-M 2.6CM-5.0 CM,12013,HCPCS,,,XU,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12013 - SIMPLE REPAIR F-E-E-N-L-M 2.6CM-5.0 CM,12013,HCPCS,,,XS,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12013 - SIMPLE REPAIR F-E-E-N-L-M 2.6CM-5.0 CM,12013,HCPCS,,,RT,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12013 - SIMPLE REPAIR F-E-E-N-L-M 2.6CM-5.0 CM,12013,HCPCS,,,LT,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12014 - SIMPLE REPAIR F-E-E-N-L-M 5.1CM-7.5 CM,12014,HCPCS,,,RT,Outpatient,,,775,193.75,188.91,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12014 - SIMPLE REPAIR F-E-E-N-L-M 5.1CM-7.5 CM,12014,HCPCS,,,LT,Outpatient,,,775,193.75,188.91,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12016 - SIMPLE REPAIR F-E-E-N-L-M 12.6CM-20.0 CM,12016,HCPCS,,,XS,Outpatient,,,2320,580,0.01,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12031 - REPAIR INTERMEDIATE S-A-T-E 2.5 CM-LESS THAN,12031,HCPCS,,,XU,Outpatient,,,775,193.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12031 - REPAIR INTERMEDIATE S-A-T-E 2.5 CM-LESS THAN,12031,HCPCS,,,RT,Outpatient,,,775,193.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12031 - REPAIR INTERMEDIATE S-A-T-E 2.5 CM-LESS THAN,12031,HCPCS,,,LT,Outpatient,,,775,193.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12031 - REPAIR INTERMEDIATE S-A-T-E 2.5 CM-LESS THAN,12031,HCPCS,,,F5,Outpatient,,,775,193.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12032 - REPAIR INTERMEDIATE S-A-T-E 2.6-7.5 CM,12032,HCPCS,,,RT,Outpatient,,,775,193.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12032 - REPAIR INTERMEDIATE S-A-T-E 2.6-7.5 CM,12032,HCPCS,,,LT,Outpatient,,,775,193.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12032 - REPAIR INTERMEDIATE S-A-T-E 2.6-7.5 CM,12032,HCPCS,,,FA,Outpatient,,,,,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,,,,,,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12034 - REPAIR INTERMEDIATE S-A-T-E 7.6-12.5 CM,12034,HCPCS,,,RT,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,TA,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,T5,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,RT,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,LT,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,FA,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,F9,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,F6,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,F5,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,F4,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12041 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.5CM-LESS THAN,12041,HCPCS,,,F1,Outpatient,,,775,193.75,379.85,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12042 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 2.6-7.5 CM,12042,HCPCS,,,RT,Outpatient,,,775,193.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12044 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 7.6-12.5CM,12044,HCPCS,,,RT,Outpatient,,,2320,580,581.98,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12044 - REPAIR INTERMEDIATE N-H-F-XTRNL GENT 7.6-12.5CM,12044,HCPCS,,,F7,Outpatient,,,2320,580,581.98,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12051 - REPAIR INTERMEDIATE F-E-E-N-LAND-MUC 2.5 CM-LESS THAN,12051,HCPCS,,,LT,Outpatient,,,775,193.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
12052 - REPAIR INTERMEDIATE F-E-E-N-LAND-MUC 2.6-5.0 CM,12052,HCPCS,,,LT,Outpatient,,,775,193.75,379.85,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13121 - REPAIR COMPLEX SCALP-ARM-LEG 2.6-7.5 CM,13121,HCPCS,,,RT,Outpatient,,,9462,2365.5,581.98,8042.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13121 - REPAIR COMPLEX SCALP-ARM-LEG 2.6-7.5 CM,13121,HCPCS,,,LT,Outpatient,,,9462,2365.5,581.98,8042.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13122 - REPAIR COMPLEX SCALP-ARM-LEG EA ADDL 5 CM-LESS THAN,13122,HCPCS,,,RT,Outpatient,,,776,194,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,509.06,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,543.2,Percent of Total Billed Charges, ,,85,,659.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
13131 - REPAIR COMPLEX F-C-C-M-N-AX-G-H-F 1.1-2.5 CM,13131,HCPCS,,,RT,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
13131 - REPAIR COMPLEX F-C-C-M-N-AX-G-H-F 1.1-2.5 CM,13131,HCPCS,,,LT,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
16020 - DRSAND-DBRDMT PRTL-THKNS BURNS 1ST-SBSQ SMALL,16020,HCPCS,,,RT,Outpatient,,,1800,450,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,50,,900,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,302.94,,,302.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,302.94,,,302.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,302.94,,,302.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,302.94,,,302.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
16020 - DRSAND-DBRDMT PRTL-THKNS BURNS 1ST-SBSQ SMALL,16020,HCPCS,,,LT,Outpatient,,,1800,450,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,50,,900,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,302.94,,,302.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,302.94,,,302.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,302.94,,,302.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,302.94,,,302.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
16025 - DRSAND-DBRDMT PRTL-THKNS BURNS 1ST-SBSQ MEDIUM,16025,HCPCS,,,50,Outpatient,,,725,181.25,188.91,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.85,,,608.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,608.85,,,608.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,608.85,,,608.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,608.85,,,608.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20552 - INJECTION SINGLE-MLT TRIGGER POINT 1-2 MUSCLES,20552,HCPCS,,,LT,Outpatient,,,1800,450,280.65,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20605 - ARTHROCENTESIS ASPIRAND-INJ INTERM JT-BURS W-O US,20605,HCPCS,,,RT,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20605 - ARTHROCENTESIS ASPIRAND-INJ INTERM JT-BURS W-O US,20605,HCPCS,,,LT,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,RT,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,LT,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20610 - ARTHROCENTESIS ASPIRAND-INJ MAJOR JT-BURSA W-O US,20610,HCPCS,,,74,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST-SBSQ,21480,HCPCS,,,RT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST-SBSQ,21480,HCPCS,,,LT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST-SBSQ,21480,HCPCS,,,50,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23605 - CLTX PROX HUMRL FX W-MNPJ W-WO SKELETAL TRACJ,23605,HCPCS,,,RT,Outpatient,,,3148,787,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2065.09,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2203.6,Percent of Total Billed Charges, ,,85,,2675.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2140.64,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1762.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1888.8,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23650 - CLSD TX SHOULDER DISLC W-MANIPULATION W-O ANES,23650,HCPCS,,,RT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23650 - CLSD TX SHOULDER DISLC W-MANIPULATION W-O ANES,23650,HCPCS,,,LT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23650 - CLSD TX SHOULDER DISLC W-MANIPULATION W-O ANES,23650,HCPCS,,,53,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23650 - CLSD TX SHOULDER DISLC W-MANIPULATION W-O ANES,23650,HCPCS,,,50,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23655 - CLSD TX SHOULDER DISLC W-MANIPULATION REQ ANES,23655,HCPCS,,,RT,Outpatient,,,2169,542.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1422.86,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1518.3,Percent of Total Billed Charges, ,,85,,1843.65,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1474.92,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1214.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1301.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23655 - CLSD TX SHOULDER DISLC W-MANIPULATION REQ ANES,23655,HCPCS,,,LT,Outpatient,,,2169,542.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1422.86,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1518.3,Percent of Total Billed Charges, ,,85,,1843.65,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1474.92,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1214.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1301.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
23665 - CLTX SHOULDER DISLC W-FX HUMERAL TUBRST W-MNPJ,23665,HCPCS,,,RT,Outpatient,,,2320,580,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24505 - CLTX HUMERAL SHFT FX W-MANJ W-WO SKELETAL TRACJ,24505,HCPCS,,,RT,Outpatient,,,2134,533.5,674,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24505 - CLTX HUMERAL SHFT FX W-MANJ W-WO SKELETAL TRACJ,24505,HCPCS,,,LT,Outpatient,,,2134,533.5,674,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24600 - TREATMENT CLOSED ELBOW DISLOCATION W-O ANES,24600,HCPCS,,,RT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24600 - TREATMENT CLOSED ELBOW DISLOCATION W-O ANES,24600,HCPCS,,,LT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24620 - CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W-MANJ,24620,HCPCS,,,LT,Outpatient,,,2148,537,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1409.09,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1503.6,Percent of Total Billed Charges, ,,85,,1825.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1460.64,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1202.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1288.8,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W-MANJ,24640,HCPCS,,,RT,Outpatient,,,1800,450,228.06,2100,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,50,,900,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W-MANJ,24640,HCPCS,,,LT,Outpatient,,,1800,450,228.06,2100,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,50,,900,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24655 - CLOSED TX RADIAL HEAD-NECK FX W-MANIPULATION,24655,HCPCS,,,RT,Outpatient,,,2134,533.5,674,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W-MANJ,24675,HCPCS,,,LT,Outpatient,,,2134,533.5,674,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25505 - CLOSED TX RADIAL SHAFT FRACTURE W-MANIPULATION,25505,HCPCS,,,RT,Outpatient,,,2134,533.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25505 - CLOSED TX RADIAL SHAFT FRACTURE W-MANIPULATION,25505,HCPCS,,,LT,Outpatient,,,2134,533.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25535 - CLOSED TX ULNAR SHAFT FRACTURE W-MANIPULATION,25535,HCPCS,,,RT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25535 - CLOSED TX ULNAR SHAFT FRACTURE W-MANIPULATION,25535,HCPCS,,,LT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25565 - CLOSED TX RADIALANDULNAR SHAFT FRACTURES W-MNPJ,25565,HCPCS,,,RT,Outpatient,,,2320,580,674,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25565 - CLOSED TX RADIALANDULNAR SHAFT FRACTURES W-MNPJ,25565,HCPCS,,,LT,Outpatient,,,2320,580,674,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25600 - CLTX DSTL RADIAL FX-EPIPHYSL SEP W-O MNPJ,25600,HCPCS,,,RT,Outpatient,,,775,193.75,228.06,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25600 - CLTX DSTL RADIAL FX-EPIPHYSL SEP W-O MNPJ,25600,HCPCS,,,LT,Outpatient,,,775,193.75,228.06,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25605 - CLTX DSTL RDL FX-EPIPHYSL SEP W-MNPJ,25605,HCPCS,,,RT,Outpatient,,,9462,2365.5,742.5,8042.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25605 - CLTX DSTL RDL FX-EPIPHYSL SEP W-MNPJ,25605,HCPCS,,,LT,Outpatient,,,9462,2365.5,742.5,8042.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
25605 - CLTX DSTL RDL FX-EPIPHYSL SEP W-MNPJ,25605,HCPCS,,,50,Outpatient,,,9462,2365.5,742.5,8042.7,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,RT,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,LT,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,FA,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F8,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F7,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F6,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F5,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F4,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F3,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F2,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26010 - DRAINAGE FINGER ABSCESS SIMPLE,26010,HCPCS,,,F1,Outpatient,,,775,193.75,188.91,775,,,,,,,Service Paid at Rev Code level,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26605 - CLTX METACARPAL FX W-MANIPULATION EACH BONE,26605,HCPCS,,,RT,Outpatient,,,725,181.25,228.06,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26605 - CLTX METACARPAL FX W-MANIPULATION EACH BONE,26605,HCPCS,,,LT,Outpatient,,,725,181.25,228.06,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26605 - CLTX METACARPAL FX W-MANIPULATION EACH BONE,26605,HCPCS,,,F5,Outpatient,,,725,181.25,228.06,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26605 - CLTX METACARPAL FX W-MANIPULATION EACH BONE,26605,HCPCS,,,F4,Outpatient,,,725,181.25,228.06,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26641 - CLTX CARPO-METACARPAL DISLOCATION THUMB W-MANJ,26641,HCPCS,,,LT,Outpatient,,,725,181.25,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26670 - CLTX CARPO-METACARPL DISLC THMB MANJ EA W-O ANES,26670,HCPCS,,,F7,Outpatient,,,725,181.25,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26670 - CLTX CARPO-METACARPL DISLC THMB MANJ EA W-O ANES,26670,HCPCS,,,F2,Outpatient,,,725,181.25,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26700 - CLTX METACARPOPHALANGEAL DISLC W-MANJ W-O ANES,26700,HCPCS,,,FA,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26700 - CLTX METACARPOPHALANGEAL DISLC W-MANJ W-O ANES,26700,HCPCS,,,F9,Outpatient,,,750,187.5,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,492,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,525,Percent of Total Billed Charges, ,,85,,637.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,510,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,420,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,450,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26700 - CLTX METACARPOPHALANGEAL DISLC W-MANJ W-O ANES,26700,HCPCS,,,F8,Outpatient,,,725,181.25,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26725 - CLTX PHLNGL FX PROX-MIDDLE PX-F-T W-MANJ EA,26725,HCPCS,,,LT,Outpatient,,,775,193.75,228.06,4145,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26725 - CLTX PHLNGL FX PROX-MIDDLE PX-F-T W-MANJ EA,26725,HCPCS,,,F9,Outpatient,,,775,193.75,228.06,4145,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26725 - CLTX PHLNGL FX PROX-MIDDLE PX-F-T W-MANJ EA,26725,HCPCS,,,F5,Outpatient,,,775,193.75,228.06,4145,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26725 - CLTX PHLNGL FX PROX-MIDDLE PX-F-T W-MANJ EA,26725,HCPCS,,,F4,Outpatient,,,775,193.75,228.06,4145,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26725 - CLTX PHLNGL FX PROX-MIDDLE PX-F-T W-MANJ EA,26725,HCPCS,,,F3,Outpatient,,,775,193.75,228.06,4145,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26755 - CLTX DSTL PHLNGL FX FNGR-THMB W-MANJ EA,26755,HCPCS,,,LT,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26755 - CLTX DSTL PHLNGL FX FNGR-THMB W-MANJ EA,26755,HCPCS,,,F5,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,T6,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,T4,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,T2,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,T1,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,RT,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,LT,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,FA,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,F9,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,F8,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,F7,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,F6,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,F4,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,F3,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,F2,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26770 - CLTX IPHAL JT DISLC W-MANJ W-O ANES,26770,HCPCS,,,F1,Outpatient,,,775,193.75,228.06,9153,,,,,,,Service Paid at Rev Code level,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26775 - CLTX IPHAL JT DISLC W-MANJ REQ ANES,26775,HCPCS,,,F9,Outpatient,,,2285,571.25,252.5,6015,,,,,,,Service Paid at Rev Code level,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1498.96,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1599.5,Percent of Total Billed Charges, ,,85,,1942.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1553.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1279.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1371,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26775 - CLTX IPHAL JT DISLC W-MANJ REQ ANES,26775,HCPCS,,,F7,Outpatient,,,2285,571.25,252.5,6015,,,,,,,Service Paid at Rev Code level,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1498.96,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1599.5,Percent of Total Billed Charges, ,,85,,1942.25,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1553.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1279.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1371,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
26785 - OPEN TX INTERPHALANGEAL JOINT DISLOCATION,26785,HCPCS,,,F8,Outpatient,,,6638,1659.5,950.4,5642.3,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4791.81,,,4791.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4354.53,Percent of Total Billed Charges, ,4828.64,,,4828.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4646.6,Percent of Total Billed Charges, ,,85,,5642.3,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4513.84,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3982.8,Percent of Total Billed Charges, ,4742.85,,,4742.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4677.27,,,4677.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3192.75,,,3192.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3223.6,,,3223.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3084.78,,,3084.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3115.63,,,3115.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3177.32,,,3177.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3231.31,,,3231.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27250 - CLTX HIP DISLOCATION TRAUMATIC W-O ANESTHESIA,27250,HCPCS,,,RT,Outpatient,,,1800,450,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27250 - CLTX HIP DISLOCATION TRAUMATIC W-O ANESTHESIA,27250,HCPCS,,,LT,Outpatient,,,1800,450,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27252 - CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA,27252,HCPCS,,,RT,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27252 - CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA,27252,HCPCS,,,LT,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27256 - TX SPONTAN HIP DISLC ABDCT SPLNT-TRCJ W-O ANES,27256,HCPCS,,,LT,Outpatient,,,762,190.5,228.06,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,499.87,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,533.4,Percent of Total Billed Charges, ,,85,,647.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,518.16,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,426.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,457.2,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27265 - CLTX POST HIP ARTHRP DISLC W-O ANES,27265,HCPCS,,,RT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27265 - CLTX POST HIP ARTHRP DISLC W-O ANES,27265,HCPCS,,,LT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27266 - CLTX POST HIP ARTHRP DISLC REQ ANES,27266,HCPCS,,,RT,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27266 - CLTX POST HIP ARTHRP DISLC REQ ANES,27266,HCPCS,,,LT,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27520 - CLOSED TX PATELLAR FRACTURE W-O MANIPULATION,27520,HCPCS,,,LT,Outpatient,,,725,181.25,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27550 - CLOSED TX KNEE DISLOCATION W-O ANESTHESIA,27550,HCPCS,,,LT,Outpatient,,,1800,450,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27560 - CLOSED TX PATELLAR DISLOCATION W-O ANESTHESIA,27560,HCPCS,,,RT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27560 - CLOSED TX PATELLAR DISLOCATION W-O ANESTHESIA,27560,HCPCS,,,LT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27752 - CLTX TIBIAL SHAFT FX W-MANJ W-WO SKEL TRACJ,27752,HCPCS,,,RT,Outpatient,,,2148,537,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1409.09,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1503.6,Percent of Total Billed Charges, ,,85,,1825.8,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1460.64,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1202.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1288.8,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27752 - CLTX TIBIAL SHAFT FX W-MANJ W-WO SKEL TRACJ,27752,HCPCS,,,50,Outpatient,,,2148,537,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1409.09,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1503.6,Percent of Total Billed Charges, ,,85,,1825.8,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1460.64,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1202.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1288.8,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27786 - CLTX DSTL FIBULAR FX LAT MALLS W-O MANJ,27786,HCPCS,,,RT,Outpatient,,,725,181.25,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27788 - CLTX DSTL FIBULAR FX LAT MALLS W-MANJ,27788,HCPCS,,,RT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27788 - CLTX DSTL FIBULAR FX LAT MALLS W-MANJ,27788,HCPCS,,,LT,Outpatient,,,1800,450,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W-O MANJ,27808,HCPCS,,,LT,Outpatient,,,725,181.25,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W-MANJ,27810,HCPCS,,,RT,Outpatient,,,2134,533.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W-MANJ,27810,HCPCS,,,LT,Outpatient,,,2134,533.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27816 - CLTX TRIMALLEOLAR ANKLE FX W-O MANIPULATION,27816,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27818 - CLTX TRIMALLEOLAR ANKLE FX W-MANIPULATION,27818,HCPCS,,,RT,Outpatient,,,2134,533.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27818 - CLTX TRIMALLEOLAR ANKLE FX W-MANIPULATION,27818,HCPCS,,,LT,Outpatient,,,2134,533.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27840 - CLOSED TX ANKLE DISLOCATION W-O ANESTHESIA,27840,HCPCS,,,RT,Outpatient,,,1800,450,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27840 - CLOSED TX ANKLE DISLOCATION W-O ANESTHESIA,27840,HCPCS,,,LT,Outpatient,,,1800,450,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
27840 - CLOSED TX ANKLE DISLOCATION W-O ANESTHESIA,27840,HCPCS,,,25,Outpatient,,,1800,450,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,28190,HCPCS,,,RT,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,28190,HCPCS,,,LT,Outpatient,,,1800,450,668.93,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28192 - REMOVAL FOREIGN BODY FOOT DEEP,28192,HCPCS,,,RT,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28430 - CLOSED TX TALUS FRACTURE W-O MANIPULATION,28430,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28435 - CLOSED TX TALUS FRACTURE W-MANIPULATION,28435,HCPCS,,,LT,Outpatient,,,2134,533.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1399.9,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1493.8,Percent of Total Billed Charges, ,,85,,1813.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1451.12,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1195.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1280.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28495 - CLTX FX GRT TOE PHLX-PHLG W-MANJ,28495,HCPCS,,,TA,Outpatient,,,775,193.75,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28515 - CLTX FX PHLX-PHLG OTH-THN GRT TOE W-MANJ,28515,HCPCS,,,T4,Outpatient,,,775,193.75,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28515 - CLTX FX PHLX-PHLG OTH-THN GRT TOE W-MANJ,28515,HCPCS,,,T1,Outpatient,,,775,193.75,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28515 - CLTX FX PHLX-PHLG OTH-THN GRT TOE W-MANJ,28515,HCPCS,,,RT,Outpatient,,,775,193.75,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28630 - CLTX METATARSOPHLNGL JT DISLC W-O ANES,28630,HCPCS,,,T6,Outpatient,,,775,193.75,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28630 - CLTX METATARSOPHLNGL JT DISLC W-O ANES,28630,HCPCS,,,T5,Outpatient,,,775,193.75,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28630 - CLTX METATARSOPHLNGL JT DISLC W-O ANES,28630,HCPCS,,,RT,Outpatient,,,775,193.75,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28660 - CLTX INTERPHALANGEAL JOINT DISLOCATION W-O ANES,28660,HCPCS,,,TA,Outpatient,,,775,193.75,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28660 - CLTX INTERPHALANGEAL JOINT DISLOCATION W-O ANES,28660,HCPCS,,,T2,Outpatient,,,775,193.75,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28660 - CLTX INTERPHALANGEAL JOINT DISLOCATION W-O ANES,28660,HCPCS,,,RT,Outpatient,,,775,193.75,228.06,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.27,,,354.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,335.81,,,335.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,350.64,,,350.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,325.28,,,325.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.04,,,236.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.32,,,238.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.06,,,228.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.34,,,230.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.9,,,234.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.89,,,238.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND,29105,HCPCS,,,RT,Outpatient,,,775,193.75,150.02,775,,,,,,,Service Paid at Rev Code level,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND,29105,HCPCS,,,LT,Outpatient,,,775,193.75,150.02,775,,,,,,,Service Paid at Rev Code level,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,29125,HCPCS,,,RT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,29125,HCPCS,,,LT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,29125,HCPCS,,,F9,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,29125,HCPCS,,,50,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29126 - APPLICATION SHORT ARM SPLINT DYNAMIC,29126,HCPCS,,,LT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,RT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,FA,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,F9,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,F7,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,F6,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,F5,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,F4,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,F3,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,F2,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29130 - APPLICATION FINGER SPLINT STATIC,29130,HCPCS,,,F1,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE-TOES,29505,HCPCS,,,RT,Outpatient,,,775,193.75,150.02,775,,,,,,,Service Paid at Rev Code level,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE-TOES,29505,HCPCS,,,LT,Outpatient,,,775,193.75,150.02,775,,,,,,,Service Paid at Rev Code level,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29515 - APPLICATION SHORT LEG SPLINT CALF FOOT,29515,HCPCS,,,RT,Outpatient,,,775,193.75,150.02,775,,,,,,,Service Paid at Rev Code level,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29515 - APPLICATION SHORT LEG SPLINT CALF FOOT,29515,HCPCS,,,LT,Outpatient,,,775,193.75,150.02,775,,,,,,,Service Paid at Rev Code level,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29515 - APPLICATION SHORT LEG SPLINT CALF FOOT,29515,HCPCS,,,50,Outpatient,,,775,193.75,150.02,775,,,,,,,Service Paid at Rev Code level,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29520 - STRAPPING HIP,29520,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29700 - REMOVAL-BIVALVING GAUNTLET BOOT-BODY CAST,29700,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,775,,,,,,,Service Paid at Rev Code level,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29700 - REMOVAL-BIVALVING GAUNTLET BOOT-BODY CAST,29700,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,775,,,,,,,Service Paid at Rev Code level,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29705 - REMOVAL-BIVALVING FULL ARM-FULL LEG CAST,29705,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,775,,,,,,,Service Paid at Rev Code level,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29705 - REMOVAL-BIVALVING FULL ARM-FULL LEG CAST,29705,HCPCS,,,50,Outpatient,,,725,181.25,0.01,775,,,,,,,Service Paid at Rev Code level,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE,30300,HCPCS,,,RT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30300 - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE,30300,HCPCS,,,LT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,30901,HCPCS,,,RT,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,30901,HCPCS,,,LT,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,30901,HCPCS,,,50,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30903 - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX,30903,HCPCS,,,RT,Outpatient,,,1800,450,122.55,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30905 - CTRL NSL HEMRRG PST NASAL PACKSAND-CAUTERY 1ST,30905,HCPCS,,,LT,Outpatient,,,1800,450,122.55,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL,32551,HCPCS,,,RT,Outpatient,,,2154,538.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1413.02,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1507.8,Percent of Total Billed Charges, ,,85,,1830.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1464.72,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1206.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1292.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL,32551,HCPCS,,,LT,Outpatient,,,2154,538.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1413.02,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1507.8,Percent of Total Billed Charges, ,,85,,1830.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1464.72,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1206.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1292.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
35226 - REPAIR BLOOD VESSEL DIRECT LOWER EXTREMITY,35226,HCPCS,,,RT,Outpatient,,,2658,664.5,668.93,9034,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1743.65,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1860.6,Percent of Total Billed Charges, ,,85,,2259.3,Percent of Total Billed Charges, ,,50,,1329,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1807.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1488.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1594.8,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36000 - INTRODUCTION NEEDLE-INTRACATHETER VEIN,36000,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,6015,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36000 - INTRODUCTION NEEDLE-INTRACATHETER VEIN,36000,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,6015,,,,,,,Service Paid at Rev Code level,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,50,,362.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
36556 - INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR-GREATER THAN,36556,HCPCS,,,RT,Outpatient,,,5043,1260.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36556 - INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR-GREATER THAN,36556,HCPCS,,,LT,Outpatient,,,5043,1260.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36556 - INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR-GREATER THAN,36556,HCPCS,,,59,Outpatient,,,5043,1260.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36569 - INSERTION PICC W-O IMG GDN 5 YR-GREATER THAN,36569,HCPCS,,,LT,Outpatient,,,2933,733.25,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1924.05,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2053.1,Percent of Total Billed Charges, ,,85,,2493.05,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1994.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1642.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1759.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36620 - ARTL CATHJ-CANNULJ MNTR-TRANSFUSION SPX PRQ,36620,HCPCS,,,RT,Outpatient,,,1552,388,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1018.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1086.4,Percent of Total Billed Charges, ,,85,,1319.2,Percent of Total Billed Charges, ,,50,,776,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1055.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,869.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,931.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36620 - ARTL CATHJ-CANNULJ MNTR-TRANSFUSION SPX PRQ,36620,HCPCS,,,LT,Outpatient,,,1552,388,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1018.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1086.4,Percent of Total Billed Charges, ,,85,,1319.2,Percent of Total Billed Charges, ,,50,,776,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1055.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,869.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,931.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36620 - ARTL CATHJ-CANNULJ MNTR-TRANSFUSION SPX PRQ,36620,HCPCS,,,59,Outpatient,,,1552,388,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1018.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1086.4,Percent of Total Billed Charges, ,,85,,1319.2,Percent of Total Billed Charges, ,,50,,776,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1055.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,869.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,931.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49505 - RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN REDUCIBLE,49505,HCPCS,,,RT,Outpatient,,,,,1078.11,10028,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,,,,,,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,51702,HCPCS,,,XU,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,51702,HCPCS,,,XP,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,51702,HCPCS,,,59,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51702 - INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,51702,HCPCS,,,52,Outpatient,,,775,193.75,122.55,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
51703 - INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED,51703,HCPCS,,,XU,Outpatient,,,1800,450,148.75,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,235.9,,,235.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,235.9,,,235.9,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,228.7,,,228.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.51,,,228.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,RT,Outpatient,,,,,1078.11,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,,,,,,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
52332 - CYSTO W-INSERT URETERAL STENT,52332,HCPCS,,,LT,Outpatient,,,3386,846.5,1078.11,5199.25,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2221.22,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2370.2,Percent of Total Billed Charges, ,,85,,2878.1,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2302.48,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1896.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2031.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64400 - INJECTION AAAND-STRD TRIGEMINAL NERVE EACH BRANCH,64400,HCPCS,,,RT,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64400 - INJECTION AAAND-STRD TRIGEMINAL NERVE EACH BRANCH,64400,HCPCS,,,LT,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,TA,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,RT,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,LT,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,F7,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,F5,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,F2,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64450 - INJECTION AAAND-STRD OTHER PERIPHERAL NERVE-BRANCH,64450,HCPCS,,,F1,Outpatient,,,1800,450,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,65205,HCPCS,,,RT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,65205,HCPCS,,,LT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65220 - RMVL FB XTRNL EYE CORNEAL W-O SLIT LAMP,65220,HCPCS,,,RT,Outpatient,,,775,193.75,379.38,775,,,,,,,Service Paid at Rev Code level,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,589.32,,,589.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,583.3,,,583.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.28,,,593.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.66,,,392.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.45,,,396.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.38,,,379.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,390.76,,,390.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.4,,,397.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65220 - RMVL FB XTRNL EYE CORNEAL W-O SLIT LAMP,65220,HCPCS,,,LT,Outpatient,,,775,193.75,379.38,775,,,,,,,Service Paid at Rev Code level,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,589.32,,,589.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,612.48,,,612.48,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,583.3,,,583.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.28,,,593.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.66,,,392.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.45,,,396.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.38,,,379.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.17,,,383.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,390.76,,,390.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.4,,,397.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
65222 - RMVL FB XTRNL EYE CORNEAL W-SLIT LAMP,65222,HCPCS,,,LT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID,67700,HCPCS,,,E3,Outpatient,,,1800,450,284.2,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,50,,900,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID,67700,HCPCS,,,E2,Outpatient,,,1800,450,284.2,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,50,,900,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
67700 - BLEPHAROTOMY DRAINAGE ABSCESS EYELID,67700,HCPCS,,,E1,Outpatient,,,1800,450,284.2,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.48,,,441.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,429.41,,,429.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,,50,,900,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,436.96,,,436.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,415.94,,,415.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,294.15,,,294.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.99,,,296.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.2,,,284.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.04,,,287.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.73,,,292.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,297.7,,,297.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69000 - DRAINAGE EXTERNAL EAR ABSCESS-HEMATOMA SIMPLE,69000,HCPCS,,,LT,Outpatient,,,1429,357.25,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,937.42,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1000.3,Percent of Total Billed Charges, ,,85,,1214.65,Percent of Total Billed Charges, ,,50,,714.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,971.72,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,800.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,857.4,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69200 - RMVL FB XTRNL AUDITORY CANAL W-O ANES,69200,HCPCS,,,RT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69200 - RMVL FB XTRNL AUDITORY CANAL W-O ANES,69200,HCPCS,,,LT,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69200 - RMVL FB XTRNL AUDITORY CANAL W-O ANES,69200,HCPCS,,,53,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69200 - RMVL FB XTRNL AUDITORY CANAL W-O ANES,69200,HCPCS,,,50,Outpatient,,,775,193.75,122.55,775,,,,,,,Service Paid at Rev Code level,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,188.35,,,188.35,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.45,,,182.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69209 - REMOVAL IMPACTED CERUMEN IRRIGATION-LVG UNILAT,69209,HCPCS,,,RT,Outpatient,,,775,193.75,56.47,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.32,,,90.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69209 - REMOVAL IMPACTED CERUMEN IRRIGATION-LVG UNILAT,69209,HCPCS,,,LT,Outpatient,,,775,193.75,56.47,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.32,,,90.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69209 - REMOVAL IMPACTED CERUMEN IRRIGATION-LVG UNILAT,69209,HCPCS,,,50,Outpatient,,,775,193.75,56.47,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.32,,,90.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69210 - REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,69210,HCPCS,,,RT,Outpatient,,,775,193.75,56.47,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.32,,,90.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69210 - REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,69210,HCPCS,,,LT,Outpatient,,,775,193.75,56.47,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.32,,,90.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
69210 - REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,69210,HCPCS,,,50,Outpatient,,,775,193.75,56.47,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,93.24,,,93.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,50,,387.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.32,,,90.32,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,96360,HCPCS,,,XU,Outpatient,,,393,98.25,0.01,334.05,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,182.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,257.81,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,275.1,Percent of Total Billed Charges, ,,85,,334.05,Percent of Total Billed Charges, ,,50,,196.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,267.24,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,220.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,235.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,96360,HCPCS,,,XS,Outpatient,,,393,98.25,0.01,334.05,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,182.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,257.81,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,275.1,Percent of Total Billed Charges, ,,85,,334.05,Percent of Total Billed Charges, ,,50,,196.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,267.24,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,220.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,235.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,96360,HCPCS,,,59,Outpatient,,,393,98.25,0.01,334.05,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,182.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,257.81,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,275.1,Percent of Total Billed Charges, ,,85,,334.05,Percent of Total Billed Charges, ,,50,,196.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,267.24,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,220.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,235.8,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR,96361,HCPCS,,,XU,Outpatient,,,104,26,0.01,88.4,,,,,,,Service Paid at Rev Code level,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,48.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,68.22,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,72.8,Percent of Total Billed Charges, ,,85,,88.4,Percent of Total Billed Charges, ,,50,,52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,70.72,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,58.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,62.4,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR,96361,HCPCS,,,59,Outpatient,,,104,26,0.01,88.4,,,,,,,Service Paid at Rev Code level,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,48.36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,68.22,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,72.8,Percent of Total Billed Charges, ,,85,,88.4,Percent of Total Billed Charges, ,,50,,52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,70.72,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,58.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,62.4,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96365 - IV INFUSION THERAPY-PROPHYLAXIS -DX 1ST TO 1 HR,96365,HCPCS,,,XU,Outpatient,,,476,119,200.31,404.6,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,221.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,312.26,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,333.2,Percent of Total Billed Charges, ,,85,,404.6,Percent of Total Billed Charges, ,,50,,238,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,323.68,Percent of Total Billed Charges,0,,50,,238,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,266.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,285.6,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96365 - IV INFUSION THERAPY-PROPHYLAXIS -DX 1ST TO 1 HR,96365,HCPCS,,,XS,Outpatient,,,476,119,200.31,404.6,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,221.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,312.26,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,333.2,Percent of Total Billed Charges, ,,85,,404.6,Percent of Total Billed Charges, ,,50,,238,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,323.68,Percent of Total Billed Charges,0,,50,,238,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,266.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,285.6,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96365 - IV INFUSION THERAPY-PROPHYLAXIS -DX 1ST TO 1 HR,96365,HCPCS,,,59,Outpatient,,,476,119,200.31,404.6,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,221.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,312.26,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,333.2,Percent of Total Billed Charges, ,,85,,404.6,Percent of Total Billed Charges, ,,50,,238,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,323.68,Percent of Total Billed Charges,0,,50,,238,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,266.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,285.6,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,269.02,,,269.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96366 - IV INFUSION THERAPY PROPHYLAXIS-DX EA HOUR,96366,HCPCS,,,XU,Outpatient,,,164,41,43.87,139.4,,,,,,,Service Paid at Rev Code level,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,76.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,107.58,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.8,Percent of Total Billed Charges, ,,85,,139.4,Percent of Total Billed Charges, ,,50,,82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,111.52,Percent of Total Billed Charges,0,,50,,82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,91.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,98.4,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96366 - IV INFUSION THERAPY PROPHYLAXIS-DX EA HOUR,96366,HCPCS,,,XS,Outpatient,,,164,41,43.87,139.4,,,,,,,Service Paid at Rev Code level,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,76.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,107.58,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,114.8,Percent of Total Billed Charges, ,,85,,139.4,Percent of Total Billed Charges, ,,50,,82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,111.52,Percent of Total Billed Charges,0,,50,,82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,91.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,98.4,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR,96367,HCPCS,,,XU,Outpatient,,,206,51.5,67.66,175.1,,,,,,,Service Paid at Rev Code level,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,95.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,135.14,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,144.2,Percent of Total Billed Charges, ,,85,,175.1,Percent of Total Billed Charges, ,,50,,103,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,140.08,Percent of Total Billed Charges,0,,50,,103,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,115.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,123.6,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96368 - IV NFS THERAPY PROPHYLAXIS-DX CONCURRENT NFS,96368,HCPCS,,,XU,Outpatient,,,498,124.5,0.01,423.3,,,,,,,Service Paid at Rev Code level,28.67,,,28.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,231.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,326.69,Percent of Total Billed Charges, ,28.67,,,28.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,348.6,Percent of Total Billed Charges, ,,85,,423.3,Percent of Total Billed Charges, ,,50,,249,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,338.64,Percent of Total Billed Charges,0,,50,,249,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,278.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,298.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.77,,,27.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96372 - THERAPEUTIC PROPHYLACTIC-DX INJECTION SUBQ-IM,96372,HCPCS,,,XU,Outpatient,,,172,43,67.66,146.2,,,,,,,Service Paid at Rev Code level,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,79.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96372 - THERAPEUTIC PROPHYLACTIC-DX INJECTION SUBQ-IM,96372,HCPCS,,,XS,Outpatient,,,172,43,67.66,146.2,,,,,,,Service Paid at Rev Code level,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,79.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96372 - THERAPEUTIC PROPHYLACTIC-DX INJECTION SUBQ-IM,96372,HCPCS,,,59,Outpatient,,,172,43,67.66,146.2,,,,,,,Service Paid at Rev Code level,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,79.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96374 - THER PROPH-DX NJX IV PUSH SINGLE-1ST SBST-DRUG,96374,HCPCS,,,XU,Outpatient,,,364.04,91.01,169.28,311.16,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,169.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.81,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.83,Percent of Total Billed Charges, ,,85,,309.43,Percent of Total Billed Charges, ,,50,,182.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.55,Percent of Total Billed Charges,0,,50,,182.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.86,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.42,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96374 - THER PROPH-DX NJX IV PUSH SINGLE-1ST SBST-DRUG,96374,HCPCS,,,XS,Outpatient,,,364,91,169.26,311.16,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,169.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96374 - THER PROPH-DX NJX IV PUSH SINGLE-1ST SBST-DRUG,96374,HCPCS,,,XE,Outpatient,,,364,91,169.26,311.16,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,169.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96374 - THER PROPH-DX NJX IV PUSH SINGLE-1ST SBST-DRUG,96374,HCPCS,,,59,Outpatient,,,364,91,169.26,311.16,,,,,,,Service Paid at Rev Code level,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,169.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,311.16,,,311.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,238.78,Percent of Total Billed Charges, ,286.28,,,286.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,254.8,Percent of Total Billed Charges, ,,85,,309.4,Percent of Total Billed Charges, ,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.52,Percent of Total Billed Charges,0,,50,,182,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,203.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,218.4,Percent of Total Billed Charges, ,307.98,,,307.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,277.26,,,277.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.32,,,207.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.32,,,209.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.31,,,200.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.31,,,202.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.32,,,206.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.82,,,209.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,96375,HCPCS,,,XU,Outpatient,,,152.91,38.2275,43.87,129.97,,,,,,,Service Paid at Rev Code level,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,71.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,100.31,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.04,Percent of Total Billed Charges, ,,85,,129.97,Percent of Total Billed Charges, ,,50,,76.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,103.98,Percent of Total Billed Charges,0,,50,,76.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,85.63,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,91.75,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96375 - THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,96375,HCPCS,,,59,Outpatient,,,153,38.25,43.87,130.05,,,,,,,Service Paid at Rev Code level,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,71.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.15,,,68.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,100.37,Percent of Total Billed Charges, ,58.74,,,58.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,107.1,Percent of Total Billed Charges, ,,85,,130.05,Percent of Total Billed Charges, ,,50,,76.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,104.04,Percent of Total Billed Charges,0,,50,,76.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,85.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,91.8,Percent of Total Billed Charges, ,67.45,,,67.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.89,,,56.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.41,,,45.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.84,,,45.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.87,,,43.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.31,,,44.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.19,,,45.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.95,,,45.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96376 - THER PROPH-DX NJX EA SEQL IV PUSH SBST-DRUG FAC,96376,HCPCS,,,XU,Outpatient,,,126,31.5,0.01,107.1,,,,,,,Service Paid at Rev Code level,47.52,,,47.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,58.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,82.66,Percent of Total Billed Charges, ,47.52,,,47.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,88.2,Percent of Total Billed Charges, ,,85,,107.1,Percent of Total Billed Charges, ,,50,,63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,85.68,Percent of Total Billed Charges,0,,50,,63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,70.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,75.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.03,,,46.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96376 - THER PROPH-DX NJX EA SEQL IV PUSH SBST-DRUG FAC,96376,HCPCS,,,59,Outpatient,,,126,31.5,0.01,107.1,,,,,,,Service Paid at Rev Code level,47.52,,,47.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,58.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,82.66,Percent of Total Billed Charges, ,47.52,,,47.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,88.2,Percent of Total Billed Charges, ,,85,,107.1,Percent of Total Billed Charges, ,,50,,63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,85.68,Percent of Total Billed Charges,0,,50,,63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,70.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,75.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.03,,,46.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99281 - EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS-QHP,99281,HCPCS,,,27,Outpatient,,,1616,404,83.71,1373.6,,,,,,,Service Paid at Rev Code level,935.85,,,935.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1150,,,1150,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1060.1,Percent of Total Billed Charges, ,935.85,,,935.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1131.2,Percent of Total Billed Charges, ,,85,,1373.6,Percent of Total Billed Charges, ,622,,,622,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1098.88,Percent of Total Billed Charges,0,1145,,,1145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1088,,,1088,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,969.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,451.38,,,451.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99281 - EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS-QHP,99281,HCPCS,,,25,Outpatient,,,1616,404,83.71,1373.6,,,,,,,Service Paid at Rev Code level,935.85,,,935.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1150,,,1150,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.03,,,130.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1060.1,Percent of Total Billed Charges, ,935.85,,,935.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1131.2,Percent of Total Billed Charges, ,,85,,1373.6,Percent of Total Billed Charges, ,622,,,622,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1098.88,Percent of Total Billed Charges,0,1145,,,1145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1088,,,1088,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,969.6,Percent of Total Billed Charges, ,128.7,,,128.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,451.38,,,451.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,86.64,,,86.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.48,,,87.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.71,,,83.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.55,,,84.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.22,,,86.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.69,,,87.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99282 - EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM,99282,HCPCS,,,GC,Outpatient,,,2338,584.5,150.56,1987.3,,,,,,,Service Paid at Rev Code level,1068.19,,,1068.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1350,,,1350,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.87,,,233.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1533.73,Percent of Total Billed Charges, ,1068.19,,,1068.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1636.6,Percent of Total Billed Charges, ,,85,,1987.3,Percent of Total Billed Charges, ,855,,,855,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1589.84,Percent of Total Billed Charges,0,1417,,,1417,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1347,,,1347,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1402.8,Percent of Total Billed Charges, ,231.49,,,231.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,515.21,,,515.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.83,,,155.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.34,,,157.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.07,,,152.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.56,,,150.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.07,,,152.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.08,,,155.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.71,,,157.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99282 - EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM,99282,HCPCS,,,27,Outpatient,,,2338,584.5,150.56,1987.3,,,,,,,Service Paid at Rev Code level,1068.19,,,1068.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1350,,,1350,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.87,,,233.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1533.73,Percent of Total Billed Charges, ,1068.19,,,1068.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1636.6,Percent of Total Billed Charges, ,,85,,1987.3,Percent of Total Billed Charges, ,855,,,855,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1589.84,Percent of Total Billed Charges,0,1417,,,1417,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1347,,,1347,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1402.8,Percent of Total Billed Charges, ,231.49,,,231.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,515.21,,,515.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.83,,,155.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.34,,,157.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.07,,,152.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.56,,,150.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.07,,,152.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.08,,,155.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.71,,,157.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99282 - EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM,99282,HCPCS,,,25,Outpatient,,,2338,584.5,150.56,1987.3,,,,,,,Service Paid at Rev Code level,1068.19,,,1068.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1350,,,1350,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.87,,,233.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1533.73,Percent of Total Billed Charges, ,1068.19,,,1068.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1636.6,Percent of Total Billed Charges, ,,85,,1987.3,Percent of Total Billed Charges, ,855,,,855,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1589.84,Percent of Total Billed Charges,0,1417,,,1417,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1347,,,1347,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1402.8,Percent of Total Billed Charges, ,231.49,,,231.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,515.21,,,515.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.83,,,155.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.34,,,157.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.07,,,152.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.56,,,150.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.07,,,152.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.08,,,155.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.71,,,157.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99283 - EMERGENCY DEPARTMENT VISIT LOW MDM,99283,HCPCS,,,XU,Outpatient,,,2783,695.75,263.25,2365.55,,,,,,,Service Paid at Rev Code level,1284.08,,,1284.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1600,,,1600,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,408.93,,,408.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1825.65,Percent of Total Billed Charges, ,1284.08,,,1284.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1948.1,Percent of Total Billed Charges, ,,85,,2365.55,Percent of Total Billed Charges, ,1555,,,1555,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1892.44,Percent of Total Billed Charges,0,1526,,,1526,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1450,,,1450,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1669.8,Percent of Total Billed Charges, ,404.75,,,404.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,619.33,,,619.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,272.46,,,272.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.1,,,275.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,265.88,,,265.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.25,,,263.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,265.88,,,265.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,271.15,,,271.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.75,,,275.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99283 - EMERGENCY DEPARTMENT VISIT LOW MDM,99283,HCPCS,,,GC,Outpatient,,,2783,695.75,263.25,2365.55,,,,,,,Service Paid at Rev Code level,1284.08,,,1284.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1600,,,1600,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,408.93,,,408.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1825.65,Percent of Total Billed Charges, ,1284.08,,,1284.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1948.1,Percent of Total Billed Charges, ,,85,,2365.55,Percent of Total Billed Charges, ,1555,,,1555,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1892.44,Percent of Total Billed Charges,0,1526,,,1526,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1450,,,1450,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1669.8,Percent of Total Billed Charges, ,404.75,,,404.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,619.33,,,619.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,272.46,,,272.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.1,,,275.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,265.88,,,265.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.25,,,263.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,265.88,,,265.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,271.15,,,271.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.75,,,275.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99283 - EMERGENCY DEPARTMENT VISIT LOW MDM,99283,HCPCS,,,27,Outpatient,,,2783,695.75,263.25,2365.55,,,,,,,Service Paid at Rev Code level,1284.08,,,1284.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1600,,,1600,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,408.93,,,408.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1825.65,Percent of Total Billed Charges, ,1284.08,,,1284.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1948.1,Percent of Total Billed Charges, ,,85,,2365.55,Percent of Total Billed Charges, ,1555,,,1555,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1892.44,Percent of Total Billed Charges,0,1526,,,1526,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1450,,,1450,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1669.8,Percent of Total Billed Charges, ,404.75,,,404.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,619.33,,,619.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,272.46,,,272.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.1,,,275.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,265.88,,,265.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.25,,,263.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,265.88,,,265.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,271.15,,,271.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.75,,,275.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99283 - EMERGENCY DEPARTMENT VISIT LOW MDM,99283,HCPCS,,,25,Outpatient,,,2783,695.75,263.25,2365.55,,,,,,,Service Paid at Rev Code level,1284.08,,,1284.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1600,,,1600,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,408.93,,,408.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1825.65,Percent of Total Billed Charges, ,1284.08,,,1284.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1948.1,Percent of Total Billed Charges, ,,85,,2365.55,Percent of Total Billed Charges, ,1555,,,1555,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1892.44,Percent of Total Billed Charges,0,1526,,,1526,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1450,,,1450,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1669.8,Percent of Total Billed Charges, ,404.75,,,404.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,619.33,,,619.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,272.46,,,272.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.1,,,275.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,265.88,,,265.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.25,,,263.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,265.88,,,265.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,271.15,,,271.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,275.75,,,275.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99284 - EMERGENCY DEPARTMENT VISIT MODERATE MDM,99284,HCPCS,,,QJ,Outpatient,,,3033,758.25,404.84,2578.05,,,,,,,Service Paid at Rev Code level,1563.96,,,1563.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1800,,,1800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,628.88,,,628.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1989.65,Percent of Total Billed Charges, ,1563.96,,,1563.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2123.1,Percent of Total Billed Charges, ,,85,,2578.05,Percent of Total Billed Charges, ,2021,,,2021,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2062.44,Percent of Total Billed Charges,0,1690,,,1690,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1606,,,1606,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1819.8,Percent of Total Billed Charges, ,622.44,,,622.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,754.32,,,754.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,419.01,,,419.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,423.06,,,423.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,408.89,,,408.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,404.84,,,404.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,408.89,,,408.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,416.99,,,416.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,424.07,,,424.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99284 - EMERGENCY DEPARTMENT VISIT MODERATE MDM,99284,HCPCS,,,GC,Outpatient,,,3033,758.25,404.84,2578.05,,,,,,,Service Paid at Rev Code level,1563.96,,,1563.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1800,,,1800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,628.88,,,628.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1989.65,Percent of Total Billed Charges, ,1563.96,,,1563.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2123.1,Percent of Total Billed Charges, ,,85,,2578.05,Percent of Total Billed Charges, ,2021,,,2021,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2062.44,Percent of Total Billed Charges,0,1690,,,1690,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1606,,,1606,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1819.8,Percent of Total Billed Charges, ,622.44,,,622.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,754.32,,,754.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,419.01,,,419.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,423.06,,,423.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,408.89,,,408.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,404.84,,,404.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,408.89,,,408.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,416.99,,,416.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,424.07,,,424.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99284 - EMERGENCY DEPARTMENT VISIT MODERATE MDM,99284,HCPCS,,,27,Outpatient,,,3033,758.25,404.84,2578.05,,,,,,,Service Paid at Rev Code level,1563.96,,,1563.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1800,,,1800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,628.88,,,628.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1989.65,Percent of Total Billed Charges, ,1563.96,,,1563.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2123.1,Percent of Total Billed Charges, ,,85,,2578.05,Percent of Total Billed Charges, ,2021,,,2021,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2062.44,Percent of Total Billed Charges,0,1690,,,1690,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1606,,,1606,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1819.8,Percent of Total Billed Charges, ,622.44,,,622.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,754.32,,,754.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,419.01,,,419.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,423.06,,,423.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,408.89,,,408.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,404.84,,,404.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,408.89,,,408.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,416.99,,,416.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,424.07,,,424.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99284 - EMERGENCY DEPARTMENT VISIT MODERATE MDM,99284,HCPCS,,,25,Outpatient,,,3033,758.25,404.84,2578.05,,,,,,,Service Paid at Rev Code level,1563.96,,,1563.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1800,,,1800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,628.88,,,628.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1989.65,Percent of Total Billed Charges, ,1563.96,,,1563.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2123.1,Percent of Total Billed Charges, ,,85,,2578.05,Percent of Total Billed Charges, ,2021,,,2021,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2062.44,Percent of Total Billed Charges,0,1690,,,1690,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1606,,,1606,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1819.8,Percent of Total Billed Charges, ,622.44,,,622.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,754.32,,,754.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,419.01,,,419.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,423.06,,,423.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,408.89,,,408.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,404.84,,,404.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,408.89,,,408.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,416.99,,,416.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,424.07,,,424.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99285 - EMERGENCY DEPARTMENT VISIT HIGH MDM,99285,HCPCS,,,GC,Outpatient,,,3739,934.75,582.9,3178.15,,,,,,,Service Paid at Rev Code level,2019.11,,,2019.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2050,,,2050,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,905.46,,,905.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2452.78,Percent of Total Billed Charges, ,2019.11,,,2019.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2617.3,Percent of Total Billed Charges, ,,85,,3178.15,Percent of Total Billed Charges, ,2721,,,2721,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2542.52,Percent of Total Billed Charges,0,1908,,,1908,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1813,,,1813,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2243.4,Percent of Total Billed Charges, ,896.21,,,896.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,973.85,,,973.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,603.3,,,603.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.13,,,609.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,588.73,,,588.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,582.9,,,582.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,588.73,,,588.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,600.39,,,600.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,610.59,,,610.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99285 - EMERGENCY DEPARTMENT VISIT HIGH MDM,99285,HCPCS,,,27,Outpatient,,,3739,934.75,582.9,3178.15,,,,,,,Service Paid at Rev Code level,2019.11,,,2019.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2050,,,2050,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,905.46,,,905.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2452.78,Percent of Total Billed Charges, ,2019.11,,,2019.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2617.3,Percent of Total Billed Charges, ,,85,,3178.15,Percent of Total Billed Charges, ,2721,,,2721,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2542.52,Percent of Total Billed Charges,0,1908,,,1908,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1813,,,1813,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2243.4,Percent of Total Billed Charges, ,896.21,,,896.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,973.85,,,973.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,603.3,,,603.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.13,,,609.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,588.73,,,588.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,582.9,,,582.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,588.73,,,588.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,600.39,,,600.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,610.59,,,610.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99285 - EMERGENCY DEPARTMENT VISIT HIGH MDM,99285,HCPCS,,,25,Outpatient,,,3739,934.75,582.9,3178.15,,,,,,,Service Paid at Rev Code level,2019.11,,,2019.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2050,,,2050,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,905.46,,,905.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2452.78,Percent of Total Billed Charges, ,2019.11,,,2019.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2617.3,Percent of Total Billed Charges, ,,85,,3178.15,Percent of Total Billed Charges, ,2721,,,2721,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2542.52,Percent of Total Billed Charges,0,1908,,,1908,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,1813,,,1813,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2243.4,Percent of Total Billed Charges, ,896.21,,,896.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,973.85,,,973.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,603.3,,,603.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.13,,,609.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,588.73,,,588.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,582.9,,,582.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,588.73,,,588.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,600.39,,,600.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,610.59,,,610.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99291 - CRITICAL CARE ILL-INJURED PATIENT INIT 30-74 MIN,99291,HCPCS,,,25,Outpatient,,,4181,1045.25,801.1,3553.85,,,,,,,Service Paid at Rev Code level,2355.11,,,2355.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2250,,,2250,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1244.41,,,1244.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2742.74,Percent of Total Billed Charges, ,2355.11,,,2355.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2926.7,Percent of Total Billed Charges, ,,85,,3553.85,Percent of Total Billed Charges, ,2721,,,2721,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2843.08,Percent of Total Billed Charges,0,2809,,,2809,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,2670,,,2670,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2508.6,Percent of Total Billed Charges, ,1231.69,,,1231.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1135.9,,,1135.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,829.14,,,829.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,837.15,,,837.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,809.11,,,809.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,801.1,,,801.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,809.11,,,809.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,825.13,,,825.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,839.15,,,839.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99292 - CRITICAL CARE ILL-INJURED PATIENT ADDL 30 MIN,99292,HCPCS,,,27,Outpatient,,,1835,458.75,0.01,2250,,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2250,,,2250,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1203.76,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1284.5,Percent of Total Billed Charges, ,,85,,1559.75,Percent of Total Billed Charges, ,,50,,917.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1247.8,Percent of Total Billed Charges,0,,50,,917.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1027.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1101,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99292 - CRITICAL CARE ILL-INJURED PATIENT ADDL 30 MIN,99292,HCPCS,,,25,Outpatient,,,1835,458.75,0.01,2250,,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2250,,,2250,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1203.76,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1284.5,Percent of Total Billed Charges, ,,85,,1559.75,Percent of Total Billed Charges, ,,50,,917.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1247.8,Percent of Total Billed Charges,0,,50,,917.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1027.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1101,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0382 - LEV 3 HOSP TYPE B ED VISIT,G0382,HCPCS,,,25,Outpatient,,,835,208.75,177.4,709.75,,,,,,,Service Paid at Rev Code level,297.34,,,297.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,388.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,275.56,,,275.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,547.76,Percent of Total Billed Charges, ,297.34,,,297.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,584.5,Percent of Total Billed Charges, ,,85,,709.75,Percent of Total Billed Charges, ,,50,,417.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,567.8,Percent of Total Billed Charges,0,,50,,417.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,467.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,501,Percent of Total Billed Charges, ,272.75,,,272.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,287.98,,,287.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,183.61,,,183.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,185.38,,,185.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,179.17,,,179.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.4,,,177.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,179.17,,,179.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.72,,,182.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,185.83,,,185.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0383 - LEV 4 HOSP TYPE B ED VISIT,G0383,HCPCS,,,25,Outpatient,,,1564,391,271.48,1329.4,,,,,,,Service Paid at Rev Code level,362.15,,,362.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,727.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,421.72,,,421.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1025.98,Percent of Total Billed Charges, ,362.15,,,362.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1094.8,Percent of Total Billed Charges, ,,85,,1329.4,Percent of Total Billed Charges, ,,50,,782,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1063.52,Percent of Total Billed Charges,0,,50,,782,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,875.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,938.4,Percent of Total Billed Charges, ,417.4,,,417.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,350.74,,,350.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,280.98,,,280.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.7,,,283.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,274.19,,,274.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,271.48,,,271.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,274.19,,,274.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,279.62,,,279.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,284.38,,,284.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0384 - LEV 5 HOSP TYPE B ED VISIT,G0384,HCPCS,,,25,Outpatient,,,1920,480,383.99,1632,,,,,,,Service Paid at Rev Code level,467.55,,,467.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,892.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,596.49,,,596.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1259.52,Percent of Total Billed Charges, ,467.55,,,467.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1344,Percent of Total Billed Charges, ,,85,,1632,Percent of Total Billed Charges, ,,50,,960,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1305.6,Percent of Total Billed Charges,0,,50,,960,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1075.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1152,Percent of Total Billed Charges, ,590.38,,,590.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,452.82,,,452.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,397.43,,,397.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,401.27,,,401.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,387.83,,,387.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.99,,,383.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,387.83,,,387.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,395.51,,,395.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,402.23,,,402.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,0450,RC,,,,Outpatient,,,511.64,127.91,306.98,1597,,1597,,,1597,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,65.6,,335.64,Percent of Total Billed Charges, ,,,,,,,,70,,358.15,Percent of Total Billed Charges, ,,85,,434.89,Percent of Total Billed Charges, ,,,,,,,,68,,347.92,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,306.98,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
94010 - SPMTRY W-VC EXPIRATORY FLO W-WO MXML VOL VNTJ,94010,HCPCS,,,XU,Outpatient,,,298,74.5,71.28,253.3,,,46,,137.08,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,138.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,195.49,Percent of Total Billed Charges, ,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,208.6,Percent of Total Billed Charges, ,,85,,253.3,Percent of Total Billed Charges, ,,50,,149,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,202.64,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,166.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.8,Percent of Total Billed Charges, ,228.7,,,228.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.19,,,195.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94010 - SPMTRY W-VC EXPIRATORY FLO W-WO MXML VOL VNTJ,94010,HCPCS,,,26,Outpatient,,,298,74.5,71.28,253.3,,,46,,137.08,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,138.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,195.49,Percent of Total Billed Charges, ,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,208.6,Percent of Total Billed Charges, ,,85,,253.3,Percent of Total Billed Charges, ,,50,,149,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,202.64,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,166.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,178.8,Percent of Total Billed Charges, ,228.7,,,228.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.19,,,195.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.28,,,71.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94060 - BRNCDILAT RSPSE SPMTRY PREANDPOST-BRNCDILAT ADMN,94060,HCPCS,,,XU,Outpatient,,,575,143.75,115.83,488.75,,,46,,264.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,267.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,377.2,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,402.5,Percent of Total Billed Charges, ,,85,,488.75,Percent of Total Billed Charges, ,,50,,287.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,391,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,322,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,345,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.83,,,115.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,115.83,,,115.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,115.83,,,115.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,115.83,,,115.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94060 - BRNCDILAT RSPSE SPMTRY PREANDPOST-BRNCDILAT ADMN,94060,HCPCS,,,52,Outpatient,,,575,143.75,115.83,488.75,,,46,,264.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,267.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,377.2,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,402.5,Percent of Total Billed Charges, ,,85,,488.75,Percent of Total Billed Charges, ,,50,,287.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,391,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,322,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,345,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.83,,,115.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,115.83,,,115.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,115.83,,,115.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,115.83,,,115.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94150 - VITAL CAPACITY TOTAL SEPARATE PROCEDURE,94150,HCPCS,,,XU,Outpatient,,,214,53.5,0.01,231.07,,,46,,98.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,99.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,140.38,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,149.8,Percent of Total Billed Charges, ,,85,,181.9,Percent of Total Billed Charges, ,,50,,107,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,145.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,119.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,128.4,Percent of Total Billed Charges, ,228.7,,,228.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.79,,,20.79,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.79,,,20.79,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.79,,,20.79,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,20.79,,,20.79,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94621 - CARDIOPULMONARY EXERCISE TESTING,94621,HCPCS,,,Q1,Outpatient,,,486,121.5,122.07,459.89,,,46,,223.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,225.99,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,318.82,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,340.2,Percent of Total Billed Charges, ,,85,,413.1,Percent of Total Billed Charges, ,,50,,243,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,330.48,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,272.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,291.6,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.07,,,122.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,122.07,,,122.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,122.07,,,122.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,122.07,,,122.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94621 - CARDIOPULMONARY EXERCISE TESTING,94621,HCPCS,,,26,Outpatient,,,486,121.5,122.07,459.89,,,46,,223.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,225.99,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,318.82,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,340.2,Percent of Total Billed Charges, ,,85,,413.1,Percent of Total Billed Charges, ,,50,,243,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,330.48,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,272.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,291.6,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.07,,,122.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,122.07,,,122.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,122.07,,,122.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,122.07,,,122.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94760 - NONINVASIVE EAR-PULSE OXIMETRY SINGLE DETER,94760,HCPCS,,,GZ,Outpatient,,,77,19.25,0.01,83.16,,,46,,35.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.11,,,3.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,35.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,50.51,Percent of Total Billed Charges, ,3.11,,,3.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,53.9,Percent of Total Billed Charges, ,,85,,65.45,Percent of Total Billed Charges, ,,50,,38.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,52.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,43.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,46.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.01,,,3.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
94761 - NONINVASIVE EAR-PULSE OXIMETRY MULTIPLE DETER,94761,HCPCS,,,XU,Outpatient,,,157,39.25,0.01,133.45,,,46,,72.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,72.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,73.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,102.99,Percent of Total Billed Charges, ,,46,,72.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,109.9,Percent of Total Billed Charges, ,,85,,133.45,Percent of Total Billed Charges, ,,50,,78.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,106.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,87.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,94.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,40.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.16,,,83.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION,0460,RC,,,,Outpatient,,,388.3,97.075,232.98,454,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,254.72,Percent of Total Billed Charges, ,,,,,,,,70,,271.81,Percent of Total Billed Charges, ,,85,,330.06,Percent of Total Billed Charges, ,,,,,,,,68,,264.04,Percent of Total Billed Charges,0,454,,,454,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,232.98,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,XU,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,RI,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,RC,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,LM,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,LD,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,LC,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,74,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92929 - PRQ TRLUML CORONARY STENT W-ANGIO ADDL ART-BRNCH,92929,HCPCS,,,RC,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,50,,8767.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92929 - PRQ TRLUML CORONARY STENT W-ANGIO ADDL ART-BRNCH,92929,HCPCS,,,LD,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,50,,8767.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92929 - PRQ TRLUML CORONARY STENT W-ANGIO ADDL ART-BRNCH,92929,HCPCS,,,LC,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,50,,8767.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92933 - PRQ TRLUML CORONRY STENT-ATH-ANGIO ONE ART-BRNCH,92933,HCPCS,,,RC,Outpatient,,,44568,11142,950.4,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92933 - PRQ TRLUML CORONRY STENT-ATH-ANGIO ONE ART-BRNCH,92933,HCPCS,,,LD,Outpatient,,,44568,11142,950.4,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92933 - PRQ TRLUML CORONRY STENT-ATH-ANGIO ONE ART-BRNCH,92933,HCPCS,,,LC,Outpatient,,,44568,11142,950.4,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92937 - PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,92937,HCPCS,,,XU,Outpatient,,,33220,8305,950.4,28237,,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21792.32,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23254,Percent of Total Billed Charges, ,,85,,28237,Percent of Total Billed Charges, ,,50,,16610,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22589.6,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18603.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19932,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92937 - PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,92937,HCPCS,,,RC,Outpatient,,,33220,8305,950.4,28237,,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21792.32,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23254,Percent of Total Billed Charges, ,,85,,28237,Percent of Total Billed Charges, ,,50,,16610,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22589.6,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18603.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19932,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92937 - PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,92937,HCPCS,,,LD,Outpatient,,,33220,8305,950.4,28237,,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21792.32,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23254,Percent of Total Billed Charges, ,,85,,28237,Percent of Total Billed Charges, ,,50,,16610,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22589.6,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18603.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19932,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92937 - PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,92937,HCPCS,,,LC,Outpatient,,,33220,8305,950.4,28237,,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21792.32,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23254,Percent of Total Billed Charges, ,,85,,28237,Percent of Total Billed Charges, ,,50,,16610,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22589.6,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18603.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19932,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92941 - PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL,92941,HCPCS,,,LD,Outpatient,,,31638,7909.5,0.01,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18364.19,,,18364.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,18364.19,,,18364.19,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17788.51,,,17788.51,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,RC,Outpatient,,,44568,11142,950.4,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,LD,Outpatient,,,44568,11142,950.4,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,LC,Outpatient,,,44568,11142,950.4,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,74,Outpatient,,,44568,11142,950.4,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92960 - CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,92960,HCPCS,,,74,Outpatient,,,1391,347.75,225.72,1460,,,46,,639.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,954.07,,,954.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,646.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,966.42,,,966.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,912.5,Percent of Total Billed Charges, ,954.07,,,954.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,973.7,Percent of Total Billed Charges, ,,85,,1182.35,Percent of Total Billed Charges, ,,50,,695.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,945.88,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,778.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,834.6,Percent of Total Billed Charges, ,956.56,,,956.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,924.16,,,924.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,643.93,,,643.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,650.15,,,650.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,628.37,,,628.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,622.15,,,622.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,628.37,,,628.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.81,,,640.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,651.7,,,651.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,225.72,,,225.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,225.72,,,225.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,225.72,,,225.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,225.72,,,225.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER,93280,HCPCS,,,GT,Outpatient,,,74,18.5,34.04,88.74,,,46,,34.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.5,,,48.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,34.41,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.08,,,55.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.54,Percent of Total Billed Charges, ,48.5,,,48.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.8,Percent of Total Billed Charges, ,,85,,62.9,Percent of Total Billed Charges, ,,50,,37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.32,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,41.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,44.4,Percent of Total Billed Charges, ,54.5,,,54.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.97,,,46.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.69,,,36.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.05,,,37.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.45,,,35.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.51,,,36.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.13,,,37.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.74,,,88.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.74,,,88.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.74,,,88.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.74,,,88.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93280 - PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER,93280,HCPCS,,,26,Outpatient,,,74,18.5,34.04,88.74,,,46,,34.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.5,,,48.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,34.41,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.08,,,55.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.54,Percent of Total Billed Charges, ,48.5,,,48.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.8,Percent of Total Billed Charges, ,,85,,62.9,Percent of Total Billed Charges, ,,50,,37,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.32,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,41.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,44.4,Percent of Total Billed Charges, ,54.5,,,54.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.97,,,46.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.69,,,36.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.05,,,37.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.45,,,35.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.51,,,36.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.13,,,37.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.74,,,88.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.74,,,88.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.74,,,88.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,88.74,,,88.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93291 - INTERROG DEV EVAL SCRMS PHYS-QHP IN PERSON,93291,HCPCS,,,26,Outpatient,,,59,14.75,23.28,66.2,,,46,,27.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.59,,,34.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,27.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.17,,,36.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,38.7,Percent of Total Billed Charges, ,34.59,,,34.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,41.3,Percent of Total Billed Charges, ,,85,,50.15,Percent of Total Billed Charges, ,,50,,29.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,33.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,35.4,Percent of Total Billed Charges, ,35.79,,,35.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.5,,,33.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.09,,,24.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.33,,,24.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.51,,,23.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.28,,,23.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.51,,,23.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.98,,,23.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.39,,,24.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.2,,,66.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,66.2,,,66.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,66.2,,,66.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,66.2,,,66.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93308 - ECHO TRANSTHORC R-T 2D W-WO M-MODE REC F-UP-LMTD,93308,HCPCS,,,XU,Outpatient,,,887,221.75,175.23,753.95,,,46,,408.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,412.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,581.87,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,620.9,Percent of Total Billed Charges, ,,85,,753.95,Percent of Total Billed Charges, ,,50,,443.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,603.16,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,496.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,532.2,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.23,,,175.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.23,,,175.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.23,,,175.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,175.23,,,175.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93321 - DOPPLER ECHO PULSE WAVE W-SPECTRAL F-UP-LMTD STD,93321,HCPCS,,,XU,Outpatient,,,1108,277,0.01,941.8,,,46,,509.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.42,,,25.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,515.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,726.85,Percent of Total Billed Charges, ,25.42,,,25.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,775.6,Percent of Total Billed Charges, ,,85,,941.8,Percent of Total Billed Charges, ,,50,,554,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,753.44,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,620.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,664.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.62,,,24.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,112.86,,,112.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,112.86,,,112.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,112.86,,,112.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,112.86,,,112.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93620 - COMPRE EP EVAL R ATR VNTRC PACGANDREC HIS BNDL REC,93620,HCPCS,,,59,Outpatient,,,14985,3746.25,1568.75,12737.25,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10921.67,,,10921.67,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11206.53,,,11206.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,10921.67,,,10921.67,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,50,,7492.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10189.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,11092,,,11092,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10579.29,,,10579.29,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7466.81,,,7466.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7538.95,,,7538.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7286.45,,,7286.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7214.31,,,7214.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7286.45,,,7286.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7430.74,,,7430.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7556.99,,,7556.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1568.75,,,1568.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1568.75,,,1568.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1568.75,,,1568.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1568.75,,,1568.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93668 - PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION,93668,HCPCS,,,KX,Outpatient,,,100,25,0.01,87.72,,,46,,46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,46.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93799 - UNLISTED CARDIOVASCULAR SERVICE-PROCEDURE,93799,HCPCS,,,XU,Outpatient,,,665,166.25,0.01,674,,,46,,305.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,309.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,436.24,Percent of Total Billed Charges, ,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,465.5,Percent of Total Billed Charges, ,,85,,565.25,Percent of Total Billed Charges, ,,50,,332.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,452.2,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,372.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,399,Percent of Total Billed Charges, ,228.7,,,228.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.19,,,195.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,XU,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,RI,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,RC,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,LM,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,LD,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,LC,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,74,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,50,,15819,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9601 - PERC DRUG-EL COR STENT BRAN,C9601,HCPCS,,,RC,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,50,,8767.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11923.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,4559.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9601 - PERC DRUG-EL COR STENT BRAN,C9601,HCPCS,,,LD,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,50,,8767.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11923.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,4559.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9601 - PERC DRUG-EL COR STENT BRAN,C9601,HCPCS,,,LC,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,50,,8767.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11923.8,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,4559.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9602 - PERC D-E COR STENT ATHER S,C9602,HCPCS,,,XU,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9602 - PERC D-E COR STENT ATHER S,C9602,HCPCS,,,RC,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9602 - PERC D-E COR STENT ATHER S,C9602,HCPCS,,,LM,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9602 - PERC D-E COR STENT ATHER S,C9602,HCPCS,,,LD,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9602 - PERC D-E COR STENT ATHER S,C9602,HCPCS,,,LC,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9604 - PERC D-E COR REVASC T CABG S,C9604,HCPCS,,,RI,Outpatient,,,33220,8305,0.01,28237,,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21792.32,Percent of Total Billed Charges, ,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23254,Percent of Total Billed Charges, ,,85,,28237,Percent of Total Billed Charges, ,,50,,16610,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22589.6,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18603.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19932,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8637.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9604 - PERC D-E COR REVASC T CABG S,C9604,HCPCS,,,RC,Outpatient,,,33220,8305,0.01,28237,,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21792.32,Percent of Total Billed Charges, ,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23254,Percent of Total Billed Charges, ,,85,,28237,Percent of Total Billed Charges, ,,50,,16610,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22589.6,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18603.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19932,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8637.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9604 - PERC D-E COR REVASC T CABG S,C9604,HCPCS,,,LD,Outpatient,,,33220,8305,0.01,28237,,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21792.32,Percent of Total Billed Charges, ,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23254,Percent of Total Billed Charges, ,,85,,28237,Percent of Total Billed Charges, ,,50,,16610,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22589.6,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18603.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19932,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8637.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9604 - PERC D-E COR REVASC T CABG S,C9604,HCPCS,,,LC,Outpatient,,,33220,8305,0.01,28237,,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21792.32,Percent of Total Billed Charges, ,,46,,15281.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23254,Percent of Total Billed Charges, ,,85,,28237,Percent of Total Billed Charges, ,,50,,16610,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,22589.6,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18603.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19932,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8637.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9607 - PERC D-E COR REVASC CHRO SIN,C9607,HCPCS,,,RC,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9607 - PERC D-E COR REVASC CHRO SIN,C9607,HCPCS,,,LM,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9607 - PERC D-E COR REVASC CHRO SIN,C9607,HCPCS,,,LD,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9607 - PERC D-E COR REVASC CHRO SIN,C9607,HCPCS,,,LC,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9607 - PERC D-E COR REVASC CHRO SIN,C9607,HCPCS,,,74,Outpatient,,,44568,11142,0.01,37882.8,,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,,46,,20501.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,50,,22284,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30306.24,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,11587.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0480 - CARDIOLOGY - GENERAL CLASSIFICATION,0480,RC,,,,Outpatient,,,30393.26,7598.315,1466,25834.27,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,19937.98,Percent of Total Billed Charges, ,,,,,,,,70,,21275.28,Percent of Total Billed Charges, ,,85,,25834.27,Percent of Total Billed Charges, ,,,,,,,,68,,20667.42,Percent of Total Billed Charges,0,1466,,,1466,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,18235.96,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
33274 - TCAT INSJ-RPL PERM LEADLESS PACEMAKER RV W-IMG,33274,HCPCS,,,Q0,Outpatient,,,28294,7073.5,6015,28165.36,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28165.36,,,28165.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19239.92,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,27877.5,,,27877.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18766.32,,,18766.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18947.64,,,18947.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18313.03,,,18313.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18131.71,,,18131.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18313.03,,,18313.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18675.66,,,18675.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18992.97,,,18992.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
33274 - TCAT INSJ-RPL PERM LEADLESS PACEMAKER RV W-IMG,33274,HCPCS,,,KX,Outpatient,,,28294,7073.5,6015,28165.36,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28165.36,,,28165.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19239.92,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,27877.5,,,27877.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18766.32,,,18766.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18947.64,,,18947.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18313.03,,,18313.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18131.71,,,18131.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18313.03,,,18313.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18675.66,,,18675.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18992.97,,,18992.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
33286 - REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR,33286,HCPCS,,,XU,Outpatient,,,14373,3593.25,668.93,12217.05,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9428.69,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10061.1,Percent of Total Billed Charges, ,,85,,12217.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9773.64,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8048.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8623.8,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
33286 - REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR,33286,HCPCS,,,74,Outpatient,,,2320,580,668.93,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1577.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37246 - TRLML BALO ANGIOP OPEN-PERQ IMG SANDI 1ST ART,37246,HCPCS,,,RT,Outpatient,,,10462,2615.5,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6863.07,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7323.4,Percent of Total Billed Charges, ,,85,,8892.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,7114.16,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5858.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6277.2,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37248 - TRLML BALO ANGIOP OPEN-PERQ W-IMG SANDI 1ST VEIN,37248,HCPCS,,,RT,Outpatient,,,9804,2451,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6431.42,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6862.8,Percent of Total Billed Charges, ,,85,,8333.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6666.72,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5490.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5882.4,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37248 - TRLML BALO ANGIOP OPEN-PERQ W-IMG SANDI 1ST VEIN,37248,HCPCS,,,LT,Outpatient,,,9804,2451,1078.11,12074,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6431.42,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6862.8,Percent of Total Billed Charges, ,,85,,8333.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6666.72,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5490.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5882.4,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37249 - TRLML BALO ANGIOP OPEN-PERQ W-IMG SANDI ADDL VEIN,37249,HCPCS,,,XU,Outpatient,,,8854,2213.5,0.01,7525.9,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5808.22,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6197.8,Percent of Total Billed Charges, ,,85,,7525.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6020.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4958.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5312.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37249 - TRLML BALO ANGIOP OPEN-PERQ W-IMG SANDI ADDL VEIN,37249,HCPCS,,,RT,Outpatient,,,8854,2213.5,0.01,7525.9,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5808.22,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6197.8,Percent of Total Billed Charges, ,,85,,7525.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6020.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4958.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5312.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37249 - TRLML BALO ANGIOP OPEN-PERQ W-IMG SANDI ADDL VEIN,37249,HCPCS,,,LT,Outpatient,,,8854,2213.5,0.01,7525.9,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5808.22,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6197.8,Percent of Total Billed Charges, ,,85,,7525.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6020.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4958.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5312.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92920 - PRQ TRLUML CORONARY ANGIOPLASTY ONE ART-BRANCH,92920,HCPCS,,,XU,Outpatient,,,17535,4383.75,950.4,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92920 - PRQ TRLUML CORONARY ANGIOPLASTY ONE ART-BRANCH,92920,HCPCS,,,RI,Outpatient,,,17535,4383.75,950.4,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92920 - PRQ TRLUML CORONARY ANGIOPLASTY ONE ART-BRANCH,92920,HCPCS,,,RC,Outpatient,,,17535,4383.75,950.4,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92920 - PRQ TRLUML CORONARY ANGIOPLASTY ONE ART-BRANCH,92920,HCPCS,,,LM,Outpatient,,,17535,4383.75,950.4,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92920 - PRQ TRLUML CORONARY ANGIOPLASTY ONE ART-BRANCH,92920,HCPCS,,,LD,Outpatient,,,17535,4383.75,950.4,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92920 - PRQ TRLUML CORONARY ANGIOPLASTY ONE ART-BRANCH,92920,HCPCS,,,LC,Outpatient,,,17535,4383.75,950.4,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92920 - PRQ TRLUML CORONARY ANGIOPLASTY ONE ART-BRANCH,92920,HCPCS,,,74,Outpatient,,,17535,4383.75,950.4,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8420.32,,,8420.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,8460.26,,,8460.26,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,8334.26,,,8334.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8195.05,,,8195.05,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5610.38,,,5610.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5664.59,,,5664.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5420.66,,,5420.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5474.87,,,5474.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5583.28,,,5583.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5678.14,,,5678.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92921 - PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH,92921,HCPCS,,,XU,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92921 - PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH,92921,HCPCS,,,RC,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92921 - PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH,92921,HCPCS,,,LD,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92921 - PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH,92921,HCPCS,,,LC,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92924 - PRQ TRLUML CORONARY ANGIO-ATHERECT ONE ART-BRNCH,92924,HCPCS,,,XU,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92924 - PRQ TRLUML CORONARY ANGIO-ATHERECT ONE ART-BRNCH,92924,HCPCS,,,RC,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92924 - PRQ TRLUML CORONARY ANGIO-ATHERECT ONE ART-BRNCH,92924,HCPCS,,,LD,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92924 - PRQ TRLUML CORONARY ANGIO-ATHERECT ONE ART-BRNCH,92924,HCPCS,,,LC,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,XU,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,RI,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,RC,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,LD,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92928 - PRQ TRLUML CORONARY STENT W-ANGIO ONE ART-BRNCH,92928,HCPCS,,,LC,Outpatient,,,31638,7909.5,950.4,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21513.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92929 - PRQ TRLUML CORONARY STENT W-ANGIO ADDL ART-BRNCH,92929,HCPCS,,,RC,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92929 - PRQ TRLUML CORONARY STENT W-ANGIO ADDL ART-BRNCH,92929,HCPCS,,,LC,Outpatient,,,17535,4383.75,0.01,15343,,,46,,8066.1,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11502.96,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12274.5,Percent of Total Billed Charges, ,,85,,14904.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,11923.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,9819.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,10521,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92937 - PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,92937,HCPCS,,,RC,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92937 - PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,92937,HCPCS,,,LD,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92937 - PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,92937,HCPCS,,,LC,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,RI,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,RC,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,LD,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,LC,Outpatient,,,32818.5,8204.625,950.4,27895.73,,,46,,15096.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21528.94,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22972.95,Percent of Total Billed Charges, ,,85,,27895.73,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,22316.58,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18378.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19691.1,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,74,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92943 - PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,92943,HCPCS,,,53,Outpatient,,,28902,7225.5,950.4,24566.7,,,46,,13294.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18959.71,Percent of Total Billed Charges, ,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,20231.4,Percent of Total Billed Charges, ,,85,,24566.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19653.36,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,16185.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,17341.2,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92944 - PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL,92944,HCPCS,,,LD,Outpatient,,,9859,2464.75,0.01,15343,,,46,,4535.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6467.5,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6901.3,Percent of Total Billed Charges, ,,85,,8380.15,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6704.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5521.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5915.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92972 - PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY,92972,HCPCS,,,RI,Outpatient,,,4601,1150.25,0.01,3910.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3018.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3220.7,Percent of Total Billed Charges, ,,85,,3910.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3128.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,2576.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2760.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92972 - PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY,92972,HCPCS,,,RC,Outpatient,,,4601,1150.25,0.01,3910.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3018.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3220.7,Percent of Total Billed Charges, ,,85,,3910.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3128.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,2576.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2760.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92972 - PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY,92972,HCPCS,,,LM,Outpatient,,,4601,1150.25,0.01,3910.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3018.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3220.7,Percent of Total Billed Charges, ,,85,,3910.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3128.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,2576.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2760.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92972 - PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY,92972,HCPCS,,,LD,Outpatient,,,4601,1150.25,0.01,3910.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3018.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3220.7,Percent of Total Billed Charges, ,,85,,3910.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3128.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,2576.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2760.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92972 - PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY,92972,HCPCS,,,LC,Outpatient,,,4601,1150.25,0.01,3910.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3018.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3220.7,Percent of Total Billed Charges, ,,85,,3910.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3128.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,2576.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2760.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92972 - PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY,92972,HCPCS,,,74,Outpatient,,,4601,1150.25,0.01,3910.85,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3018.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3220.7,Percent of Total Billed Charges, ,,85,,3910.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3128.68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,2576.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2760.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92973 - PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY,92973,HCPCS,,,LD,Outpatient,,,4601,1150.25,0.01,3910.85,,,46,,2116.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3018.26,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3220.7,Percent of Total Billed Charges, ,,85,,3910.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3128.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2576.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2760.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92973 - PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY,92973,HCPCS,,,LC,Outpatient,,,4601,1150.25,0.01,3910.85,,,46,,2116.46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3018.26,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3220.7,Percent of Total Billed Charges, ,,85,,3910.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3128.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2576.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2760.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92978 - ENDOLUMINAL CORONARY IVUS OCT IANDR INITIAL VESSEL,92978,HCPCS,,,RI,Outpatient,,,3052,763,0.01,2594.2,,,46,,1403.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2002.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2136.4,Percent of Total Billed Charges, ,,85,,2594.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2075.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1709.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1831.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92978 - ENDOLUMINAL CORONARY IVUS OCT IANDR INITIAL VESSEL,92978,HCPCS,,,RC,Outpatient,,,3052,763,0.01,2594.2,,,46,,1403.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2002.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2136.4,Percent of Total Billed Charges, ,,85,,2594.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2075.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1709.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1831.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92978 - ENDOLUMINAL CORONARY IVUS OCT IANDR INITIAL VESSEL,92978,HCPCS,,,LM,Outpatient,,,3052,763,0.01,2594.2,,,46,,1403.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2002.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2136.4,Percent of Total Billed Charges, ,,85,,2594.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2075.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1709.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1831.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92978 - ENDOLUMINAL CORONARY IVUS OCT IANDR INITIAL VESSEL,92978,HCPCS,,,LD,Outpatient,,,3052,763,0.01,2594.2,,,46,,1403.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2002.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2136.4,Percent of Total Billed Charges, ,,85,,2594.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2075.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1709.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1831.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92978 - ENDOLUMINAL CORONARY IVUS OCT IANDR INITIAL VESSEL,92978,HCPCS,,,LC,Outpatient,,,3052,763,0.01,2594.2,,,46,,1403.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2002.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2136.4,Percent of Total Billed Charges, ,,85,,2594.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2075.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1709.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1831.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92978 - ENDOLUMINAL CORONARY IVUS OCT IANDR INITIAL VESSEL,92978,HCPCS,,,53,Outpatient,,,3052,763,0.01,2594.2,,,46,,1403.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2002.11,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2136.4,Percent of Total Billed Charges, ,,85,,2594.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2075.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1709.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1831.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,542.44,,,542.44,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
92979 - ENDOLUMINAL CORONARY IVUS OCT IANDR ADDL VESSEL,92979,HCPCS,,,XU,Outpatient,,,2504,626,0.01,2128.4,,,46,,1151.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1642.62,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1752.8,Percent of Total Billed Charges, ,,85,,2128.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1702.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1402.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1502.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92979 - ENDOLUMINAL CORONARY IVUS OCT IANDR ADDL VESSEL,92979,HCPCS,,,RC,Outpatient,,,2504,626,0.01,2128.4,,,46,,1151.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1642.62,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1752.8,Percent of Total Billed Charges, ,,85,,2128.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1702.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1402.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1502.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92979 - ENDOLUMINAL CORONARY IVUS OCT IANDR ADDL VESSEL,92979,HCPCS,,,LM,Outpatient,,,2504,626,0.01,2128.4,,,46,,1151.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1642.62,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1752.8,Percent of Total Billed Charges, ,,85,,2128.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1702.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1402.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1502.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92979 - ENDOLUMINAL CORONARY IVUS OCT IANDR ADDL VESSEL,92979,HCPCS,,,LD,Outpatient,,,2504,626,0.01,2128.4,,,46,,1151.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1642.62,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1752.8,Percent of Total Billed Charges, ,,85,,2128.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1702.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1402.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1502.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
92979 - ENDOLUMINAL CORONARY IVUS OCT IANDR ADDL VESSEL,92979,HCPCS,,,LC,Outpatient,,,2504,626,0.01,2128.4,,,46,,1151.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1642.62,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1752.8,Percent of Total Billed Charges, ,,85,,2128.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1702.72,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1402.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1502.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93297 - REM INTERROG ICPMS LESS THAN 30 D PHYS-QHP,93297,HCPCS,,,GZ,Outpatient,,,82,20.5,35.45,69.7,,,46,,37.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.27,,,50.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,55.08,,,55.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,53.79,Percent of Total Billed Charges, ,50.27,,,50.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,57.4,Percent of Total Billed Charges, ,,85,,69.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,55.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,45.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,49.2,Percent of Total Billed Charges, ,54.5,,,54.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.68,,,48.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.69,,,36.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.05,,,37.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.45,,,35.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.51,,,36.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.13,,,37.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.99,,,59.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.99,,,59.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.99,,,59.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.99,,,59.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93451 - RIGHT HEART CATH O2 SATURATION AND CARDIAC OUTPUT,93451,HCPCS,,,XU,Outpatient,,,14985,3746.25,228.36,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.36,,,228.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,228.36,,,228.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,228.36,,,228.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,228.36,,,228.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93451 - RIGHT HEART CATH O2 SATURATION AND CARDIAC OUTPUT,93451,HCPCS,,,74,Outpatient,,,14985,3746.25,228.36,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.36,,,228.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,228.36,,,228.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,228.36,,,228.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,228.36,,,228.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93454 - CATH PLACEMENT AND NJX CORONARY ART ANGIO IMG SANDI,93454,HCPCS,,,XU,Outpatient,,,14985,3746.25,403.53,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93454 - CATH PLACEMENT AND NJX CORONARY ART ANGIO IMG SANDI,93454,HCPCS,,,LC,Outpatient,,,14985,3746.25,403.53,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93454 - CATH PLACEMENT AND NJX CORONARY ART ANGIO IMG SANDI,93454,HCPCS,,,74,Outpatient,,,14985,3746.25,403.53,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93454 - CATH PLACEMENT AND NJX CORONARY ART ANGIO IMG SANDI,93454,HCPCS,,,59,Outpatient,,,14985,3746.25,403.53,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,403.53,,,403.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93455 - CATH PLMT AND NJX CORONARY ART-GRFT ANGIO IMG SANDI,93455,HCPCS,,,XU,Outpatient,,,14985,3746.25,465.43,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,465.43,,,465.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,465.43,,,465.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,465.43,,,465.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,465.43,,,465.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93455 - CATH PLMT AND NJX CORONARY ART-GRFT ANGIO IMG SANDI,93455,HCPCS,,,59,Outpatient,,,14985,3746.25,465.43,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,465.43,,,465.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,465.43,,,465.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,465.43,,,465.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,465.43,,,465.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93457 - CATH PLMT R HRT-ARTS-GRFTS W-NJXAND ANGIO IMG SANDI,93457,HCPCS,,,59,Outpatient,,,14985,3746.25,578.79,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,578.79,,,578.79,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,578.79,,,578.79,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,578.79,,,578.79,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,578.79,,,578.79,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93458 - CATH PLMT L HRT AND ARTS W-NJX AND ANGIO IMG SANDI,93458,HCPCS,,,XU,Outpatient,,,14985,3746.25,491.95,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93458 - CATH PLMT L HRT AND ARTS W-NJX AND ANGIO IMG SANDI,93458,HCPCS,,,XP,Outpatient,,,14985,3746.25,491.95,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93458 - CATH PLMT L HRT AND ARTS W-NJX AND ANGIO IMG SANDI,93458,HCPCS,,,RC,Outpatient,,,14985,3746.25,491.95,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93458 - CATH PLMT L HRT AND ARTS W-NJX AND ANGIO IMG SANDI,93458,HCPCS,,,LD,Outpatient,,,14985,3746.25,491.95,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93458 - CATH PLMT L HRT AND ARTS W-NJX AND ANGIO IMG SANDI,93458,HCPCS,,,59,Outpatient,,,14985,3746.25,491.95,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.95,,,491.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93459 - CATH PLMT L HRT-ARTS-GRFTS WNJX AND ANGIO IMG SANDI,93459,HCPCS,,,XU,Outpatient,,,14985,3746.25,554.26,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93459 - CATH PLMT L HRT-ARTS-GRFTS WNJX AND ANGIO IMG SANDI,93459,HCPCS,,,XP,Outpatient,,,14985,3746.25,554.26,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93459 - CATH PLMT L HRT-ARTS-GRFTS WNJX AND ANGIO IMG SANDI,93459,HCPCS,,,59,Outpatient,,,14985,3746.25,554.26,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,554.26,,,554.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93460 - R AND L HRT CATH WINJX HRT ARTAND L VENTR IMG,93460,HCPCS,,,XU,Outpatient,,,14985,3746.25,617.46,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93460 - R AND L HRT CATH WINJX HRT ARTAND L VENTR IMG,93460,HCPCS,,,XP,Outpatient,,,14985,3746.25,617.46,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93460 - R AND L HRT CATH WINJX HRT ARTAND L VENTR IMG,93460,HCPCS,,,59,Outpatient,,,14985,3746.25,617.46,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93460 - R AND L HRT CATH WINJX HRT ARTAND L VENTR IMG,93460,HCPCS,,,53,Outpatient,,,14985,3746.25,617.46,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,617.46,,,617.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93461 - RAND L HRT CATH W-INJEC HRT ART-GRFTAND L VENT I,93461,HCPCS,,,XU,Outpatient,,,14985,3746.25,681.02,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,681.02,,,681.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,681.02,,,681.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,681.02,,,681.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,681.02,,,681.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93461 - RAND L HRT CATH W-INJEC HRT ART-GRFTAND L VENT I,93461,HCPCS,,,XP,Outpatient,,,14985,3746.25,681.02,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4750.17,,,4750.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,4799.13,,,4799.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,6722,,,6722,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,4701.63,,,4701.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4648.69,,,4648.69,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3165,,,3165,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3195.58,,,3195.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3057.97,,,3057.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3088.55,,,3088.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3149.71,,,3149.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3203.22,,,3203.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,681.02,,,681.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,681.02,,,681.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,681.02,,,681.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,681.02,,,681.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93505 - ENDOMYOCARDIAL BIOPSY,93505,HCPCS,,,74,Outpatient,,,13694,3423.5,659.34,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8983.26,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9585.8,Percent of Total Billed Charges, ,,85,,11639.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,9311.92,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,7668.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8216.4,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,659.34,,,659.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,659.34,,,659.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,659.34,,,659.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,659.34,,,659.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93567 - NJX DRG C-CATHJ SUPRAVALVULAR AORTOGRAPHY SANDI,93567,HCPCS,,,XU,Outpatient,,,725,181.25,0.01,14814,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93571 - IV DOP VELAND-OR PRESS C-FLO RSRV MEAS 1ST VSL,93571,HCPCS,,,RC,Outpatient,,,963,240.75,0.01,818.55,,,46,,442.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,631.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,674.1,Percent of Total Billed Charges, ,,85,,818.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,654.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,539.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,577.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93571 - IV DOP VELAND-OR PRESS C-FLO RSRV MEAS 1ST VSL,93571,HCPCS,,,LM,Outpatient,,,963,240.75,0.01,818.55,,,46,,442.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,631.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,674.1,Percent of Total Billed Charges, ,,85,,818.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,654.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,539.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,577.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93571 - IV DOP VELAND-OR PRESS C-FLO RSRV MEAS 1ST VSL,93571,HCPCS,,,LD,Outpatient,,,963,240.75,0.01,818.55,,,46,,442.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,631.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,674.1,Percent of Total Billed Charges, ,,85,,818.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,654.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,539.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,577.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93571 - IV DOP VELAND-OR PRESS C-FLO RSRV MEAS 1ST VSL,93571,HCPCS,,,LC,Outpatient,,,963,240.75,0.01,818.55,,,46,,442.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,631.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,674.1,Percent of Total Billed Charges, ,,85,,818.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,654.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,539.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,577.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93571 - IV DOP VELAND-OR PRESS C-FLO RSRV MEAS 1ST VSL,93571,HCPCS,,,74,Outpatient,,,963,240.75,0.01,818.55,,,46,,442.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,631.73,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,674.1,Percent of Total Billed Charges, ,,85,,818.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,654.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,539.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,577.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93572 - IV DOP VELAND-OR PRESS C-FLO RSRV MEAS ADDL VSL,93572,HCPCS,,,RC,Outpatient,,,725,181.25,0.01,674,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93572 - IV DOP VELAND-OR PRESS C-FLO RSRV MEAS ADDL VSL,93572,HCPCS,,,LD,Outpatient,,,725,181.25,0.01,674,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93572 - IV DOP VELAND-OR PRESS C-FLO RSRV MEAS ADDL VSL,93572,HCPCS,,,LC,Outpatient,,,725,181.25,0.01,674,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93580 - PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W-IMPLT,93580,HCPCS,,,74,Outpatient,,,44568,11142,2949.45,37882.8,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29236.61,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31197.6,Percent of Total Billed Charges, ,,85,,37882.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,30306.24,Percent of Total Billed Charges,0,12266,,,12266,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24958.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,26740.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2949.45,,,2949.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2949.45,,,2949.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2949.45,,,2949.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2949.45,,,2949.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93591 - PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE,93591,HCPCS,,,74,Outpatient,,,28294,7073.5,2673.98,27864.95,,14814,,,14814,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,27864.95,,,27864.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19239.92,Percent of Total Billed Charges,0,14495,,,14495,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26991.44,,,26991.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2673.98,,,2673.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2673.98,,,2673.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2673.98,,,2673.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2673.98,,,2673.98,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93620 - COMPRE EP EVAL R ATR VNTRC PACGANDREC HIS BNDL REC,93620,HCPCS,,,59,Outpatient,,,14985,3746.25,1568.75,12737.25,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10921.67,,,10921.67,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11206.53,,,11206.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9830.16,Percent of Total Billed Charges, ,10921.67,,,10921.67,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10489.5,Percent of Total Billed Charges, ,,85,,12737.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10189.8,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8391.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,8991,Percent of Total Billed Charges, ,11092,,,11092,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10579.29,,,10579.29,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7466.81,,,7466.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7538.95,,,7538.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7286.45,,,7286.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7214.31,,,7214.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7286.45,,,7286.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7430.74,,,7430.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7556.99,,,7556.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1568.75,,,1568.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1568.75,,,1568.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1568.75,,,1568.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1568.75,,,1568.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93653 - COMPRE EP EVAL ABLTJ 3D MAPG TX SVT,93653,HCPCS,,,74,Outpatient,,,43115,10778.75,1181.41,38090.59,,12074,,,12074,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38090.59,,,38090.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20568,,,20568,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36230.66,,,36230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28283.44,Percent of Total Billed Charges, ,38090.59,,,38090.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30180.5,Percent of Total Billed Charges, ,,85,,36647.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,29318.2,Percent of Total Billed Charges,0,12266,,,12266,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,24144.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,25869,Percent of Total Billed Charges, ,35860.4,,,35860.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36896.53,,,36896.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24140.17,,,24140.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24373.41,,,24373.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23557.08,,,23557.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23323.84,,,23323.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23557.08,,,23557.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24023.56,,,24023.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24431.72,,,24431.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1181.41,,,1181.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1181.41,,,1181.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1181.41,,,1181.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1181.41,,,1181.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93655 - ICAR CATH ABLATION DISCRETE MECHANISM ARRHYTHMIA,93655,HCPCS,,,XU,Outpatient,,,20569,5142.25,0.01,20568,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20568,,,20568,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13493.26,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14398.3,Percent of Total Billed Charges, ,,85,,17483.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,13986.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,11518.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,12341.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,590.7,,,590.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,590.7,,,590.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,590.7,,,590.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,590.7,,,590.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,RC,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,LM,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9600 - PERC DRUG-EL COR STENT SING,C9600,HCPCS,,,LC,Outpatient,,,31638,7909.5,8225.88,26892.3,,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15343,,,15343,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20754.53,Percent of Total Billed Charges, ,,46,,14553.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,22146.6,Percent of Total Billed Charges, ,,85,,26892.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,21513.84,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,17717.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,18982.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8225.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9764 - REVASC INTRAVASC LITHOTRIPSY,C9764,HCPCS,,,XU,Outpatient,,,15388,3847,0.01,16748.39,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,7078.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10094.53,Percent of Total Billed Charges, ,,46,,7078.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10771.6,Percent of Total Billed Charges, ,,85,,13079.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10463.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8617.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9232.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,4000.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9764 - REVASC INTRAVASC LITHOTRIPSY,C9764,HCPCS,,,RT,Outpatient,,,15388,3847,0.01,16748.39,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,7078.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10094.53,Percent of Total Billed Charges, ,,46,,7078.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10771.6,Percent of Total Billed Charges, ,,85,,13079.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10463.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8617.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9232.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,4000.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9764 - REVASC INTRAVASC LITHOTRIPSY,C9764,HCPCS,,,LT,Outpatient,,,15388,3847,0.01,16748.39,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,7078.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10094.53,Percent of Total Billed Charges, ,,46,,7078.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10771.6,Percent of Total Billed Charges, ,,85,,13079.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10463.84,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8617.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9232.8,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,4000.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9765 - REVASC INTRA LITHOTRIP-STENT,C9765,HCPCS,,,RT,Outpatient,,,28294,7073.5,0.01,26519.48,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19239.92,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,7356.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9765 - REVASC INTRA LITHOTRIP-STENT,C9765,HCPCS,,,LT,Outpatient,,,28294,7073.5,0.01,26519.48,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19239.92,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,7356.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9765 - REVASC INTRA LITHOTRIP-STENT,C9765,HCPCS,,,74,Outpatient,,,28294,7073.5,0.01,26519.48,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19239.92,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,7356.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9765 - REVASC INTRA LITHOTRIP-STENT,C9765,HCPCS,,,50,Outpatient,,,33009.67,8252.4175,0.01,28058.22,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,15184.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,21654.34,Percent of Total Billed Charges, ,,46,,15184.45,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,23106.77,Percent of Total Billed Charges, ,,85,,28058.22,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,22446.58,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,18485.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,19805.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,8582.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9766 - REVASC INTRA LITHOTRIP-ATHER,C9766,HCPCS,,,RT,Outpatient,,,28294,7073.5,0.01,26519.48,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19239.92,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,7356.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9766 - REVASC INTRA LITHOTRIP-ATHER,C9766,HCPCS,,,LT,Outpatient,,,28294,7073.5,0.01,26519.48,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18560.86,Percent of Total Billed Charges, ,,46,,13015.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19805.8,Percent of Total Billed Charges, ,,85,,24049.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,19239.92,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,15844.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,16976.4,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,7356.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C9773 - REVASC LITHOTR-STENT TIB-PER,C9773,HCPCS,,,RT,Outpatient,,,38303,9575.75,9034,32557.55,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,17619.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,26519.48,,,26519.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,25126.77,Percent of Total Billed Charges, ,,46,,17619.38,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26812.1,Percent of Total Billed Charges, ,,85,,32557.55,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,26046.04,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,21449.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,22981.8,Percent of Total Billed Charges, ,26248.46,,,26248.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,9958.78,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17669.7,,,17669.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17840.42,,,17840.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17072.17,,,17072.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17242.89,,,17242.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17584.34,,,17584.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17883.1,,,17883.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0278 - ILIAC ART ANGIOCARDIAC CATH,G0278,HCPCS,,,59,Outpatient,,,1288,322,0.01,1094.8,,,46,,592.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,844.93,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,901.6,Percent of Total Billed Charges, ,,85,,1094.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,875.84,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,721.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,772.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0481 - CARDIOLOGY - CARDIAC CATH LAB,0481,RC,,,,Outpatient,,,10142.36,2535.59,1442,14031,,,,,,,,,,,,,,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,6653.39,Percent of Total Billed Charges, ,,,,,,,,70,,7099.65,Percent of Total Billed Charges, ,,85,,8621.01,Percent of Total Billed Charges, ,14031,,,14031,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6896.8,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6085.42,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
93017 - CV STRS TST XERSAND-OR RX CONT ECG TRCG ONLY,93017,HCPCS,,,GA,Outpatient,,,677,169.25,181.17,575.45,,,46,,311.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,314.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,444.11,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,473.9,Percent of Total Billed Charges, ,,85,,575.45,Percent of Total Billed Charges, ,,50,,338.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,460.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,379.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,406.2,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93017 - CV STRS TST XERSAND-OR RX CONT ECG TRCG ONLY,93017,HCPCS,,,52,Outpatient,,,677,169.25,181.17,575.45,,,46,,311.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,314.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,444.11,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,473.9,Percent of Total Billed Charges, ,,85,,575.45,Percent of Total Billed Charges, ,,50,,338.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,460.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,379.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,406.2,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,181.17,,,181.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93660 - CARDIOVASCULAR FUNCTION EVAL W-TILT TABLE W-MNTR,93660,HCPCS,,,59,Outpatient,,,933,233.25,188.24,793.05,,,46,,429.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,669.96,,,669.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,433.85,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,783.62,,,783.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,612.05,Percent of Total Billed Charges, ,669.96,,,669.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,653.1,Percent of Total Billed Charges, ,,85,,793.05,Percent of Total Billed Charges, ,,50,,466.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,634.44,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,522.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,559.8,Percent of Total Billed Charges, ,775.61,,,775.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,648.86,,,648.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,522.12,,,522.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,527.16,,,527.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,509.5,,,509.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,504.46,,,504.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,509.5,,,509.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,519.59,,,519.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,528.42,,,528.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.24,,,188.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.24,,,188.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.24,,,188.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,188.24,,,188.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0482 - CARDIOLOGY - STRESS TEST,0482,RC,,,,Outpatient,,,750.14,187.535,450.08,1482,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,492.09,Percent of Total Billed Charges, ,,,,,,,,70,,525.1,Percent of Total Billed Charges, ,,85,,637.62,Percent of Total Billed Charges, ,,,,,,,,68,,510.1,Percent of Total Billed Charges,0,1482,,,1482,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,450.08,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
93306 - ECHO TTHRC R-T 2D W-WOM-MODE COMPL SPECANDCOLR D,93306,HCPCS,,,XU,Outpatient,,,1172,293,521.29,996.2,,,46,,539.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,697.27,,,697.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,544.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,809.76,,,809.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,768.83,Percent of Total Billed Charges, ,697.27,,,697.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,820.4,Percent of Total Billed Charges, ,,85,,996.2,Percent of Total Billed Charges, ,,50,,586,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,796.96,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,656.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,703.2,Percent of Total Billed Charges, ,801.48,,,801.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.3,,,675.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,539.54,,,539.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,544.75,,,544.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.5,,,526.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,521.29,,,521.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,526.5,,,526.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,536.93,,,536.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,546.05,,,546.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,764.8,,,764.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,764.8,,,764.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,764.8,,,764.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,764.8,,,764.8,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93325 - DOPPLER ECHO COLOR FLOW VELOCITY MAPPING,93325,HCPCS,,,XU,Outpatient,,,88,22,0.01,74.8,,,46,,40.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.72,,,28.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,40.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,57.73,Percent of Total Billed Charges, ,28.72,,,28.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,61.6,Percent of Total Billed Charges, ,,85,,74.8,Percent of Total Billed Charges, ,,50,,44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,59.84,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,49.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,52.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.81,,,27.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,47.52,,,47.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93355 - ECHO TEE GUID TCAT ICAR-VESSEL STRUCTURAL INTVN,93355,HCPCS,,,XU,Outpatient,,,2415,603.75,0.01,2052.75,,,46,,1110.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,333.68,,,333.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,1122.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1584.24,Percent of Total Billed Charges, ,333.68,,,333.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1690.5,Percent of Total Billed Charges, ,,85,,2052.75,Percent of Total Billed Charges, ,,50,,1207.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1642.2,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,1352.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1449,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,323.17,,,323.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,389.72,,,389.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,389.72,,,389.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,389.72,,,389.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,389.72,,,389.72,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0483 - CARDIOLOGY - ECHOCARDIOLOGY,0483,RC,,,,Outpatient,,,1549.86,387.465,539,1317.38,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,1016.71,Percent of Total Billed Charges, ,,,,,,,,70,,1084.9,Percent of Total Billed Charges, ,,85,,1317.38,Percent of Total Billed Charges, ,,,,,,,,68,,1053.9,Percent of Total Billed Charges,0,539,,,539,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,929.92,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
99202 - OFFICE-OUTPATIENT NEW SF MDM 15 MINUTES,99202,HCPCS,,,U1,Outpatient,,,310,77.5,0.01,263.5,,,46,,142.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,71.61,,,71.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,203.36,Percent of Total Billed Charges, ,71.61,,,71.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,217,Percent of Total Billed Charges, ,,85,,263.5,Percent of Total Billed Charges, ,,50,,155,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,210.8,Percent of Total Billed Charges,0,,50,,155,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,173.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,186,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.36,,,69.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99202 - OFFICE-OUTPATIENT NEW SF MDM 15 MINUTES,99202,HCPCS,,,25,Outpatient,,,310,77.5,0.01,263.5,,,46,,142.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,71.61,,,71.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,203.36,Percent of Total Billed Charges, ,71.61,,,71.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,217,Percent of Total Billed Charges, ,,85,,263.5,Percent of Total Billed Charges, ,,50,,155,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,210.8,Percent of Total Billed Charges,0,,50,,155,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,173.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,186,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.36,,,69.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99203 - OFFICE-OUTPATIENT NEW LOW MDM 30 MINUTES,99203,HCPCS,,,25,Outpatient,,,382,95.5,0.01,324.7,,,46,,175.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,107.43,,,107.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,250.59,Percent of Total Billed Charges, ,107.43,,,107.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,267.4,Percent of Total Billed Charges, ,,85,,324.7,Percent of Total Billed Charges, ,,50,,191,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,259.76,Percent of Total Billed Charges,0,,50,,191,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,213.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,229.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.04,,,104.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99211 - OFFICE-OUTPATIENT EST PT MAY NOT REQ PHYS-QHP,99211,HCPCS,,,U1,Outpatient,,,187,46.75,0.01,158.95,,,46,,86.02,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.84,,,32.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,122.67,Percent of Total Billed Charges, ,32.84,,,32.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,130.9,Percent of Total Billed Charges, ,,85,,158.95,Percent of Total Billed Charges, ,,50,,93.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,127.16,Percent of Total Billed Charges,0,,50,,93.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,104.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,112.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.8,,,31.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99211 - OFFICE-OUTPATIENT EST PT MAY NOT REQ PHYS-QHP,99211,HCPCS,,,25,Outpatient,,,174,43.5,0.01,147.9,,,46,,80.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.84,,,32.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,114.14,Percent of Total Billed Charges, ,32.84,,,32.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,121.8,Percent of Total Billed Charges, ,,85,,147.9,Percent of Total Billed Charges, ,,50,,87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,118.32,Percent of Total Billed Charges,0,,50,,87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,97.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,104.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.8,,,31.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99212 - OFFICE-OUTPATIENT ESTABLISHED SF MDM 10 MIN,99212,HCPCS,,,U1,Outpatient,,,280,70,0.01,238,,,46,,128.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.9,,,64.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,183.68,Percent of Total Billed Charges, ,64.9,,,64.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,196,Percent of Total Billed Charges, ,,85,,238,Percent of Total Billed Charges, ,,50,,140,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,190.4,Percent of Total Billed Charges,0,,50,,140,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,156.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,168,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.85,,,62.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99213 - OFFICE-OUTPATIENT ESTABLISHED LOW MDM 20 MIN,99213,HCPCS,,,25,Outpatient,,,380,95,0.01,323,,,46,,174.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,108.22,,,108.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,249.28,Percent of Total Billed Charges, ,108.22,,,108.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,266,Percent of Total Billed Charges, ,,85,,323,Percent of Total Billed Charges, ,,50,,190,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,258.4,Percent of Total Billed Charges,0,,50,,190,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,212.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,228,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.81,,,104.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99215 - OFFICE-OUTPATIENT ESTABLISHED HIGH MDM 40 MIN,99215,HCPCS,,,25,Outpatient,,,536,134,0.01,455.6,,,46,,246.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,212.39,,,212.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,351.62,Percent of Total Billed Charges, ,212.39,,,212.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,375.2,Percent of Total Billed Charges, ,,85,,455.6,Percent of Total Billed Charges, ,,50,,268,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,364.48,Percent of Total Billed Charges,0,,50,,268,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,300.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,321.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,205.69,,,205.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0463 - HOSPITAL OUTPT CLINIC VISIT,G0463,HCPCS,,,U1,Outpatient,,,174.53,43.6325,0.01,190.32,,,46,,80.28,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,190.32,,,190.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,114.49,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,122.17,Percent of Total Billed Charges, ,,85,,148.35,Percent of Total Billed Charges, ,,50,,87.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,118.68,Percent of Total Billed Charges,0,,50,,87.27,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,97.74,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,104.72,Percent of Total Billed Charges, ,188.37,,,188.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.81,,,126.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.03,,,128.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.52,,,122.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.2,,,126.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.34,,,128.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0463 - HOSPITAL OUTPT CLINIC VISIT,G0463,HCPCS,,,27,Outpatient,,,174,43.5,0.01,190.32,,,46,,80.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,190.32,,,190.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,114.14,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,121.8,Percent of Total Billed Charges, ,,85,,147.9,Percent of Total Billed Charges, ,,50,,87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,118.32,Percent of Total Billed Charges,0,,50,,87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,97.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,104.4,Percent of Total Billed Charges, ,188.37,,,188.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.81,,,126.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.03,,,128.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.52,,,122.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.2,,,126.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.34,,,128.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0463 - HOSPITAL OUTPT CLINIC VISIT,G0463,HCPCS,,,25,Outpatient,,,187.46,46.865,0.01,190.32,,,46,,86.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,190.32,,,190.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,122.97,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,131.22,Percent of Total Billed Charges, ,,85,,159.34,Percent of Total Billed Charges, ,,50,,93.73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,127.47,Percent of Total Billed Charges,0,,50,,93.73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,104.98,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,112.48,Percent of Total Billed Charges, ,188.37,,,188.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.81,,,126.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.03,,,128.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.52,,,122.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.2,,,126.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.34,,,128.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0510 - CLINIC - GENERAL CLASSIFICATION,0510,RC,,,,Outpatient,,,184.16,46.04,110.5,450,,,,,,,,,,,,,,450,,,450,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,120.81,Percent of Total Billed Charges, ,,,,,,,,70,,128.91,Percent of Total Billed Charges, ,,85,,156.54,Percent of Total Billed Charges, ,,,,,,,,68,,125.23,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,110.5,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
0648T - QUAN MR ALYS TISS COMPJ W-O MRI SAME SESS 1ORGN,0648T,HCPCS,,,PO,Outpatient,,,2137,534.25,0.01,1816.45,,,34.4,,735.13,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1403.75,,,1403.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1401.87,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1495.9,Percent of Total Billed Charges, ,,85,,1816.45,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1453.16,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1282.2,Percent of Total Billed Charges, ,1389.41,,,1389.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,935.31,,,935.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,944.35,,,944.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.72,,,912.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,903.68,,,903.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.72,,,912.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,930.79,,,930.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,946.6,,,946.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0865T - QUAN MRI ALYS BRAIN W-O DIAGNOSTIC MRI SAME SESS,0865T,HCPCS,,,PO,Outpatient,,,534,133.5,0.01,453.9,,,,,,,,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,350.3,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,373.8,Percent of Total Billed Charges, ,,85,,453.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,363.12,Percent of Total Billed Charges,0,287.17,,,287.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,320.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C8937 - CAD BREAST MRI,C8937,HCPCS,,,PO,Outpatient,,,2234,558.5,0.01,1898.9,,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1519.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,580.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C8937 - CAD BREAST MRI,C8937,HCPCS,,,GA,Outpatient,,,2234,558.5,0.01,1898.9,,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1519.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,580.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,0610,RC,,,,Outpatient,,,864.3,216.075,400,875,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,566.98,Percent of Total Billed Charges, ,,,,,,,,70,,605.01,Percent of Total Billed Charges, ,,85,,734.66,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,587.72,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,518.58,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
70551 - MRI BRAIN BRAIN STEM W-O CONTRAST MATERIAL,70551,HCPCS,,,XU,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70551 - MRI BRAIN BRAIN STEM W-O CONTRAST MATERIAL,70551,HCPCS,,,XP,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70551 - MRI BRAIN BRAIN STEM W-O CONTRAST MATERIAL,70551,HCPCS,,,RT,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70551 - MRI BRAIN BRAIN STEM W-O CONTRAST MATERIAL,70551,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70551 - MRI BRAIN BRAIN STEM W-O CONTRAST MATERIAL,70551,HCPCS,,,77,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70552 - MRI BRAIN BRAIN STEM W-CONTRAST MATERIAL,70552,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1470.15,,,1470.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1470.15,,,1470.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1470.15,,,1470.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1470.15,,,1470.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70553 - MRI BRAIN BRAIN STEM W-O W-CONTRAST MATERIAL,70553,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN-BRAINSTEM,0611,RC,,,,Outpatient,,,2234,558.5,400,1898.9,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,1465.5,Percent of Total Billed Charges, ,,,,,,,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,1340.4,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
72141 - MRI SPINAL CANAL CERVICAL W-O CONTRAST MATRL,72141,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1205.82,,,1205.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1205.82,,,1205.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1205.82,,,1205.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1205.82,,,1205.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72146 - MRI SPINAL CANAL THORACIC W-O CONTRAST MATRL,72146,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1324.62,,,1324.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1324.62,,,1324.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1324.62,,,1324.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1324.62,,,1324.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72147 - MRI SPINAL CANAL THORACIC W-CONTRAST MATRL,72147,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1520.64,,,1520.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1520.64,,,1520.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1520.64,,,1520.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1520.64,,,1520.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72148 - MRI SPINAL CANAL LUMBAR W-O CONTRAST MATERIAL,72148,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1283.04,,,1283.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1283.04,,,1283.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1283.04,,,1283.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1283.04,,,1283.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72156 - MRI SPINAL CANAL CERVICAL W-O AND W-CONTR MATRL,72156,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72157 - MRI SPINAL CANAL THORACIC W-O AND W-CONTR MATRL,72157,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72158 - MRI SPINAL CANAL LUMBAR W-O AND W-CONTR MATRL,72158,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1716.66,,,1716.66,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD-SPINE,0612,RC,,,,Outpatient,,,2234,558.5,400,1898.9,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,1465.5,Percent of Total Billed Charges, ,,,,,,,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,1340.4,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
70540 - MRI ORBIT FACE AND-NECK W-O CONTRAST,70540,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70543 - MRI ORBIT FACE AND NECK W-O AND W-CONTRAST MATRL,70543,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71550 - MRI CHEST W-O CONTRAST MATERIAL,71550,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1205.82,,,1205.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1205.82,,,1205.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1205.82,,,1205.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1205.82,,,1205.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
71552 - MRI CHEST W-O AND W-CONTRAST MATERIAL,71552,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2814.7,,,2814.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2814.7,,,2814.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2814.7,,,2814.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2814.7,,,2814.7,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72195 - MRI PELVIS W-O CONTRAST MATERIAL,72195,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1280.93,,,1280.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1280.93,,,1280.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1280.93,,,1280.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1280.93,,,1280.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
72197 - MRI PELVIS W-O AND W-CONTRAST MATERIAL,72197,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2836.94,,,2836.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2836.94,,,2836.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2836.94,,,2836.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2836.94,,,2836.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73218 - MRI UPPER EXTREMITY OTH THAN JT W-O CONTR MATRL,73218,HCPCS,,,RT,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1275.35,,,1275.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1275.35,,,1275.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1275.35,,,1275.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1275.35,,,1275.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73218 - MRI UPPER EXTREMITY OTH THAN JT W-O CONTR MATRL,73218,HCPCS,,,LT,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1275.35,,,1275.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1275.35,,,1275.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1275.35,,,1275.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1275.35,,,1275.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73220 - MRI UPPER EXTREM OTHER THAN JT W-O AND W-CONTRAS,73220,HCPCS,,,RT,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73220 - MRI UPPER EXTREM OTHER THAN JT W-O AND W-CONTRAS,73220,HCPCS,,,LT,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73221 - MRI ANY JT UPPER EXTREMITY W-O CONTRAST MATRL,73221,HCPCS,,,RT,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73221 - MRI ANY JT UPPER EXTREMITY W-O CONTRAST MATRL,73221,HCPCS,,,LT,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73221 - MRI ANY JT UPPER EXTREMITY W-O CONTRAST MATRL,73221,HCPCS,,,50,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73222 - MRI ANY JT UPPER EXTREMITY W-CONTRAST MATRL,73222,HCPCS,,,RT,Outpatient,,,2234,558.5,711.13,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,879.67,,,879.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,711.13,,,711.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73222 - MRI ANY JT UPPER EXTREMITY W-CONTRAST MATRL,73222,HCPCS,,,LT,Outpatient,,,2234,558.5,711.13,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,879.67,,,879.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,711.13,,,711.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73222 - MRI ANY JT UPPER EXTREMITY W-CONTRAST MATRL,73222,HCPCS,,,50,Outpatient,,,2234,558.5,711.13,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,879.67,,,879.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,711.13,,,711.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73223 - MRI ANY JT UPPER EXTREMITY W-O AND W-CONTR MATRL,73223,HCPCS,,,RT,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73223 - MRI ANY JT UPPER EXTREMITY W-O AND W-CONTR MATRL,73223,HCPCS,,,LT,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73718 - MRI LOWER EXTREM OTH-THN JT W-O CONTR MATRL,73718,HCPCS,,,XU,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73718 - MRI LOWER EXTREM OTH-THN JT W-O CONTR MATRL,73718,HCPCS,,,RT,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73718 - MRI LOWER EXTREM OTH-THN JT W-O CONTR MATRL,73718,HCPCS,,,LT,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73718 - MRI LOWER EXTREM OTH-THN JT W-O CONTR MATRL,73718,HCPCS,,,50,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73720 - MRI LOWER EXTREM OTH-THN JT W-O AND W-CONTR MATR,73720,HCPCS,,,RT,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73720 - MRI LOWER EXTREM OTH-THN JT W-O AND W-CONTR MATR,73720,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73720 - MRI LOWER EXTREM OTH-THN JT W-O AND W-CONTR MATR,73720,HCPCS,,,LT,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73720 - MRI LOWER EXTREM OTH-THN JT W-O AND W-CONTR MATR,73720,HCPCS,,,76,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1196.91,,,1196.91,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73721 - MRI ANY JT LOWER EXTREM W-O CONTRAST MATRL,73721,HCPCS,,,XS,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73721 - MRI ANY JT LOWER EXTREM W-O CONTRAST MATRL,73721,HCPCS,,,RT,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73721 - MRI ANY JT LOWER EXTREM W-O CONTRAST MATRL,73721,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73721 - MRI ANY JT LOWER EXTREM W-O CONTRAST MATRL,73721,HCPCS,,,LT,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73721 - MRI ANY JT LOWER EXTREM W-O CONTRAST MATRL,73721,HCPCS,,,77,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73721 - MRI ANY JT LOWER EXTREM W-O CONTRAST MATRL,73721,HCPCS,,,76,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73721 - MRI ANY JT LOWER EXTREM W-O CONTRAST MATRL,73721,HCPCS,,,50,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1128.6,,,1128.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73722 - MRI ANY JT LOWER EXTREM W-CONTRAST MATERIAL,73722,HCPCS,,,RT,Outpatient,,,2234,558.5,711.13,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,879.67,,,879.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,711.13,,,711.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73722 - MRI ANY JT LOWER EXTREM W-CONTRAST MATERIAL,73722,HCPCS,,,LT,Outpatient,,,2234,558.5,711.13,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,879.67,,,879.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,711.13,,,711.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73722 - MRI ANY JT LOWER EXTREM W-CONTRAST MATERIAL,73722,HCPCS,,,50,Outpatient,,,2234,558.5,711.13,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1166.81,,,1166.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,734,,,734,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,879.67,,,879.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,1154.88,,,1154.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,711.13,,,711.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,777.43,,,777.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,784.94,,,784.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,751.14,,,751.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,758.65,,,758.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,773.67,,,773.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,786.82,,,786.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1529.31,,,1529.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73723 - MRI ANY JT LOWER EXTREM W-O AND W-CONTRAST MATRL,73723,HCPCS,,,RT,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73723 - MRI ANY JT LOWER EXTREM W-O AND W-CONTRAST MATRL,73723,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
73723 - MRI ANY JT LOWER EXTREM W-O AND W-CONTRAST MATRL,73723,HCPCS,,,LT,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2830.26,,,2830.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74181 - MRI ABDOMEN W-O CONTRAST MATERIAL,74181,HCPCS,,,XU,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1214.73,,,1214.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1214.73,,,1214.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1214.73,,,1214.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1214.73,,,1214.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74181 - MRI ABDOMEN W-O CONTRAST MATERIAL,74181,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1214.73,,,1214.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1214.73,,,1214.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1214.73,,,1214.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1214.73,,,1214.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
74183 - MRI ABDOMEN W-O CONTRAST FLWD BY W-CONTRAST,74183,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2836.94,,,2836.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2836.94,,,2836.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2836.94,,,2836.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2836.94,,,2836.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76376 - 3D RENDERING W-INTERP AND POSTPROCESS SUPERVISION,76376,HCPCS,,,XU,Outpatient,,,2234,558.5,0.01,1898.9,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.78,,,13.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,13.78,,,13.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1519.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.35,,,13.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
76376 - 3D RENDERING W-INTERP AND POSTPROCESS SUPERVISION,76376,HCPCS,,,PO,Outpatient,,,2234,558.5,0.01,1898.9,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.78,,,13.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,13.78,,,13.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1519.12,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.35,,,13.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,59.4,,,59.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
C8908 - MRI W-O FOL W-CONT BREAST,C8908,HCPCS,,,PO,Outpatient,,,3169,792.25,339.54,3030,,,46,,1457.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,1457.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2078.86,Percent of Total Billed Charges, ,,46,,1457.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2218.3,Percent of Total Billed Charges, ,,85,,2693.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2154.92,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1774.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1901.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,823.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C8908 - MRI W-O FOL W-CONT BREAST,C8908,HCPCS,,,GA,Outpatient,,,3169,792.25,339.54,3030,,,46,,1457.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,1457.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2078.86,Percent of Total Billed Charges, ,,46,,1457.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2218.3,Percent of Total Billed Charges, ,,85,,2693.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2154.92,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1774.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1901.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,823.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0614 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - OTHER,0614,RC,,,,Outpatient,,,2234.27,558.5675,400,1899.13,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,1465.68,Percent of Total Billed Charges, ,,,,,,,,70,,1563.99,Percent of Total Billed Charges, ,,85,,1899.13,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.3,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,1340.56,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
70544 - MRA HEAD W-O CONTRST MATERIAL,70544,HCPCS,,,XU,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70544 - MRA HEAD W-O CONTRST MATERIAL,70544,HCPCS,,,XP,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70544 - MRA HEAD W-O CONTRST MATERIAL,70544,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70544 - MRA HEAD W-O CONTRST MATERIAL,70544,HCPCS,,,GA,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70544 - MRA HEAD W-O CONTRST MATERIAL,70544,HCPCS,,,76,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70546 - MRA HEAD W-O AND W-CONTRAST MATERIAL,70546,HCPCS,,,XU,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70546 - MRA HEAD W-O AND W-CONTRAST MATERIAL,70546,HCPCS,,,XP,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70546 - MRA HEAD W-O AND W-CONTRAST MATERIAL,70546,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70546 - MRA HEAD W-O AND W-CONTRAST MATERIAL,70546,HCPCS,,,GA,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70546 - MRA HEAD W-O AND W-CONTRAST MATERIAL,70546,HCPCS,,,76,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70547 - MRA NECK W-O CONTRST MATERIAL,70547,HCPCS,,,PO,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70547 - MRA NECK W-O CONTRST MATERIAL,70547,HCPCS,,,GA,Outpatient,,,2234,558.5,229.81,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,251.25,,,251.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,243.42,,,243.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1294.27,,,1294.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70549 - MRA NECK W-O ANDW-CONTRAST MATERIAL,70549,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
70549 - MRA NECK W-O ANDW-CONTRAST MATERIAL,70549,HCPCS,,,GA,Outpatient,,,2234,558.5,339.54,3030,,,34.4,,768.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,411.68,,,411.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,398.85,,,398.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2532.88,,,2532.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK,0615,RC,,,,Outpatient,,,2234,558.5,400,1898.9,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,1465.5,Percent of Total Billed Charges, ,,,,,,,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,1340.4,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
C8900 - MRA W-CONT ABD,C8900,HCPCS,,,PO,Outpatient,,,2234,558.5,339.54,1898.9,,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,527.43,,,527.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1519.12,Percent of Total Billed Charges,0,452.79,,,452.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,522.04,,,522.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,580.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,351.42,,,351.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,354.82,,,354.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,339.54,,,339.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.94,,,342.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.73,,,349.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.67,,,355.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C8935 - MRA W-O DYE UPPER EXTR,C8935,HCPCS,,,LT,Outpatient,,,2234,558.5,0.01,1898.9,,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1465.5,Percent of Total Billed Charges, ,,46,,1027.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1519.12,Percent of Total Billed Charges,0,283.06,,,283.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1251.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1340.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,580.84,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER,0618,RC,,,,Outpatient,,,2234,558.5,400,1898.9,,,,,,,,,,,,,,400,,,400,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,1465.5,Percent of Total Billed Charges, ,,,,,,,,70,,1563.8,Percent of Total Billed Charges, ,,85,,1898.9,Percent of Total Billed Charges, ,875,,,875,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1519.12,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,1340.4,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
J0885 - EPOETIN ALFA NON-ESRD,J0885,HCPCS,,,JZ,Outpatient,1000,UN,62.49,15.6225,6.46,53.12,,,,,,,,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.16,,,10.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.11,,,11.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,40.99,Percent of Total Billed Charges, ,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,43.74,Percent of Total Billed Charges, ,,85,,53.12,Percent of Total Billed Charges, ,6.46,,,6.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,42.49,Percent of Total Billed Charges,0,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,37.49,Percent of Total Billed Charges, ,11.01,,,11.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.48,,,7.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.16,,,7.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.37,,,7.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.5,,,7.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0885 - EPOETIN ALFA NON-ESRD,J0885,HCPCS,,,EC,Outpatient,1000,UN,75.38,18.845,6.46,64.07,,,,,,,,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.16,,,10.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.11,,,11.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,49.45,Percent of Total Billed Charges, ,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,52.77,Percent of Total Billed Charges, ,,85,,64.07,Percent of Total Billed Charges, ,6.46,,,6.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,51.26,Percent of Total Billed Charges,0,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,45.23,Percent of Total Billed Charges, ,11.01,,,11.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.48,,,7.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.16,,,7.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.37,,,7.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.5,,,7.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0886 - Injection epoetin alfa 1000 units (for esrd on dialysis),J0886,HCPCS,,,JZ,Outpatient,,,62.75,15.6875,37.65,53.34,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,41.16,Percent of Total Billed Charges, ,,,,,,,,70,,43.93,Percent of Total Billed Charges, ,,85,,53.34,Percent of Total Billed Charges, ,,,,,,,,68,,42.67,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,37.65,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Q4081 - EPOETIN ALFA 100 UNITS ESRD,Q4081,HCPCS,,,JZ,Outpatient,100,UN,7.54,1.885,0.01,6.41,,,,,,,,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.01,,,1.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.95,Percent of Total Billed Charges, ,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5.28,Percent of Total Billed Charges, ,,85,,6.41,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5.13,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.52,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0634 - PHARMACY - EXTENSION OF 025X - ERYTHROPOIETIN (EPO) LESS THAN 10000 UNITS,0634,RC,,,,Outpatient,,,17.7,4.425,10.62,15.05,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,11.61,Percent of Total Billed Charges, ,,,,,,,,70,,12.39,Percent of Total Billed Charges, ,,85,,15.05,Percent of Total Billed Charges, ,,,,,,,,68,,12.04,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,10.62,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
J0885 - EPOETIN ALFA NON-ESRD,J0885,HCPCS,,,JZ,Outpatient,1000,UN,85.07,21.2675,6.46,72.31,,,,,,,,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.16,,,10.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.11,,,11.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,55.81,Percent of Total Billed Charges, ,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,59.55,Percent of Total Billed Charges, ,,85,,72.31,Percent of Total Billed Charges, ,6.46,,,6.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,57.85,Percent of Total Billed Charges,0,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,51.04,Percent of Total Billed Charges, ,11.01,,,11.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.48,,,7.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.16,,,7.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.37,,,7.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.5,,,7.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0885 - EPOETIN ALFA NON-ESRD,J0885,HCPCS,,,JG,Outpatient,1000,UN,37.9,9.475,6.46,34.75,,,,,,,,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.16,,,10.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.11,,,11.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24.86,Percent of Total Billed Charges, ,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26.53,Percent of Total Billed Charges, ,,85,,32.22,Percent of Total Billed Charges, ,6.46,,,6.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25.77,Percent of Total Billed Charges,0,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,22.74,Percent of Total Billed Charges, ,11.01,,,11.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.48,,,7.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.16,,,7.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.37,,,7.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.5,,,7.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0885 - EPOETIN ALFA NON-ESRD,J0885,HCPCS,,,EC,Outpatient,1000,UN,45.73,11.4325,6.46,38.87,,,,,,,,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.16,,,10.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.11,,,11.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,30,Percent of Total Billed Charges, ,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,32.01,Percent of Total Billed Charges, ,,85,,38.87,Percent of Total Billed Charges, ,6.46,,,6.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,31.1,Percent of Total Billed Charges,0,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,27.44,Percent of Total Billed Charges, ,11.01,,,11.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.48,,,7.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.16,,,7.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.37,,,7.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.5,,,7.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q4081 - EPOETIN ALFA 100 UNITS ESRD,Q4081,HCPCS,,,JZ,Outpatient,100,UN,7.06,1.765,0.01,6,,,,,,,,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.01,,,1.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.63,Percent of Total Billed Charges, ,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4.94,Percent of Total Billed Charges, ,,85,,6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4.8,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.24,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q4081 - EPOETIN ALFA 100 UNITS ESRD,Q4081,HCPCS,,,JB,Outpatient,100,UN,5.64,1.41,0.01,4.79,,,,,,,,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.01,,,1.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.7,Percent of Total Billed Charges, ,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.95,Percent of Total Billed Charges, ,,85,,4.79,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,3.84,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.38,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.85,,,2.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JZ,Outpatient,100,UN,5.61,1.4025,0.72,4.77,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.68,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.93,Percent of Total Billed Charges, ,,85,,4.77,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,3.81,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.37,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JW,Outpatient,100,UN,1.32,0.33,0.72,3.39,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.87,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.92,Percent of Total Billed Charges, ,,85,,1.12,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.2,,0.9,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.79,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JG,Outpatient,100,UN,4.62,1.155,0.72,3.93,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.03,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.23,Percent of Total Billed Charges, ,,85,,3.93,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.14,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.77,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JB,Outpatient,100,UN,5.72,1.43,0.72,4.86,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.75,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4,Percent of Total Billed Charges, ,,85,,4.86,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.89,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.43,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JA,Outpatient,100,UN,5.72,1.43,0.72,4.86,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.75,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4,Percent of Total Billed Charges, ,,85,,4.86,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.89,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.43,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,EC,Outpatient,100,UN,5.72,1.43,0.72,4.86,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.75,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4,Percent of Total Billed Charges, ,,85,,4.86,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.89,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.43,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,JZ,Outpatient,1000,UN,45.63,11.4075,7.24,38.79,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29.93,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31.94,Percent of Total Billed Charges, ,,85,,38.79,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,31.03,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,27.38,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,JW,Outpatient,1000,UN,10.11,2.5275,6.07,33.74,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.63,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7.08,Percent of Total Billed Charges, ,,85,,8.59,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6.87,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6.07,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,JG,Outpatient,1000,UN,31.38,7.845,7.24,33.74,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,20.59,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21.97,Percent of Total Billed Charges, ,,85,,26.67,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,21.34,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,18.83,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,EC,Outpatient,1000,UN,36.77,9.1925,7.24,33.74,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24.12,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.74,Percent of Total Billed Charges, ,,85,,31.25,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,22.06,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,EA,Outpatient,1000,UN,52.55,13.1375,7.24,44.67,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.47,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,36.79,Percent of Total Billed Charges, ,,85,,44.67,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,35.73,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,31.53,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0635 - PHARMACY - EXTENSION OF 025X - ERYTHROPOIETIN (EPO) GREATER THAN =10000 UNITS,0635,RC,,,,Outpatient,,,14.03,3.5075,8.42,11.93,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,9.2,Percent of Total Billed Charges, ,,,,,,,,70,,9.82,Percent of Total Billed Charges, ,,85,,11.93,Percent of Total Billed Charges, ,,,,,,,,68,,9.54,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,8.42,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
90375 - RABIES IMMUNE GLOBULIN RIG HUMAN IM-SUBQ,90375,HCPCS,,,JZ,Outpatient,150,F2,1034.79,258.6975,273.54,879.57,,,,,,,,328.42,,,328.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,469.31,,,469.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,424.9,,,424.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,678.82,Percent of Total Billed Charges, ,328.42,,,328.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,724.35,Percent of Total Billed Charges, ,,85,,879.57,Percent of Total Billed Charges, ,280.37,,,280.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,703.66,Percent of Total Billed Charges,0,289.98,,,289.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,620.87,Percent of Total Billed Charges, ,420.57,,,420.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,328.42,,,328.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,283.11,,,283.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,285.85,,,285.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,276.28,,,276.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,273.54,,,273.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,276.28,,,276.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,281.75,,,281.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,286.53,,,286.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
90375 - RABIES IMMUNE GLOBULIN RIG HUMAN IM-SUBQ,90375,HCPCS,,,JW,Outpatient,150,F2,412.49,103.1225,247.49,837.27,,,,,,,,328.42,,,328.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,469.31,,,469.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,424.9,,,424.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,270.59,Percent of Total Billed Charges, ,328.42,,,328.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,288.74,Percent of Total Billed Charges, ,,85,,350.62,Percent of Total Billed Charges, ,280.37,,,280.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,280.49,Percent of Total Billed Charges,0,289.98,,,289.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,247.49,Percent of Total Billed Charges, ,420.57,,,420.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,328.42,,,328.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,283.11,,,283.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,285.85,,,285.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,276.28,,,276.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,273.54,,,273.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,276.28,,,276.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,281.75,,,281.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,286.53,,,286.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
90375 - RABIES IMMUNE GLOBULIN RIG HUMAN IM-SUBQ,90375,HCPCS,,,JG,Outpatient,150,F2,766.75,191.6875,273.54,837.27,,,,,,,,328.42,,,328.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,469.31,,,469.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,424.9,,,424.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,502.99,Percent of Total Billed Charges, ,328.42,,,328.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,536.73,Percent of Total Billed Charges, ,,85,,651.74,Percent of Total Billed Charges, ,280.37,,,280.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,521.39,Percent of Total Billed Charges,0,289.98,,,289.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,460.05,Percent of Total Billed Charges, ,420.57,,,420.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,328.42,,,328.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,283.11,,,283.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,285.85,,,285.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,276.28,,,276.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,273.54,,,273.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,276.28,,,276.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,281.75,,,281.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,286.53,,,286.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,837.27,,,837.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
90376 - RABIES IG HEAT-TREATED HUMAN IM-SUBQ,90376,HCPCS,,,JZ,Outpatient,,,1185.01,296.2525,456.09,1007.26,,,,,,,,547.6,,,547.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,633.6,,,633.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,708.47,,,708.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,777.37,Percent of Total Billed Charges, ,547.6,,,547.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,829.51,Percent of Total Billed Charges, ,,85,,1007.26,Percent of Total Billed Charges, ,,,,,,,,68,,805.81,Percent of Total Billed Charges,0,479.72,,,479.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,711.01,Percent of Total Billed Charges, ,701.24,,,701.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,547.6,,,547.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,472.05,,,472.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,476.61,,,476.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,460.65,,,460.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,456.09,,,456.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,460.65,,,460.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,469.77,,,469.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,477.75,,,477.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,879.83,,,879.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,879.83,,,879.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,879.83,,,879.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,879.83,,,879.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
90377 - RABIES IG HEATANDSOLVENT-DETERGENT HUMAN IMAND-SUBQ,90377,HCPCS,,,JZ,Outpatient,150,F2,1017.19,254.2975,250.52,864.61,,,,,,,,303.07,,,303.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,499.2,,,499.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.11,,,392.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,667.28,Percent of Total Billed Charges, ,303.07,,,303.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,712.03,Percent of Total Billed Charges, ,,85,,864.61,Percent of Total Billed Charges, ,250.52,,,250.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,691.69,Percent of Total Billed Charges,0,256.31,,,256.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,610.31,Percent of Total Billed Charges, ,388.11,,,388.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,303.07,,,303.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.27,,,261.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.79,,,263.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,254.95,,,254.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.43,,,252.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,254.95,,,254.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260,,,260,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.42,,,264.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,734.45,,,734.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,734.45,,,734.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,734.45,,,734.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,734.45,,,734.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
90377 - RABIES IG HEATANDSOLVENT-DETERGENT HUMAN IMAND-SUBQ,90377,HCPCS,,,JW,Outpatient,150,F2,415.72,103.93,249.43,734.45,,,,,,,,303.07,,,303.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,499.2,,,499.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.11,,,392.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,272.71,Percent of Total Billed Charges, ,303.07,,,303.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,291,Percent of Total Billed Charges, ,,85,,353.36,Percent of Total Billed Charges, ,250.52,,,250.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,282.69,Percent of Total Billed Charges,0,256.31,,,256.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,249.43,Percent of Total Billed Charges, ,388.11,,,388.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,303.07,,,303.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.27,,,261.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.79,,,263.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,254.95,,,254.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.43,,,252.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,254.95,,,254.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260,,,260,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.42,,,264.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,734.45,,,734.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,734.45,,,734.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,734.45,,,734.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,734.45,,,734.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
90675 - RABIES VACCINE INTRAMUSCULAR,90675,HCPCS,,,JZ,Outpatient,1,ML,1314.37,328.5925,324.74,1117.21,,,,,,,,399.69,,,399.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,579.48,,,579.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,517.1,,,517.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,862.23,Percent of Total Billed Charges, ,399.69,,,399.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,920.06,Percent of Total Billed Charges, ,,85,,1117.21,Percent of Total Billed Charges, ,327.78,,,327.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,893.77,Percent of Total Billed Charges,0,324.74,,,324.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,788.62,Percent of Total Billed Charges, ,511.82,,,511.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,399.69,,,399.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,344.54,,,344.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,347.87,,,347.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,336.22,,,336.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,332.89,,,332.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,336.22,,,336.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,342.88,,,342.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,348.7,,,348.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,781.05,,,781.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,781.05,,,781.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,781.05,,,781.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,781.05,,,781.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
90715 - TDAP VACCINE 7 YRS-GREATER THAN IM,90715,HCPCS,,,GZ,Outpatient,0.5,ML,43.4,10.85,0.01,85.54,,,,,,,,43.97,,,43.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,66.35,,,66.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.47,Percent of Total Billed Charges, ,43.97,,,43.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.38,Percent of Total Billed Charges, ,,85,,36.89,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.51,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,26.04,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.97,,,43.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.54,,,85.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,85.54,,,85.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,85.54,,,85.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,85.54,,,85.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0129 - ABATACEPT INJECTION,J0129,HCPCS,,,JZ,Outpatient,10,ME,296.06,74.015,41.3,251.65,,,,,,,,49.59,,,49.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.66,,,54.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.16,,,64.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,194.22,Percent of Total Billed Charges, ,49.59,,,49.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,207.24,Percent of Total Billed Charges, ,,85,,251.65,Percent of Total Billed Charges, ,43.8,,,43.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,201.32,Percent of Total Billed Charges,0,43.16,,,43.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,177.64,Percent of Total Billed Charges, ,63.5,,,63.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.59,,,49.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.75,,,42.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.16,,,43.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.71,,,41.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.3,,,41.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.71,,,41.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.54,,,42.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.26,,,43.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.54,,,55.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.54,,,55.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.54,,,55.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,55.54,,,55.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0134 - INJ ACETAMINOPHEN -FRESENIUS,J0134,HCPCS,,,JG,Outpatient,10,ME,0.24,0.06,0.01,0.2,,,,,,,,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.06,,,0.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.16,Percent of Total Billed Charges, ,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.17,Percent of Total Billed Charges, ,,85,,0.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,66.7,,0.16,Percent of Total Billed Charges,0,0.05,,,0.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.14,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J0174 - INJ LECANEMAB-IRMB 1 MGG          I,J0174,HCPCS,,,Q0,Outpatient,1,ME,2.71,0.6775,1.27,2.3,,,,,,,,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.68,,,1.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.97,,,1.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.78,Percent of Total Billed Charges, ,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.9,Percent of Total Billed Charges, ,,85,,2.3,Percent of Total Billed Charges, ,1.33,,,1.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,1.84,Percent of Total Billed Charges,0,1.35,,,1.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.63,Percent of Total Billed Charges, ,1.95,,,1.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.31,,,1.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.33,,,1.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.28,,,1.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.27,,,1.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.28,,,1.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.31,,,1.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.33,,,1.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J0174 - INJ LECANEMAB-IRMB 1 MGG          I,J0174,HCPCS,,,JZ,Outpatient,1,ME,2.71,0.6775,1.27,2.3,,,,,,,,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.68,,,1.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.97,,,1.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.78,Percent of Total Billed Charges, ,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.9,Percent of Total Billed Charges, ,,85,,2.3,Percent of Total Billed Charges, ,1.33,,,1.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,1.84,Percent of Total Billed Charges,0,1.35,,,1.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.63,Percent of Total Billed Charges, ,1.95,,,1.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.31,,,1.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.33,,,1.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.28,,,1.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.27,,,1.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.28,,,1.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.31,,,1.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.33,,,1.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J0174 - INJ LECANEMAB-IRMB 1 MGG          I,J0174,HCPCS,,,JW,Outpatient,1,ME,1.53,0.3825,0.92,1.97,,,,,,,,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.68,,,1.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.97,,,1.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1,Percent of Total Billed Charges, ,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.07,Percent of Total Billed Charges, ,,85,,1.3,Percent of Total Billed Charges, ,1.33,,,1.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1.04,Percent of Total Billed Charges,0,1.35,,,1.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.92,Percent of Total Billed Charges, ,1.95,,,1.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.31,,,1.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.33,,,1.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.28,,,1.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.27,,,1.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.28,,,1.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.31,,,1.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.33,,,1.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J0174 - INJ LECANEMAB-IRMB 1 MGG          I,J0174,HCPCS,,,GA,Outpatient,1,ME,2.7,0.675,1.27,2.3,,,,,,,,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.68,,,1.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.97,,,1.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.77,Percent of Total Billed Charges, ,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.89,Percent of Total Billed Charges, ,,85,,2.3,Percent of Total Billed Charges, ,1.33,,,1.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,1.84,Percent of Total Billed Charges,0,1.35,,,1.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.62,Percent of Total Billed Charges, ,1.95,,,1.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.53,,,1.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.31,,,1.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.33,,,1.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.28,,,1.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.27,,,1.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.28,,,1.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.31,,,1.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.33,,,1.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J0175 - INJ DONANEMAB-AZBT 2 MGG          I,J0175,HCPCS,,,JZ,Outpatient,2,ME,8.42,2.105,3.89,7.16,,,,,,,,4.68,,,4.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,6.04,,,6.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5.52,Percent of Total Billed Charges, ,4.68,,,4.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5.89,Percent of Total Billed Charges, ,,85,,7.16,Percent of Total Billed Charges, ,4.09,,,4.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,5.73,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,5.05,Percent of Total Billed Charges, ,5.98,,,5.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.68,,,4.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.03,,,4.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.07,,,4.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.93,,,3.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.89,,,3.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.93,,,3.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.01,,,4.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.07,,,4.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J0222 - INJ. PATISIRAN 0.1 MG,J0222,HCPCS,,,JZ,Outpatient,0.1,ME,152.75,38.1875,91.65,321.65,,,,,,,,112.87,,,112.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,124.19,,,124.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,146.03,,,146.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,100.2,Percent of Total Billed Charges, ,112.87,,,112.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,106.93,Percent of Total Billed Charges, ,,85,,129.84,Percent of Total Billed Charges, ,98.83,,,98.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,103.87,Percent of Total Billed Charges,0,99.98,,,99.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,91.65,Percent of Total Billed Charges, ,144.54,,,144.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,112.87,,,112.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,97.3,,,97.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.24,,,98.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.95,,,94.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.01,,,94.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.95,,,94.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.83,,,96.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.48,,,98.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0222 - INJ. PATISIRAN 0.1 MG,J0222,HCPCS,,,JW,Outpatient,0.1,ME,118.99,29.7475,71.39,321.65,,,,,,,,112.87,,,112.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,124.19,,,124.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,146.03,,,146.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,78.06,Percent of Total Billed Charges, ,112.87,,,112.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,83.29,Percent of Total Billed Charges, ,,85,,101.14,Percent of Total Billed Charges, ,98.83,,,98.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,80.91,Percent of Total Billed Charges,0,99.98,,,99.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,71.39,Percent of Total Billed Charges, ,144.54,,,144.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,112.87,,,112.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,97.3,,,97.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.24,,,98.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.95,,,94.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.01,,,94.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.95,,,94.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.83,,,96.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.48,,,98.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0222 - INJ. PATISIRAN 0.1 MG,J0222,HCPCS,,,JG,Outpatient,0.1,ME,196.53,49.1325,94.01,321.65,,,,,,,,112.87,,,112.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,124.19,,,124.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,146.03,,,146.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,128.92,Percent of Total Billed Charges, ,112.87,,,112.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,137.57,Percent of Total Billed Charges, ,,85,,167.05,Percent of Total Billed Charges, ,98.83,,,98.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,133.64,Percent of Total Billed Charges,0,99.98,,,99.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,117.92,Percent of Total Billed Charges, ,144.54,,,144.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,112.87,,,112.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,97.3,,,97.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.24,,,98.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.95,,,94.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.01,,,94.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.95,,,94.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.83,,,96.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.48,,,98.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,321.65,,,321.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0248 - INJ REMDESIVIR 1 MG,J0248,HCPCS,,,JZ,Outpatient,1,ME,14.27,3.5675,6.04,16.36,,,,,,,,7.25,,,7.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.94,,,7.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.38,,,9.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.36,Percent of Total Billed Charges, ,7.25,,,7.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9.99,Percent of Total Billed Charges, ,,85,,12.13,Percent of Total Billed Charges, ,6.35,,,6.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9.7,Percent of Total Billed Charges,0,6.06,,,6.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,8.56,Percent of Total Billed Charges, ,9.29,,,9.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.25,,,7.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.25,,,6.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.31,,,6.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.1,,,6.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.04,,,6.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.1,,,6.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.22,,,6.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.33,,,6.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.36,,,16.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.36,,,16.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.36,,,16.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.36,,,16.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0457 - INJECTION AZTREONAM 100 MGG       I,J0457,HCPCS,,,JG,Outpatient,100,ME,9.99,2.4975,0.01,10.07,,,,,,,,2.26,,,2.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.66,,,2.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.55,Percent of Total Billed Charges, ,2.26,,,2.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6.99,Percent of Total Billed Charges, ,,85,,8.49,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6.79,Percent of Total Billed Charges,0,2.54,,,2.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,5.99,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.26,,,2.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.07,,,10.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.07,,,10.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.07,,,10.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.07,,,10.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0461 - ATROPINE SULFATE INJECTION,J0461,HCPCS,,,JW,Outpatient,0.01,ME,0.04,0.01,0.01,0.12,,,,,,,,0.12,,,0.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.1,,,0.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.03,Percent of Total Billed Charges, ,0.12,,,0.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.03,Percent of Total Billed Charges, ,,85,,0.03,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,75,,0.03,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.02,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.12,,,0.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.09,,,0.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.09,,,0.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.09,,,0.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.09,,,0.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0485 - BELATACEPT INJECTION,J0485,HCPCS,,,JZ,Outpatient,1,ME,12.6,3.15,3.62,11.32,,,,,,,,4.36,,,4.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.84,,,4.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.63,,,5.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8.27,Percent of Total Billed Charges, ,4.36,,,4.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8.82,Percent of Total Billed Charges, ,,85,,10.71,Percent of Total Billed Charges, ,3.93,,,3.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8.57,Percent of Total Billed Charges,0,3.87,,,3.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,7.56,Percent of Total Billed Charges, ,5.57,,,5.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.36,,,4.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.75,,,3.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.66,,,3.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.62,,,3.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.66,,,3.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.73,,,3.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.79,,,3.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0485 - BELATACEPT INJECTION,J0485,HCPCS,,,JW,Outpatient,1,ME,4.68,1.17,2.81,11.32,,,,,,,,4.36,,,4.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.84,,,4.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.63,,,5.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.07,Percent of Total Billed Charges, ,4.36,,,4.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.28,Percent of Total Billed Charges, ,,85,,3.98,Percent of Total Billed Charges, ,3.93,,,3.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,3.18,Percent of Total Billed Charges,0,3.87,,,3.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.81,Percent of Total Billed Charges, ,5.57,,,5.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.36,,,4.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.75,,,3.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.66,,,3.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.62,,,3.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.66,,,3.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.73,,,3.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.79,,,3.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0485 - BELATACEPT INJECTION,J0485,HCPCS,,,JG,Outpatient,1,ME,14.61,3.6525,3.62,12.42,,,,,,,,4.36,,,4.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.84,,,4.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.63,,,5.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.58,Percent of Total Billed Charges, ,4.36,,,4.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.23,Percent of Total Billed Charges, ,,85,,12.42,Percent of Total Billed Charges, ,3.93,,,3.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9.93,Percent of Total Billed Charges,0,3.87,,,3.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,8.77,Percent of Total Billed Charges, ,5.57,,,5.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.36,,,4.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.75,,,3.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.66,,,3.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.62,,,3.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.66,,,3.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.73,,,3.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.79,,,3.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0490 - BELIMUMAB INJECTION,J0490,HCPCS,,,JZ,Outpatient,10,ME,151.3,37.825,51.48,128.61,,,,,,,,61.81,,,61.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.98,,,79.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,99.25,Percent of Total Billed Charges, ,61.81,,,61.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105.91,Percent of Total Billed Charges, ,,85,,128.61,Percent of Total Billed Charges, ,54.91,,,54.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,102.88,Percent of Total Billed Charges,0,52,,,52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,90.78,Percent of Total Billed Charges, ,79.15,,,79.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.81,,,61.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.28,,,53.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.8,,,53.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.99,,,51.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.48,,,51.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.99,,,51.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.02,,,53.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.93,,,53.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0490 - BELIMUMAB INJECTION,J0490,HCPCS,,,JW,Outpatient,10,ME,45.92,11.48,27.55,114.11,,,,,,,,61.81,,,61.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.98,,,79.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,30.12,Percent of Total Billed Charges, ,61.81,,,61.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,32.14,Percent of Total Billed Charges, ,,85,,39.03,Percent of Total Billed Charges, ,54.91,,,54.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,31.23,Percent of Total Billed Charges,0,52,,,52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,27.55,Percent of Total Billed Charges, ,79.15,,,79.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.81,,,61.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.28,,,53.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.8,,,53.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.99,,,51.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.48,,,51.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.99,,,51.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.02,,,53.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.93,,,53.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0490 - BELIMUMAB INJECTION,J0490,HCPCS,,,JA,Outpatient,10,ME,88.51,22.1275,51.48,114.11,,,,,,,,61.81,,,61.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.98,,,79.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,58.06,Percent of Total Billed Charges, ,61.81,,,61.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,61.96,Percent of Total Billed Charges, ,,85,,75.23,Percent of Total Billed Charges, ,54.91,,,54.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,60.19,Percent of Total Billed Charges,0,52,,,52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,53.11,Percent of Total Billed Charges, ,79.15,,,79.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.81,,,61.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.28,,,53.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.8,,,53.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.99,,,51.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.48,,,51.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.99,,,51.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.02,,,53.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.93,,,53.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.11,,,114.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0558 - PENG BENZATHINE-PROCAINE INJ,J0558,HCPCS,,,JZ,Outpatient,100000,UN,,,14.32,28.83,,,,,,,,22.29,,,22.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.4,,,24.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.83,,,28.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,22.29,,,22.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,17.37,,,17.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,,,,,,28.54,,,28.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.29,,,22.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.21,,,19.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.4,,,19.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.75,,,18.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.56,,,18.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.75,,,18.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.12,,,19.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.44,,,19.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.32,,,14.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.32,,,14.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.32,,,14.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.32,,,14.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0561 - PENICILLIN G BENZATHINE INJ,J0561,HCPCS,,,JZ,Outpatient,100000,UN,42.14,10.535,16.81,35.98,,,,,,,,27.82,,,27.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.96,,,29.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.64,Percent of Total Billed Charges, ,27.82,,,27.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.5,Percent of Total Billed Charges, ,,85,,35.82,Percent of Total Billed Charges, ,26.82,,,26.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.66,Percent of Total Billed Charges,0,21.73,,,21.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,25.28,Percent of Total Billed Charges, ,35.62,,,35.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.82,,,27.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.98,,,23.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.21,,,24.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.4,,,23.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.17,,,23.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.4,,,23.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.87,,,23.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.27,,,24.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0561 - PENICILLIN G BENZATHINE INJ,J0561,HCPCS,,,JW,Outpatient,100000,UN,10.13,2.5325,6.08,35.98,,,,,,,,27.82,,,27.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.96,,,29.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.65,Percent of Total Billed Charges, ,27.82,,,27.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7.09,Percent of Total Billed Charges, ,,85,,8.61,Percent of Total Billed Charges, ,26.82,,,26.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6.89,Percent of Total Billed Charges,0,21.73,,,21.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6.08,Percent of Total Billed Charges, ,35.62,,,35.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.82,,,27.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.98,,,23.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.21,,,24.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.4,,,23.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.17,,,23.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.4,,,23.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.87,,,23.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.27,,,24.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0561 - PENICILLIN G BENZATHINE INJ,J0561,HCPCS,,,JG,Outpatient,100000,UN,51.09,12.7725,16.81,43.43,,,,,,,,27.82,,,27.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.96,,,29.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,33.52,Percent of Total Billed Charges, ,27.82,,,27.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,35.76,Percent of Total Billed Charges, ,,85,,43.43,Percent of Total Billed Charges, ,26.82,,,26.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,34.74,Percent of Total Billed Charges,0,21.73,,,21.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,30.65,Percent of Total Billed Charges, ,35.62,,,35.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.82,,,27.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.98,,,23.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.21,,,24.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.4,,,23.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.17,,,23.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.4,,,23.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.87,,,23.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.27,,,24.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0565 - INJ BEZLOTOXUMAB 10 MG,J0565,HCPCS,,,JZ,Outpatient,10,ME,80.38,20.095,37.9,90.29,,,,,,,,45.51,,,45.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,49.86,,,49.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.88,,,58.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.73,Percent of Total Billed Charges, ,45.51,,,45.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56.27,Percent of Total Billed Charges, ,,85,,68.32,Percent of Total Billed Charges, ,39.87,,,39.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.66,Percent of Total Billed Charges,0,39.86,,,39.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,48.23,Percent of Total Billed Charges, ,58.27,,,58.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,45.51,,,45.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.23,,,39.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.61,,,39.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.28,,,38.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.9,,,37.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.28,,,38.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.04,,,39.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.7,,,39.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.29,,,90.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.29,,,90.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.29,,,90.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.29,,,90.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0584 - INJECTION BUROSUMAB-TWZA 1M,J0584,HCPCS,,,JZ,Outpatient,1,ME,307.36,76.84,184.42,1151.17,,,,,,,,536.03,,,536.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,580.93,,,580.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,693.49,,,693.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,201.63,Percent of Total Billed Charges, ,536.03,,,536.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,215.15,Percent of Total Billed Charges, ,,85,,261.26,Percent of Total Billed Charges, ,469.73,,,469.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,209,Percent of Total Billed Charges,0,443.5,,,443.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,184.42,Percent of Total Billed Charges, ,686.4,,,686.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,536.03,,,536.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,462.07,,,462.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,466.53,,,466.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,450.9,,,450.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,446.44,,,446.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,450.9,,,450.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,459.83,,,459.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,467.65,,,467.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1151.17,,,1151.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1151.17,,,1151.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1151.17,,,1151.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1151.17,,,1151.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0585 - INJECTIONONABOTULINUMTOXINA,J0585,HCPCS,,,JZ,Outpatient,1,UN,15.38,3.845,6.09,18.18,,,,,,,,7.32,,,7.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.66,,,7.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.46,,,9.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10.09,Percent of Total Billed Charges, ,7.32,,,7.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.77,Percent of Total Billed Charges, ,,85,,13.07,Percent of Total Billed Charges, ,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.46,Percent of Total Billed Charges,0,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,9.23,Percent of Total Billed Charges, ,9.36,,,9.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.32,,,7.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.3,,,6.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.36,,,6.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.09,,,6.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.27,,,6.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.38,,,6.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0585 - INJECTIONONABOTULINUMTOXINA,J0585,HCPCS,,,JW,Outpatient,1,UN,12.77,3.1925,6.09,18.18,,,,,,,,7.32,,,7.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.66,,,7.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.46,,,9.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8.38,Percent of Total Billed Charges, ,7.32,,,7.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8.94,Percent of Total Billed Charges, ,,85,,10.85,Percent of Total Billed Charges, ,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8.68,Percent of Total Billed Charges,0,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,7.66,Percent of Total Billed Charges, ,9.36,,,9.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.32,,,7.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.3,,,6.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.36,,,6.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.09,,,6.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.27,,,6.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.38,,,6.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0585 - INJECTIONONABOTULINUMTOXINA,J0585,HCPCS,,,JG,Outpatient,1,UN,4.6,1.15,2.76,18.18,,,,,,,,7.32,,,7.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.66,,,7.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.46,,,9.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.02,Percent of Total Billed Charges, ,7.32,,,7.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.22,Percent of Total Billed Charges, ,,85,,3.91,Percent of Total Billed Charges, ,6.47,,,6.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.13,Percent of Total Billed Charges,0,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.76,Percent of Total Billed Charges, ,9.36,,,9.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.32,,,7.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.3,,,6.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.36,,,6.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.09,,,6.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.15,,,6.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.27,,,6.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.38,,,6.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.18,,,18.18,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0612 - INJ CALCIUM GLUCONATE NOSS        I,J0612,HCPCS,,,JG,Outpatient,10,ME,0.25,0.0625,0.01,0.21,,,,,,,,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.05,,,0.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.16,Percent of Total Billed Charges, ,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.18,Percent of Total Billed Charges, ,,85,,0.21,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,0.17,Percent of Total Billed Charges,0,0.05,,,0.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.15,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.15,,,0.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.15,,,0.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.15,,,0.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.15,,,0.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0613 - CALCIUM GLUCON (WG CRITICAL)      I,J0613,HCPCS,,,JG,Outpatient,10,ME,0.48,0.12,0.01,0.41,,,,,,,,0.1,,,0.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.11,,,0.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.31,Percent of Total Billed Charges, ,0.1,,,0.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.34,Percent of Total Billed Charges, ,,85,,0.41,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.8,,0.33,Percent of Total Billed Charges,0,0.09,,,0.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.29,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.1,,,0.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.24,,,0.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.24,,,0.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.24,,,0.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.24,,,0.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0651 - INJ LEVOTHYROXINE FRESKABII       I,J0651,HCPCS,,,JG,Outpatient,10,GR,38.32,9.58,3.56,32.57,,,,,,,,8.24,,,8.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.3,,,11.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.53,,,5.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,25.14,Percent of Total Billed Charges, ,8.24,,,8.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26.82,Percent of Total Billed Charges, ,,85,,32.57,Percent of Total Billed Charges, ,3.82,,,3.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,26.06,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,22.99,Percent of Total Billed Charges, ,5.47,,,5.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.24,,,8.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.68,,,3.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.72,,,3.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.6,,,3.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.56,,,3.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.6,,,3.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.67,,,3.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.73,,,3.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J0665 - INJ BUPIVACAINE NOS 0.5MGMG       I,J0665,HCPCS,,,JG,Outpatient,0.5,ME,0.09,0.0225,0.01,0.62,,,,,,,,0.01,,,0.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.01,,,0.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.06,Percent of Total Billed Charges, ,0.01,,,0.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.06,Percent of Total Billed Charges, ,,85,,0.08,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,66.7,,0.06,Percent of Total Billed Charges,0,0.01,,,0.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.05,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.01,,,0.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.62,,,0.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.62,,,0.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.62,,,0.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.62,,,0.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0712 - CEFTAROLINE FOSAMIL INJ,J0712,HCPCS,,,JZ,Outpatient,10,ME,21.19,5.2975,2.2,18.01,,,,,,,,4.49,,,4.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.04,,,5.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.8,,,5.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13.9,Percent of Total Billed Charges, ,4.49,,,4.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14.83,Percent of Total Billed Charges, ,,85,,18.01,Percent of Total Billed Charges, ,3.95,,,3.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.41,Percent of Total Billed Charges,0,3.84,,,3.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,12.71,Percent of Total Billed Charges, ,5.75,,,5.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.49,,,4.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.87,,,3.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.91,,,3.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.74,,,3.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.85,,,3.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.92,,,3.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0712 - CEFTAROLINE FOSAMIL INJ,J0712,HCPCS,,,JW,Outpatient,10,ME,4.91,1.2275,2.2,5.8,,,,,,,,4.49,,,4.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.04,,,5.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.8,,,5.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.22,Percent of Total Billed Charges, ,4.49,,,4.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.44,Percent of Total Billed Charges, ,,85,,4.17,Percent of Total Billed Charges, ,3.95,,,3.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.34,Percent of Total Billed Charges,0,3.84,,,3.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.95,Percent of Total Billed Charges, ,5.75,,,5.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.49,,,4.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.87,,,3.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.91,,,3.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.74,,,3.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.85,,,3.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.92,,,3.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0712 - CEFTAROLINE FOSAMIL INJ,J0712,HCPCS,,,JG,Outpatient,10,ME,21.19,5.2975,2.2,18.01,,,,,,,,4.49,,,4.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.04,,,5.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.8,,,5.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13.9,Percent of Total Billed Charges, ,4.49,,,4.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14.83,Percent of Total Billed Charges, ,,85,,18.01,Percent of Total Billed Charges, ,3.95,,,3.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.41,Percent of Total Billed Charges,0,3.84,,,3.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,12.71,Percent of Total Billed Charges, ,5.75,,,5.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.49,,,4.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.87,,,3.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.91,,,3.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.74,,,3.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.78,,,3.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.85,,,3.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.92,,,3.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.2,,,2.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0736 - INJ CLINDAMYCIN PHOSP 300MG       I,J0736,HCPCS,,,JG,Outpatient,300,ME,11.07,2.7675,0.01,9.41,,,,,,,,2.82,,,2.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.99,,,2.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7.26,Percent of Total Billed Charges, ,2.82,,,2.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7.75,Percent of Total Billed Charges, ,,85,,9.41,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7.53,Percent of Total Billed Charges,0,1.9,,,1.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6.64,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.82,,,2.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.78,,,4.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4.78,,,4.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4.78,,,4.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4.78,,,4.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0737 - INJ CLINDAMYCIN (BAXTER)          I,J0737,HCPCS,,,JZ,Outpatient,300,ME,12.27,3.0675,0.01,14.73,,,,,,,,3.21,,,3.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.08,,,4.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8.05,Percent of Total Billed Charges, ,3.21,,,3.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8.59,Percent of Total Billed Charges, ,,85,,10.43,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8.34,Percent of Total Billed Charges,0,1.75,,,1.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,7.36,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.21,,,3.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.73,,,14.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.73,,,14.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.73,,,14.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.73,,,14.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0791 - INJ CRIZANLIZUMAB-TMCA 5MG,J0791,HCPCS,,,JW,Outpatient,5,ME,147.18,36.795,88.31,363.65,,,,,,,,146.73,,,146.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,159.24,,,159.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,189.83,,,189.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,96.55,Percent of Total Billed Charges, ,146.73,,,146.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,103.03,Percent of Total Billed Charges, ,,85,,125.1,Percent of Total Billed Charges, ,128.68,,,128.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,100.08,Percent of Total Billed Charges,0,127.1,,,127.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,88.31,Percent of Total Billed Charges, ,187.9,,,187.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,146.73,,,146.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.49,,,126.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.71,,,127.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.43,,,123.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.21,,,122.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.43,,,123.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,125.88,,,125.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.01,,,128.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.65,,,363.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,363.65,,,363.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,363.65,,,363.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,363.65,,,363.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0840 - CROTALIDAE POLY IMMUNE FAB,J0840,HCPCS,,,JG,Outpatient,1,GM,9088.72,2272.18,1675.53,7725.41,,,,,,,,2011.74,,,2011.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2367.69,,,2367.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2602.73,,,2602.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5962.2,Percent of Total Billed Charges, ,2011.74,,,2011.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6362.1,Percent of Total Billed Charges, ,,85,,7725.41,Percent of Total Billed Charges, ,1779.64,,,1779.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6180.33,Percent of Total Billed Charges,0,1949.92,,,1949.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,5453.23,Percent of Total Billed Charges, ,2576.13,,,2576.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2011.74,,,2011.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1734.17,,,1734.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1750.93,,,1750.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1692.29,,,1692.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1675.53,,,1675.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1692.29,,,1692.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1725.8,,,1725.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1755.12,,,1755.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J0875 - INJECTION DALBAVANCIN,J0875,HCPCS,,,JZ,Outpatient,5,ME,40.55,10.1375,14.84,43.3,,,,,,,,17.82,,,17.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.74,,,19.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.06,,,23.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26.6,Percent of Total Billed Charges, ,17.82,,,17.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28.39,Percent of Total Billed Charges, ,,85,,34.47,Percent of Total Billed Charges, ,15.6,,,15.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,27.57,Percent of Total Billed Charges,0,15.29,,,15.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,24.33,Percent of Total Billed Charges, ,22.82,,,22.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.36,,,15.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.51,,,15.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.99,,,14.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.84,,,14.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.99,,,14.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.29,,,15.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.54,,,15.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,43.3,,,43.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.3,,,43.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.3,,,43.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,43.3,,,43.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0878 - DAPTOMYCIN INJECTION,J0878,HCPCS,,,JZ,Outpatient,1,ME,0.31,0.0775,0.01,0.86,,,,,,,,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.2,Percent of Total Billed Charges, ,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.22,Percent of Total Billed Charges, ,,85,,0.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.7,,0.21,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.19,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.86,,,0.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.86,,,0.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.86,,,0.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.86,,,0.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0878 - DAPTOMYCIN INJECTION,J0878,HCPCS,,,JW,Outpatient,1,ME,0.07,0.0175,0.01,0.86,,,,,,,,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.05,Percent of Total Billed Charges, ,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.05,Percent of Total Billed Charges, ,,85,,0.06,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,71.4,,0.05,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.04,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.86,,,0.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.86,,,0.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.86,,,0.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.86,,,0.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0881 - DARBEPOETIN ALFA NON-ESRD,J0881,HCPCS,,,JW,Outpatient,1,GR,9.29,2.3225,2.89,13.63,,,,,,,,3.47,,,3.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.73,,,3.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.48,,,4.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.09,Percent of Total Billed Charges, ,3.47,,,3.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6.5,Percent of Total Billed Charges, ,,85,,7.9,Percent of Total Billed Charges, ,2.97,,,2.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6.32,Percent of Total Billed Charges,0,2.93,,,2.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,5.57,Percent of Total Billed Charges, ,4.44,,,4.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.47,,,3.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.99,,,2.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.02,,,3.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.92,,,2.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.89,,,2.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.92,,,2.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.98,,,2.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.63,,,13.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,13.63,,,13.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,13.63,,,13.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,13.63,,,13.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0882 - DARBEPOETIN ALFA ESRD USE,J0882,HCPCS,,,JZ,Outpatient,1,GR,16.35,4.0875,2.89,13.9,,,,,,,,3.47,,,3.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.83,,,3.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.48,,,4.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10.73,Percent of Total Billed Charges, ,3.47,,,3.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11.45,Percent of Total Billed Charges, ,,85,,13.9,Percent of Total Billed Charges, ,2.97,,,2.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11.12,Percent of Total Billed Charges,0,2.93,,,2.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,9.81,Percent of Total Billed Charges, ,4.44,,,4.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.47,,,3.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.99,,,2.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.02,,,3.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.92,,,2.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.89,,,2.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.92,,,2.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.98,,,2.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.03,,,3.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.63,,,13.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,13.63,,,13.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,13.63,,,13.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,13.63,,,13.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0885 - EPOETIN ALFA NON-ESRD,J0885,HCPCS,,,EC,Outpatient,1000,UN,56.45,14.1125,6.46,47.98,,,,,,,,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.16,,,10.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.11,,,11.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,37.03,Percent of Total Billed Charges, ,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,39.52,Percent of Total Billed Charges, ,,85,,47.98,Percent of Total Billed Charges, ,6.46,,,6.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,38.39,Percent of Total Billed Charges,0,8.89,,,8.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,33.87,Percent of Total Billed Charges, ,11.01,,,11.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.59,,,8.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.41,,,7.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.48,,,7.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.16,,,7.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.23,,,7.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.37,,,7.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.5,,,7.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.75,,,34.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0896 - INJ LUSPATERCEPT-AAMT 0.25MG,J0896,HCPCS,,,JZ,Outpatient,0.25,ME,140.32,35.08,0.01,119.27,,,,,,,,46.37,,,46.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.85,,,50.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.97,,,59.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,92.05,Percent of Total Billed Charges, ,46.37,,,46.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,98.22,Percent of Total Billed Charges, ,,85,,119.27,Percent of Total Billed Charges, ,41.28,,,41.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,95.42,Percent of Total Billed Charges,0,39.97,,,39.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,84.19,Percent of Total Billed Charges, ,59.36,,,59.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.37,,,46.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.96,,,39.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.35,,,40.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39,,,39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39,,,39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.77,,,39.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.44,,,40.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0896 - INJ LUSPATERCEPT-AAMT 0.25MG,J0896,HCPCS,,,JW,Outpatient,0.25,ME,42.65,10.6625,0.01,59.97,,,,,,,,46.37,,,46.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.85,,,50.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.97,,,59.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.98,Percent of Total Billed Charges, ,46.37,,,46.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.86,Percent of Total Billed Charges, ,,85,,36.25,Percent of Total Billed Charges, ,41.28,,,41.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29,Percent of Total Billed Charges,0,39.97,,,39.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,25.59,Percent of Total Billed Charges, ,59.36,,,59.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.37,,,46.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.96,,,39.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.35,,,40.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39,,,39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39,,,39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.77,,,39.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.44,,,40.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0896 - INJ LUSPATERCEPT-AAMT 0.25MG,J0896,HCPCS,,,JG,Outpatient,0.25,ME,130.61,32.6525,0.01,111.02,,,,,,,,46.37,,,46.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.85,,,50.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.97,,,59.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,85.68,Percent of Total Billed Charges, ,46.37,,,46.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,91.43,Percent of Total Billed Charges, ,,85,,111.02,Percent of Total Billed Charges, ,41.28,,,41.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,88.81,Percent of Total Billed Charges,0,39.97,,,39.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,78.37,Percent of Total Billed Charges, ,59.36,,,59.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.37,,,46.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.96,,,39.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.35,,,40.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39,,,39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.61,,,38.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39,,,39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.77,,,39.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.44,,,40.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0897 - DENOSUMAB INJECTION,J0897,HCPCS,,,JZ,Outpatient,1,ME,117.45,29.3625,25.2,99.83,,,,,,,,30.78,,,30.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.44,,,33.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.81,,,39.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,77.05,Percent of Total Billed Charges, ,30.78,,,30.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,82.22,Percent of Total Billed Charges, ,,85,,99.83,Percent of Total Billed Charges, ,27.66,,,27.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,79.87,Percent of Total Billed Charges,0,25.2,,,25.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,70.47,Percent of Total Billed Charges, ,39.41,,,39.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.78,,,30.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.53,,,26.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.78,,,26.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.89,,,25.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.63,,,25.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.89,,,25.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.4,,,26.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.85,,,26.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.86,,,42.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,42.86,,,42.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,42.86,,,42.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,42.86,,,42.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J0897 - DENOSUMAB INJECTION,J0897,HCPCS,,,JG,Outpatient,1,ME,141.93,35.4825,25.2,120.64,,,,,,,,30.78,,,30.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.44,,,33.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.81,,,39.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,93.11,Percent of Total Billed Charges, ,30.78,,,30.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,99.35,Percent of Total Billed Charges, ,,85,,120.64,Percent of Total Billed Charges, ,27.66,,,27.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,96.51,Percent of Total Billed Charges,0,25.2,,,25.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,85.16,Percent of Total Billed Charges, ,39.41,,,39.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.78,,,30.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.53,,,26.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.78,,,26.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.89,,,25.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.63,,,25.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.89,,,25.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.4,,,26.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.85,,,26.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.86,,,42.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,42.86,,,42.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,42.86,,,42.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,42.86,,,42.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1097 - PHENYLEP KETOROLAC OPTH SOLN,J1097,HCPCS,,,JZ,Outpatient,,,249.23,62.3075,0.01,211.85,,,,,,,,124.58,,,124.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,150.45,,,150.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,142.64,,,142.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,163.49,Percent of Total Billed Charges, ,124.58,,,124.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,174.46,Percent of Total Billed Charges, ,,85,,211.85,Percent of Total Billed Charges, ,,,,,,,,68,,169.48,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,149.54,Percent of Total Billed Charges, ,141.19,,,141.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.58,,,124.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,95.04,,,95.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.96,,,95.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.75,,,92.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.83,,,91.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.75,,,92.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.58,,,94.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.19,,,96.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J1200 - DIPHENHYDRAMINE HCL INJECTIO,J1200,HCPCS,,,AY,Outpatient,50,ME,7.49,1.8725,0.01,9.27,,,,,,,,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.14,,,1.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.91,Percent of Total Billed Charges, ,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5.24,Percent of Total Billed Charges, ,,85,,6.37,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5.09,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.49,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.86,,,0.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.27,,,9.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.27,,,9.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.27,,,9.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.27,,,9.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1300 - ECULIZUMAB INJECTION,J1300,HCPCS,,,JZ,Outpatient,10,ME,459.22,114.805,213.57,523.85,,,,,,,,256.42,,,256.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,281.84,,,281.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,331.75,,,331.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,301.25,Percent of Total Billed Charges, ,256.42,,,256.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,321.45,Percent of Total Billed Charges, ,,85,,390.34,Percent of Total Billed Charges, ,224.16,,,224.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,312.27,Percent of Total Billed Charges,0,225.69,,,225.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,275.53,Percent of Total Billed Charges, ,328.36,,,328.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,256.42,,,256.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,221.04,,,221.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,223.18,,,223.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,215.71,,,215.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,213.57,,,213.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,215.71,,,215.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,219.98,,,219.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,223.71,,,223.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,523.85,,,523.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,523.85,,,523.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,523.85,,,523.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,523.85,,,523.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1303 - INJ. RAVULIZUMAB-CWVZ 10 MG,J1303,HCPCS,,,JZ,Outpatient,10,ME,981.12,245.28,209.88,833.95,,,,,,,,251.99,,,251.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,276.51,,,276.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,326.01,,,326.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,643.61,Percent of Total Billed Charges, ,251.99,,,251.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,686.78,Percent of Total Billed Charges, ,,85,,833.95,Percent of Total Billed Charges, ,220.59,,,220.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,667.16,Percent of Total Billed Charges,0,221.77,,,221.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,588.67,Percent of Total Billed Charges, ,322.69,,,322.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,251.99,,,251.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,217.23,,,217.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,219.32,,,219.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,211.98,,,211.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,209.88,,,209.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,211.98,,,211.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.18,,,216.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,219.85,,,219.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,672.05,,,672.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,672.05,,,672.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,672.05,,,672.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,672.05,,,672.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1306 - INJECTION INCLISIRAN 1 MG,J1306,HCPCS,,,TB,Outpatient,1,ME,62.35,15.5875,11.58,53,,,,,,,,13.9,,,13.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.26,,,15.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18,,,18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,40.9,Percent of Total Billed Charges, ,13.9,,,13.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,43.65,Percent of Total Billed Charges, ,,85,,53,Percent of Total Billed Charges, ,12.28,,,12.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,42.4,Percent of Total Billed Charges,0,12.13,,,12.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,37.41,Percent of Total Billed Charges, ,17.8,,,17.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.9,,,13.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.99,,,11.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.7,,,11.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.58,,,11.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.7,,,11.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.93,,,11.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.13,,,12.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.73,,,38.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.73,,,38.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.73,,,38.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.73,,,38.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1306 - INJECTION INCLISIRAN 1 MG,J1306,HCPCS,,,JZ,Outpatient,1,ME,14,3.5,8.4,38.73,,,,,,,,13.9,,,13.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.26,,,15.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18,,,18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.18,Percent of Total Billed Charges, ,13.9,,,13.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9.8,Percent of Total Billed Charges, ,,85,,11.9,Percent of Total Billed Charges, ,12.28,,,12.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9.52,Percent of Total Billed Charges,0,12.13,,,12.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,8.4,Percent of Total Billed Charges, ,17.8,,,17.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.9,,,13.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.99,,,11.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.1,,,12.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.7,,,11.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.58,,,11.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.7,,,11.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.93,,,11.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.13,,,12.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.73,,,38.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.73,,,38.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.73,,,38.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.73,,,38.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1327 - EPTIFIBATIDE INJECTION,J1327,HCPCS,,,JZ,Outpatient,,,61.74,15.435,0.01,52.48,,,,,,,,19.12,,,19.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.14,,,15.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,40.5,Percent of Total Billed Charges, ,19.12,,,19.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,43.22,Percent of Total Billed Charges, ,,85,,52.48,Percent of Total Billed Charges, ,,,,,,,,68,,41.98,Percent of Total Billed Charges,0,3.35,,,3.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,37.04,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.12,,,19.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.1,,,34.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.1,,,34.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.1,,,34.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.1,,,34.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1327 - EPTIFIBATIDE INJECTION,J1327,HCPCS,,,JG,Outpatient,,,72.41,18.1025,0.01,61.55,,,,,,,,19.12,,,19.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.14,,,15.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,47.5,Percent of Total Billed Charges, ,19.12,,,19.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,50.69,Percent of Total Billed Charges, ,,85,,61.55,Percent of Total Billed Charges, ,,,,,,,,68,,49.24,Percent of Total Billed Charges,0,3.35,,,3.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,43.45,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.12,,,19.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.1,,,34.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.1,,,34.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.1,,,34.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,34.1,,,34.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1364 - ERYTHRO LACTOBIONATE -500 MG,J1364,HCPCS,,,JZ,Outpatient,500,ME,183.01,45.7525,0.01,155.56,,,,,,,,74.64,,,74.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.24,,,87.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,120.05,Percent of Total Billed Charges, ,74.64,,,74.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,128.11,Percent of Total Billed Charges, ,,85,,155.56,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,124.45,Percent of Total Billed Charges,0,80.78,,,80.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,109.81,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.64,,,74.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.39,,,22.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.39,,,22.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.39,,,22.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.39,,,22.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1410 - INJ ESTROGEN CONJUGATE 25 MG,J1410,HCPCS,,,JG,Outpatient,25,ME,1908,477,10.93,1621.8,,,,,,,,436.95,,,436.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,480.04,,,480.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,565.32,,,565.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1251.65,Percent of Total Billed Charges, ,436.95,,,436.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1335.6,Percent of Total Billed Charges, ,,85,,1621.8,Percent of Total Billed Charges, ,382.91,,,382.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1297.44,Percent of Total Billed Charges,0,372.15,,,372.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1144.8,Percent of Total Billed Charges, ,559.54,,,559.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,436.95,,,436.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,376.67,,,376.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,380.31,,,380.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,367.57,,,367.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,363.93,,,363.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,367.57,,,367.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,374.85,,,374.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,381.22,,,381.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.93,,,10.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.93,,,10.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.93,,,10.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.93,,,10.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1437 - INJ. FE DERISOMALTOSE 10 MG,J1437,HCPCS,,,TB,Outpatient,10,ME,168.31,42.0775,18.86,143.06,,,,,,,,24.04,,,24.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.81,,,25.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.08,,,31.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,110.41,Percent of Total Billed Charges, ,24.04,,,24.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,117.82,Percent of Total Billed Charges, ,,85,,143.06,Percent of Total Billed Charges, ,20.77,,,20.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,114.45,Percent of Total Billed Charges,0,18.86,,,18.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,100.99,Percent of Total Billed Charges, ,30.77,,,30.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.04,,,24.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.71,,,20.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.91,,,20.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.21,,,20.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.01,,,20.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.21,,,20.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.61,,,20.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.96,,,20.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1437 - INJ. FE DERISOMALTOSE 10 MG,J1437,HCPCS,,,JZ,Outpatient,10,ME,142.42,35.605,18.86,121.06,,,,,,,,24.04,,,24.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.81,,,25.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.08,,,31.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,93.43,Percent of Total Billed Charges, ,24.04,,,24.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,99.69,Percent of Total Billed Charges, ,,85,,121.06,Percent of Total Billed Charges, ,20.77,,,20.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,96.85,Percent of Total Billed Charges,0,18.86,,,18.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,85.45,Percent of Total Billed Charges, ,30.77,,,30.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.04,,,24.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.71,,,20.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.91,,,20.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.21,,,20.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.01,,,20.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.21,,,20.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.61,,,20.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.96,,,20.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1437 - INJ. FE DERISOMALTOSE 10 MG,J1437,HCPCS,,,JG,Outpatient,10,ME,168.31,42.0775,18.86,143.06,,,,,,,,24.04,,,24.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.81,,,25.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.08,,,31.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,110.41,Percent of Total Billed Charges, ,24.04,,,24.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,117.82,Percent of Total Billed Charges, ,,85,,143.06,Percent of Total Billed Charges, ,20.77,,,20.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,114.45,Percent of Total Billed Charges,0,18.86,,,18.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,100.99,Percent of Total Billed Charges, ,30.77,,,30.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.04,,,24.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.71,,,20.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.91,,,20.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.21,,,20.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.01,,,20.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.21,,,20.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.61,,,20.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.96,,,20.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,68.22,,,68.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1439 - INJ FERRIC CARBOXYMALTOS 1MG,J1439,HCPCS,,,JZ,Outpatient,1,ME,4.68,1.17,1.05,3.98,,,,,,,,1.25,,,1.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.41,,,1.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.62,,,1.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.07,Percent of Total Billed Charges, ,1.25,,,1.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.28,Percent of Total Billed Charges, ,,85,,3.98,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,3.18,Percent of Total Billed Charges,0,1.15,,,1.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.81,Percent of Total Billed Charges, ,1.61,,,1.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.25,,,1.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.09,,,1.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.1,,,1.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.06,,,1.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.05,,,1.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.06,,,1.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.08,,,1.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.1,,,1.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.15,,,3.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.15,,,3.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.15,,,3.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.15,,,3.15,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1451 - FOMEPIZOLE 15 MG,J1451,HCPCS,,,JZ,Outpatient,,,36.68,9.17,6.06,35.28,,,,,,,,13.67,,,13.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.11,,,16.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.51,,,9.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24.06,Percent of Total Billed Charges, ,13.67,,,13.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.68,Percent of Total Billed Charges, ,,85,,31.18,Percent of Total Billed Charges, ,,,,,,,,68,,24.94,Percent of Total Billed Charges,0,6.06,,,6.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,22.01,Percent of Total Billed Charges, ,9.41,,,9.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.67,,,13.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.33,,,6.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.4,,,6.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.18,,,6.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.12,,,6.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.18,,,6.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.3,,,6.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.41,,,6.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.28,,,35.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.28,,,35.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.28,,,35.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.28,,,35.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1459 - INJ IVIG PRIVIGEN 500 MG,J1459,HCPCS,,,JZ,Outpatient,500,ME,273.39,68.3475,46.19,232.38,,,,,,,,55.45,,,55.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,60.84,,,60.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,71.74,,,71.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,179.34,Percent of Total Billed Charges, ,55.45,,,55.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,191.37,Percent of Total Billed Charges, ,,85,,232.38,Percent of Total Billed Charges, ,49.28,,,49.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,185.91,Percent of Total Billed Charges,0,48.29,,,48.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,164.03,Percent of Total Billed Charges, ,71.02,,,71.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.45,,,55.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.81,,,47.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.27,,,48.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.65,,,46.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.19,,,46.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.65,,,46.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.58,,,47.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.38,,,48.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.43,,,101.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,101.43,,,101.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,101.43,,,101.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,101.43,,,101.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1561 - GAMUNEX-C-GAMMAKED,J1561,HCPCS,,,JZ,Outpatient,500,ME,149.2,37.3,46.4,126.82,,,,,,,,55.72,,,55.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,61.98,,,61.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,72.07,,,72.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,97.88,Percent of Total Billed Charges, ,55.72,,,55.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,104.44,Percent of Total Billed Charges, ,,85,,126.82,Percent of Total Billed Charges, ,49.01,,,49.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,101.46,Percent of Total Billed Charges,0,49.79,,,49.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,89.52,Percent of Total Billed Charges, ,71.34,,,71.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.72,,,55.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.02,,,48.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.49,,,48.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.86,,,46.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.4,,,46.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.86,,,46.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.79,,,47.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.6,,,48.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,97.65,,,97.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,97.65,,,97.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,97.65,,,97.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,97.65,,,97.65,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1568 - OCTAGAM INJECTION,J1568,HCPCS,,,JZ,Outpatient,500,ME,503.5,125.875,44.98,427.98,,,,,,,,55.92,,,55.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.68,,,59.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,72.36,,,72.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,330.3,Percent of Total Billed Charges, ,55.92,,,55.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,352.45,Percent of Total Billed Charges, ,,85,,427.98,Percent of Total Billed Charges, ,49.3,,,49.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,342.38,Percent of Total Billed Charges,0,44.98,,,44.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,302.1,Percent of Total Billed Charges, ,71.62,,,71.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.92,,,55.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.21,,,48.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.68,,,48.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.05,,,47.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.58,,,46.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.05,,,47.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.98,,,47.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.79,,,48.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,100.42,,,100.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,100.42,,,100.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,100.42,,,100.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,100.42,,,100.42,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1569 - GAMMAGARD LIQUID INJECTION,J1569,HCPCS,,,JZ,Outpatient,500,ME,285.3,71.325,44.15,242.51,,,,,,,,56.73,,,56.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,56.34,,,56.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.39,,,73.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,187.16,Percent of Total Billed Charges, ,56.73,,,56.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,199.71,Percent of Total Billed Charges, ,,85,,242.51,Percent of Total Billed Charges, ,46.46,,,46.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,194,Percent of Total Billed Charges,0,44.15,,,44.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,171.18,Percent of Total Billed Charges, ,72.63,,,72.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.73,,,56.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.89,,,48.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.37,,,49.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.71,,,47.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.24,,,47.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.71,,,47.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.66,,,48.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.48,,,49.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1569 - GAMMAGARD LIQUID INJECTION,J1569,HCPCS,,,JA,Outpatient,500,ME,231.9,57.975,44.15,197.12,,,,,,,,56.73,,,56.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,56.34,,,56.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.39,,,73.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,152.13,Percent of Total Billed Charges, ,56.73,,,56.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,162.33,Percent of Total Billed Charges, ,,85,,197.12,Percent of Total Billed Charges, ,46.46,,,46.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,157.69,Percent of Total Billed Charges,0,44.15,,,44.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,139.14,Percent of Total Billed Charges, ,72.63,,,72.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.73,,,56.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.89,,,48.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.37,,,49.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.71,,,47.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.24,,,47.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.71,,,47.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.66,,,48.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.48,,,49.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1569 - GAMMAGARD LIQUID INJECTION,J1569,HCPCS,,,GA,Outpatient,500,ME,316.78,79.195,44.15,269.26,,,,,,,,56.73,,,56.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,56.34,,,56.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.39,,,73.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,207.81,Percent of Total Billed Charges, ,56.73,,,56.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,221.75,Percent of Total Billed Charges, ,,85,,269.26,Percent of Total Billed Charges, ,46.46,,,46.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,215.41,Percent of Total Billed Charges,0,44.15,,,44.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,190.07,Percent of Total Billed Charges, ,72.63,,,72.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.73,,,56.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.89,,,48.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.37,,,49.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.71,,,47.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.24,,,47.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.71,,,47.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.66,,,48.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.48,,,49.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,94,,,94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1610 - GLUCAGON HYDROCHLORIDE-1 MG,J1610,HCPCS,,,JZ,Outpatient,1,ME,638.46,159.615,114.49,542.69,,,,,,,,219.52,,,219.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.83,,,236.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,284.01,,,284.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,418.83,Percent of Total Billed Charges, ,219.52,,,219.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,446.92,Percent of Total Billed Charges, ,,85,,542.69,Percent of Total Billed Charges, ,184.18,,,184.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,434.15,Percent of Total Billed Charges,0,188.37,,,188.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,383.08,Percent of Total Billed Charges, ,281.1,,,281.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,219.52,,,219.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,189.23,,,189.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,191.06,,,191.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,184.66,,,184.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.83,,,182.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,184.66,,,184.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.31,,,188.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,191.51,,,191.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,114.49,,,114.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.49,,,114.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.49,,,114.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.49,,,114.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1610 - GLUCAGON HYDROCHLORIDE-1 MG,J1610,HCPCS,,,JG,Outpatient,1,ME,1103.75,275.9375,114.49,938.19,,,,,,,,219.52,,,219.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.83,,,236.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,284.01,,,284.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,724.06,Percent of Total Billed Charges, ,219.52,,,219.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,772.63,Percent of Total Billed Charges, ,,85,,938.19,Percent of Total Billed Charges, ,184.18,,,184.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,750.55,Percent of Total Billed Charges,0,188.37,,,188.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,662.25,Percent of Total Billed Charges, ,281.1,,,281.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,219.52,,,219.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,189.23,,,189.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,191.06,,,191.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,184.66,,,184.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.83,,,182.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,184.66,,,184.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.31,,,188.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,191.51,,,191.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,114.49,,,114.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.49,,,114.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.49,,,114.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,114.49,,,114.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1611 - INJ GLUCAGON HCL FRESENIUS,J1611,HCPCS,,,JZ,Outpatient,1,ME,551.65,137.9125,103.56,481.17,,,,,,,,124.34,,,124.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,162.09,,,162.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,160.86,,,160.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,361.88,Percent of Total Billed Charges, ,124.34,,,124.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,386.16,Percent of Total Billed Charges, ,,85,,468.9,Percent of Total Billed Charges, ,111.91,,,111.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,375.12,Percent of Total Billed Charges,0,123.83,,,123.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,330.99,Percent of Total Billed Charges, ,159.22,,,159.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.34,,,124.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,107.18,,,107.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,108.22,,,108.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.6,,,104.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,103.56,,,103.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.6,,,104.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,106.67,,,106.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,108.48,,,108.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,481.17,,,481.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.17,,,481.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.17,,,481.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,481.17,,,481.17,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1643 - INJ HEPARIN PFIZER 1000U,J1643,HCPCS,,,JG,Outpatient,1000,UN,2.07,0.5175,0.01,4.58,,,,,,,,4.26,,,4.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.28,,,4.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.36,Percent of Total Billed Charges, ,4.26,,,4.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.45,Percent of Total Billed Charges, ,,85,,1.76,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,1.41,Percent of Total Billed Charges,0,4.58,,,4.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.24,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.26,,,4.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.62,,,0.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.62,,,0.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.62,,,0.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.62,,,0.62,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1644 - INJ HEPARIN SODIUM PER 1000U,J1644,HCPCS,,,KQ,Outpatient,1000,UN,28.1,7.025,0.01,23.89,,,,,,,,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.29,,,0.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18.43,Percent of Total Billed Charges, ,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19.67,Percent of Total Billed Charges, ,,85,,23.89,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19.11,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,16.86,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1644 - INJ HEPARIN SODIUM PER 1000U,J1644,HCPCS,,,KP,Outpatient,1000,UN,3.78,0.945,0.01,6.89,,,,,,,,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.29,,,0.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.48,Percent of Total Billed Charges, ,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.65,Percent of Total Billed Charges, ,,85,,3.21,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2.57,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.27,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1644 - INJ HEPARIN SODIUM PER 1000U,J1644,HCPCS,,,AY,Outpatient,1000,UN,2.19,0.5475,0.01,6.89,,,,,,,,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.29,,,0.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.44,Percent of Total Billed Charges, ,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.53,Percent of Total Billed Charges, ,,85,,1.86,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1.49,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.31,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.89,,,6.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1670 - TETANUS IMMUNE GLOBULIN INJ,J1670,HCPCS,,,JZ,Outpatient,250,UN,3365.3,841.325,33.92,2860.51,,,,,,,,664.1,,,664.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,706.15,,,706.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,859.2,,,859.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2207.64,Percent of Total Billed Charges, ,664.1,,,664.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2355.71,Percent of Total Billed Charges, ,,85,,2860.51,Percent of Total Billed Charges, ,572.07,,,572.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2288.4,Percent of Total Billed Charges,0,578.61,,,578.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2019.18,Percent of Total Billed Charges, ,850.42,,,850.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.1,,,664.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,572.48,,,572.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,578.01,,,578.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,558.65,,,558.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,553.12,,,553.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,558.65,,,558.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,569.71,,,569.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,579.39,,,579.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.92,,,33.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.92,,,33.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.92,,,33.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.92,,,33.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1740 - IBANDRONATE SODIUM INJECTION,J1740,HCPCS,,,JZ,Outpatient,1,ME,293.35,73.3375,0.01,412.38,,,,,,,,30.98,,,30.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.9,,,35.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,192.44,Percent of Total Billed Charges, ,30.98,,,30.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,205.35,Percent of Total Billed Charges, ,,85,,249.35,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,199.48,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,176.01,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.98,,,30.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,412.38,,,412.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,412.38,,,412.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,412.38,,,412.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,412.38,,,412.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1745 - INFLIXIMAB NOT BIOSIMIL 10MG,J1745,HCPCS,,,JZ,Outpatient,10,ME,437.09,109.2725,30.53,371.53,,,,,,,,36.78,,,36.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.64,,,39.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,47.59,,,47.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,286.73,Percent of Total Billed Charges, ,36.78,,,36.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,305.96,Percent of Total Billed Charges, ,,85,,371.53,Percent of Total Billed Charges, ,30.53,,,30.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,297.22,Percent of Total Billed Charges,0,32.16,,,32.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,262.25,Percent of Total Billed Charges, ,47.11,,,47.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.78,,,36.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.71,,,31.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.02,,,32.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.95,,,30.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.64,,,30.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.95,,,30.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.56,,,31.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.1,,,32.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.13,,,195.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,195.13,,,195.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,195.13,,,195.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,195.13,,,195.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1750 - INJ IRON DEXTRAN,J1750,HCPCS,,,JZ,Outpatient,50,ME,37.99,9.4975,16.8,36.38,,,,,,,,20.17,,,20.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.49,,,22.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.09,,,26.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24.92,Percent of Total Billed Charges, ,20.17,,,20.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26.59,Percent of Total Billed Charges, ,,85,,32.29,Percent of Total Billed Charges, ,17.4,,,17.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25.83,Percent of Total Billed Charges,0,17.32,,,17.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,22.79,Percent of Total Billed Charges, ,25.83,,,25.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.17,,,20.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.39,,,17.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.56,,,17.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.97,,,16.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.8,,,16.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.97,,,16.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.3,,,17.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.6,,,17.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1750 - INJ IRON DEXTRAN,J1750,HCPCS,,,JW,Outpatient,50,ME,25.76,6.44,15.46,36.38,,,,,,,,20.17,,,20.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.49,,,22.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.09,,,26.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16.9,Percent of Total Billed Charges, ,20.17,,,20.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18.03,Percent of Total Billed Charges, ,,85,,21.9,Percent of Total Billed Charges, ,17.4,,,17.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17.52,Percent of Total Billed Charges,0,17.32,,,17.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,15.46,Percent of Total Billed Charges, ,25.83,,,25.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.17,,,20.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.39,,,17.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.56,,,17.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.97,,,16.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.8,,,16.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.97,,,16.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.3,,,17.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.6,,,17.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1750 - INJ IRON DEXTRAN,J1750,HCPCS,,,JG,Outpatient,50,ME,26.52,6.63,15.91,36.38,,,,,,,,20.17,,,20.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.49,,,22.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.09,,,26.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17.4,Percent of Total Billed Charges, ,20.17,,,20.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18.56,Percent of Total Billed Charges, ,,85,,22.54,Percent of Total Billed Charges, ,17.4,,,17.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,18.03,Percent of Total Billed Charges,0,17.32,,,17.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,15.91,Percent of Total Billed Charges, ,25.83,,,25.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.17,,,20.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.39,,,17.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.56,,,17.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.97,,,16.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.8,,,16.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.97,,,16.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.3,,,17.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.6,,,17.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,36.38,,,36.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1756 - IRON SUCROSE INJECTION,J1756,HCPCS,,,GZ,Outpatient,1,ME,0.25,0.0625,0.01,0.83,,,,,,,,0.26,,,0.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.29,,,0.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.16,Percent of Total Billed Charges, ,0.26,,,0.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.18,Percent of Total Billed Charges, ,,85,,0.21,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,0.17,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.15,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.26,,,0.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.83,,,0.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.83,,,0.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.83,,,0.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.83,,,0.83,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1805 - INJ ESMOLOL HCL 10MGG             I,J1805,HCPCS,,,JG,Outpatient,10,ME,2.99,0.7475,0.01,2.54,,,,,,,,0.22,,,0.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.33,,,0.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.96,Percent of Total Billed Charges, ,0.22,,,0.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.09,Percent of Total Billed Charges, ,,85,,2.54,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,2.03,Percent of Total Billed Charges,0,0.26,,,0.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.79,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.22,,,0.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.74,,,0.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.74,,,0.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.74,,,0.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1806 - INJ ESMOLOL HCL WG CRIT CARE      I,J1806,HCPCS,,,JG,Outpatient,10,ME,1.35,0.3375,0.01,1.46,,,,,,,,0.41,,,0.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.5,,,0.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.89,Percent of Total Billed Charges, ,0.41,,,0.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.95,Percent of Total Billed Charges, ,,85,,1.15,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,0.92,Percent of Total Billed Charges,0,0.45,,,0.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.81,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.41,,,0.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.46,,,1.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.46,,,1.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.46,,,1.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.46,,,1.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1815 - INSULIN INJECTION,J1815,HCPCS,,,GZ,Outpatient,,,3.9,0.975,0.01,9.59,,,,,,,,1.09,,,1.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.29,,,0.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.56,Percent of Total Billed Charges, ,1.09,,,1.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.73,Percent of Total Billed Charges, ,,85,,3.32,Percent of Total Billed Charges, ,,,,,,,,67.9,,2.65,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.34,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.09,,,1.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.59,,,9.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.59,,,9.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.59,,,9.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.59,,,9.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1836 - INJ METRONIDAZOLE 10 MGG          I,J1836,HCPCS,,,JG,Outpatient,10,ME,0.1,0.025,0.01,0.09,,,,,,,,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.07,Percent of Total Billed Charges, ,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.07,Percent of Total Billed Charges, ,,85,,0.09,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.07,Percent of Total Billed Charges,0,0.02,,,0.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.06,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.06,,,0.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.06,,,0.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.06,,,0.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.06,,,0.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1920 - INJ LABETALOL HCL 5MGG            I,J1920,HCPCS,,,JG,Outpatient,5,ME,0.5,0.125,0.01,0.71,,,,,,,,0.31,,,0.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.21,,,0.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.33,Percent of Total Billed Charges, ,0.31,,,0.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.35,Percent of Total Billed Charges, ,,85,,0.43,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,0.34,Percent of Total Billed Charges,0,0.19,,,0.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.3,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.31,,,0.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.71,,,0.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.71,,,0.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.71,,,0.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.71,,,0.71,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1921 - INJ LABETALOL HCL HIKMA 5MG       I,J1921,HCPCS,,,JG,Outpatient,5,ME,0.58,0.145,0.01,3.68,,,,,,,,1.86,,,1.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.66,,,2.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.38,Percent of Total Billed Charges, ,1.86,,,1.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.41,Percent of Total Billed Charges, ,,85,,0.49,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.2,,0.39,Percent of Total Billed Charges,0,2.56,,,2.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.35,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.86,,,1.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.68,,,3.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.68,,,3.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.68,,,3.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.68,,,3.68,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1930 - LANREOTIDE INJECTION,J1930,HCPCS,,,JZ,Outpatient,1,ME,292.06,73.015,44.98,248.25,,,,,,,,57.05,,,57.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.54,,,62.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.81,,,73.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,191.59,Percent of Total Billed Charges, ,57.05,,,57.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,204.44,Percent of Total Billed Charges, ,,85,,248.25,Percent of Total Billed Charges, ,44.98,,,44.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.6,Percent of Total Billed Charges,0,48.44,,,48.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,175.24,Percent of Total Billed Charges, ,73.05,,,73.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.05,,,57.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,49.17,,,49.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.65,,,49.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.99,,,47.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.51,,,47.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.99,,,47.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.94,,,48.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.77,,,49.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.05,,,87.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,87.05,,,87.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,87.05,,,87.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,87.05,,,87.05,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1931 - LARONIDASE INJECTION,J1931,HCPCS,,,JZ,Outpatient,0.1,ME,52.38,13.095,31.43,67.54,,,,,,,,44.18,,,44.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.29,,,48.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,57.14,,,57.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.36,Percent of Total Billed Charges, ,44.18,,,44.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,36.67,Percent of Total Billed Charges, ,,85,,44.52,Percent of Total Billed Charges, ,38.62,,,38.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,35.62,Percent of Total Billed Charges,0,37.44,,,37.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,31.43,Percent of Total Billed Charges, ,56.56,,,56.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.18,,,44.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38.08,,,38.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.45,,,38.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.16,,,37.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.79,,,36.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.16,,,37.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.89,,,37.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.54,,,38.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.54,,,67.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.54,,,67.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.54,,,67.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,67.54,,,67.54,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1932 - INJ LANREOTIDE (CIPLA) 1MG,J1932,HCPCS,,,JZ,Outpatient,1,ME,350.93,87.7325,30.68,298.29,,,,,,,,42.01,,,42.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.93,,,52.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.35,,,54.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,230.21,Percent of Total Billed Charges, ,42.01,,,42.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,245.65,Percent of Total Billed Charges, ,,85,,298.29,Percent of Total Billed Charges, ,30.68,,,30.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,238.63,Percent of Total Billed Charges,0,48.78,,,48.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,210.56,Percent of Total Billed Charges, ,53.8,,,53.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.01,,,42.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.21,,,36.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.56,,,36.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.34,,,35.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.99,,,34.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.34,,,35.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.04,,,36.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.65,,,36.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,180.84,,,180.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,180.84,,,180.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,180.84,,,180.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,180.84,,,180.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1940 - FUROSEMIDE INJECTION,J1940,HCPCS,,,AY,Outpatient,20,ME,0.31,0.0775,0.01,10.9,,,,,,,,0.45,,,0.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.55,,,0.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.2,Percent of Total Billed Charges, ,0.45,,,0.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.22,Percent of Total Billed Charges, ,,85,,0.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.7,,0.21,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.19,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.45,,,0.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.9,,,10.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.9,,,10.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.9,,,10.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.9,,,10.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J1950 - LEUPROLIDE ACETATE -3.75 MG,J1950,HCPCS,,,JZ,Outpatient,3.75,ME,8892.42,2223.105,1179.21,7558.56,,,,,,,,1846.56,,,1846.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2092.41,,,2092.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2389.04,,,2389.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5833.43,Percent of Total Billed Charges, ,1846.56,,,1846.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6224.69,Percent of Total Billed Charges, ,,85,,7558.56,Percent of Total Billed Charges, ,1666.78,,,1666.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6046.85,Percent of Total Billed Charges,0,1564.6,,,1564.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,5335.45,Percent of Total Billed Charges, ,2364.61,,,2364.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1846.56,,,1846.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1591.79,,,1591.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1607.17,,,1607.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1553.34,,,1553.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1537.96,,,1537.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1553.34,,,1553.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1584.1,,,1584.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1611.01,,,1611.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1179.21,,,1179.21,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1179.21,,,1179.21,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1179.21,,,1179.21,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1179.21,,,1179.21,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2001 - LIDOCAINE INJECTION,J2001,HCPCS,,,JW,Outpatient,,,0.98,0.245,0.01,2.61,,,,,,,,,,,,,,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.64,Percent of Total Billed Charges, ,,,,,,,,70,,0.69,Percent of Total Billed Charges, ,,85,,0.83,Percent of Total Billed Charges, ,,,,,,,,68.4,,0.67,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.59,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.61,,,2.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.61,,,2.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.61,,,2.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.61,,,2.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2001 - LIDOCAINE INJECTION,J2001,HCPCS,,,AY,Outpatient,,,0.63,0.1575,0.01,2.61,,,,,,,,,,,,,,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.41,Percent of Total Billed Charges, ,,,,,,,,70,,0.44,Percent of Total Billed Charges, ,,85,,0.54,Percent of Total Billed Charges, ,,,,,,,,68.3,,0.43,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.38,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.61,,,2.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.61,,,2.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.61,,,2.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.61,,,2.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2003 - INJ LIDOCAINE HCL 1 MGG           I,J2003,HCPCS,,,AY,Outpatient,,,0.05,0.0125,0.01,0.04,,,,,,,,0.01,,,0.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.03,Percent of Total Billed Charges, ,0.01,,,0.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.04,Percent of Total Billed Charges, ,,85,,0.04,Percent of Total Billed Charges, ,,,,,,,,60,,0.03,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,0.03,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.01,,,0.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J2182 - INJECTION MEPOLIZUMAB 1MG,J2182,HCPCS,,,JG,Outpatient,1,ME,72.36,18.09,28.94,90.67,,,,,,,,34.74,,,34.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38.08,,,38.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,44.95,,,44.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,47.47,Percent of Total Billed Charges, ,34.74,,,34.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,50.65,Percent of Total Billed Charges, ,,85,,61.51,Percent of Total Billed Charges, ,30.69,,,30.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,49.2,Percent of Total Billed Charges,0,30.51,,,30.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,43.42,Percent of Total Billed Charges, ,44.5,,,44.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.74,,,34.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,29.95,,,29.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.24,,,30.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.23,,,29.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.94,,,28.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.23,,,29.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.81,,,29.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.31,,,30.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.67,,,90.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.67,,,90.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.67,,,90.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.67,,,90.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2212 - METHYLNALTREXONE INJECTION,J2212,HCPCS,,,JG,Outpatient,,,5.13,1.2825,0.01,4.36,,,,,,,,1.47,,,1.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.7,,,1.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.37,Percent of Total Billed Charges, ,1.47,,,1.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.59,Percent of Total Billed Charges, ,,85,,4.36,Percent of Total Billed Charges, ,,,,,,,,68,,3.49,Percent of Total Billed Charges,0,1.2,,,1.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.08,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.47,,,1.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J2251 - INJ MIDAZOLAM IN 0.9PERCENT NACL  I,J2251,HCPCS,,,JG,Outpatient,1,ME,0.85,0.2125,0.01,0.92,,,,,,,,0.2,,,0.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.26,,,0.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.56,Percent of Total Billed Charges, ,0.2,,,0.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.6,Percent of Total Billed Charges, ,,85,,0.72,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.2,,0.58,Percent of Total Billed Charges,0,0.28,,,0.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.51,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.2,,,0.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.92,,,0.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.92,,,0.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.92,,,0.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.92,,,0.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2272 - INJ MORPHINE (FRESENIUS),J2272,HCPCS,,,JG,Outpatient,10,ME,6.91,1.7275,0.01,22.13,,,,,,,,5.79,,,5.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.69,,,5.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.53,Percent of Total Billed Charges, ,5.79,,,5.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4.84,Percent of Total Billed Charges, ,,85,,5.87,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4.7,Percent of Total Billed Charges,0,7.43,,,7.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.15,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.79,,,5.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.13,,,22.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.13,,,22.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.13,,,22.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,22.13,,,22.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2305 - INJ NITROGLYCERIN 5 MGG           I,J2305,HCPCS,,,JG,Outpatient,5,ME,6.68,1.67,0.01,5.68,,,,,,,,1.61,,,1.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.68,,,1.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.38,Percent of Total Billed Charges, ,1.61,,,1.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4.68,Percent of Total Billed Charges, ,,85,,5.68,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4.54,Percent of Total Billed Charges,0,1.29,,,1.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.01,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.61,,,1.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.86,,,3.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.86,,,3.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.86,,,3.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.86,,,3.86,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2323 - NATALIZUMAB INJECTION,J2323,HCPCS,,,JZ,Outpatient,1,ME,105.78,26.445,0.01,89.91,,,,,,,,27.58,,,27.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.09,,,30.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.68,,,35.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,69.39,Percent of Total Billed Charges, ,27.58,,,27.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,74.05,Percent of Total Billed Charges, ,,85,,89.91,Percent of Total Billed Charges, ,23.88,,,23.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,71.93,Percent of Total Billed Charges,0,24.45,,,24.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,63.47,Percent of Total Billed Charges, ,35.3,,,35.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.58,,,27.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.76,,,23.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.99,,,23.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.19,,,23.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.96,,,22.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.19,,,23.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.65,,,23.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.05,,,24.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2327 - INJ RISANKIZUMAB-RZAA 1 MG,J2327,HCPCS,,,TB,Outpatient,1,ME,84.72,21.18,13.91,72.01,,,,,,,,16.7,,,16.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.74,,,18.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.61,,,21.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,55.58,Percent of Total Billed Charges, ,16.7,,,16.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,59.3,Percent of Total Billed Charges, ,,85,,72.01,Percent of Total Billed Charges, ,15.08,,,15.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,57.61,Percent of Total Billed Charges,0,15.36,,,15.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,50.83,Percent of Total Billed Charges, ,21.39,,,21.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.7,,,16.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.4,,,14.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.54,,,14.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.05,,,14.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.91,,,13.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.05,,,14.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.33,,,14.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.57,,,14.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2327 - INJ RISANKIZUMAB-RZAA 1 MG,J2327,HCPCS,,,JZ,Outpatient,1,ME,84.72,21.18,13.91,72.01,,,,,,,,16.7,,,16.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.74,,,18.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.61,,,21.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,55.58,Percent of Total Billed Charges, ,16.7,,,16.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,59.3,Percent of Total Billed Charges, ,,85,,72.01,Percent of Total Billed Charges, ,15.08,,,15.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,57.61,Percent of Total Billed Charges,0,15.36,,,15.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,50.83,Percent of Total Billed Charges, ,21.39,,,21.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.7,,,16.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.4,,,14.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.54,,,14.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.05,,,14.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.91,,,13.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.05,,,14.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.33,,,14.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.57,,,14.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2327 - INJ RISANKIZUMAB-RZAA 1 MG,J2327,HCPCS,,,JG,Outpatient,1,ME,84.72,21.18,13.91,72.01,,,,,,,,16.7,,,16.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.74,,,18.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.61,,,21.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,55.58,Percent of Total Billed Charges, ,16.7,,,16.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,59.3,Percent of Total Billed Charges, ,,85,,72.01,Percent of Total Billed Charges, ,15.08,,,15.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,57.61,Percent of Total Billed Charges,0,15.36,,,15.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,50.83,Percent of Total Billed Charges, ,21.39,,,21.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.7,,,16.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.4,,,14.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.54,,,14.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.05,,,14.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.91,,,13.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.05,,,14.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.33,,,14.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.57,,,14.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,46.96,,,46.96,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2350 - INJECTION OCRELIZUMAB 1 MG,J2350,HCPCS,,,JZ,Outpatient,1,ME,253.57,63.3925,56.85,215.53,,,,,,,,68.26,,,68.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,75.31,,,75.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,88.31,,,88.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,166.34,Percent of Total Billed Charges, ,68.26,,,68.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,177.5,Percent of Total Billed Charges, ,,85,,215.53,Percent of Total Billed Charges, ,58.77,,,58.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,172.43,Percent of Total Billed Charges,0,59.75,,,59.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,152.14,Percent of Total Billed Charges, ,87.41,,,87.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.26,,,68.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.84,,,58.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.41,,,59.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.42,,,57.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.85,,,56.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.42,,,57.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.56,,,58.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.55,,,59.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.53,,,169.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,169.53,,,169.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,169.53,,,169.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,169.53,,,169.53,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2353 - OCTREOTIDE INJECTION DEPOT,J2353,HCPCS,,,JZ,Outpatient,1,ME,275.97,68.9925,165.58,317.35,,,,,,,,245.29,,,245.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,269.35,,,269.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,317.35,,,317.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,181.04,Percent of Total Billed Charges, ,245.29,,,245.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,193.18,Percent of Total Billed Charges, ,,85,,234.57,Percent of Total Billed Charges, ,218.37,,,218.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,187.66,Percent of Total Billed Charges,0,210.83,,,210.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,165.58,Percent of Total Billed Charges, ,314.11,,,314.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,245.29,,,245.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,211.45,,,211.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,213.49,,,213.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.34,,,206.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,204.3,,,204.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,206.34,,,206.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,210.43,,,210.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,214,,,214,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,211.14,,,211.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,211.14,,,211.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,211.14,,,211.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,211.14,,,211.14,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2354 - OCTREOTIDE INJ NON-DEPOT,J2354,HCPCS,,,JB,Outpatient,25,GR,6.93,1.7325,0.01,11.32,,,,,,,,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.55,Percent of Total Billed Charges, ,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4.85,Percent of Total Billed Charges, ,,85,,5.89,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4.71,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.16,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2354 - OCTREOTIDE INJ NON-DEPOT,J2354,HCPCS,,,JA,Outpatient,25,GR,7.7,1.925,0.01,11.32,,,,,,,,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5.05,Percent of Total Billed Charges, ,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5.39,Percent of Total Billed Charges, ,,85,,6.55,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,5.24,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.62,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,11.32,,,11.32,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2356 - INJ TEZEPELUMAB-EKKO 1MG,J2356,HCPCS,,,TB,Outpatient,1,ME,42.17,10.5425,17.22,58.57,,,,,,,,20.67,,,20.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.8,,,22.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.74,,,26.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.66,Percent of Total Billed Charges, ,20.67,,,20.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.52,Percent of Total Billed Charges, ,,85,,35.84,Percent of Total Billed Charges, ,18.16,,,18.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.68,Percent of Total Billed Charges,0,18.59,,,18.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,25.3,Percent of Total Billed Charges, ,26.48,,,26.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.67,,,20.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.99,,,17.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.39,,,17.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.39,,,17.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.74,,,17.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.04,,,18.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.57,,,58.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,58.57,,,58.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,58.57,,,58.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,58.57,,,58.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2356 - INJ TEZEPELUMAB-EKKO 1MG,J2356,HCPCS,,,JZ,Outpatient,1,ME,44.48,11.12,17.22,58.57,,,,,,,,20.67,,,20.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.8,,,22.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.74,,,26.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29.18,Percent of Total Billed Charges, ,20.67,,,20.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31.14,Percent of Total Billed Charges, ,,85,,37.81,Percent of Total Billed Charges, ,18.16,,,18.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30.25,Percent of Total Billed Charges,0,18.59,,,18.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,26.69,Percent of Total Billed Charges, ,26.48,,,26.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.67,,,20.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.82,,,17.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.99,,,17.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.39,,,17.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.22,,,17.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.39,,,17.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.74,,,17.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.04,,,18.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.57,,,58.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,58.57,,,58.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,58.57,,,58.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,58.57,,,58.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2359 - INJ. OLANZAPINE 0.5MG             I,J2359,HCPCS,,,JG,Outpatient,0.5,ME,5.27,1.3175,0.01,4.48,,,,,,,,1.05,,,1.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.23,,,1.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.46,Percent of Total Billed Charges, ,1.05,,,1.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.69,Percent of Total Billed Charges, ,,85,,4.48,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,3.58,Percent of Total Billed Charges,0,0.95,,,0.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.16,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.05,,,1.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.64,,,2.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.64,,,2.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.64,,,2.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.64,,,2.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2360 - ORPHENADRINE INJECTION,J2360,HCPCS,,,AY,Outpatient,60,ME,80.9,20.225,0.01,68.77,,,,,,,,10.03,,,10.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.36,,,11.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,53.07,Percent of Total Billed Charges, ,10.03,,,10.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,56.63,Percent of Total Billed Charges, ,,85,,68.77,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,55.01,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,48.54,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.03,,,10.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.25,,,19.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.25,,,19.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.25,,,19.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.25,,,19.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2401 - CHLOROPROCAINE HCL INJECTION,J2401,HCPCS,,,JG,Outpatient,1,ME,0.11,0.0275,0.01,0.12,,,,,,,,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.07,Percent of Total Billed Charges, ,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.08,Percent of Total Billed Charges, ,,85,,0.09,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,63.6,,0.07,Percent of Total Billed Charges,0,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.07,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.03,,,0.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.12,,,0.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.12,,,0.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.12,,,0.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.12,,,0.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2407 - INJECTION ORITAVANCIN,J2407,HCPCS,,,JZ,Outpatient,10,ME,150.44,37.61,27.06,127.87,,,,,,,,32.48,,,32.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.15,,,35.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.02,,,42.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.69,Percent of Total Billed Charges, ,32.48,,,32.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105.31,Percent of Total Billed Charges, ,,85,,127.87,Percent of Total Billed Charges, ,28.53,,,28.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,102.3,Percent of Total Billed Charges,0,27.6,,,27.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,90.26,Percent of Total Billed Charges, ,41.6,,,41.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.48,,,32.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.01,,,28.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.28,,,28.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.33,,,27.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.06,,,27.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.33,,,27.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.87,,,27.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.35,,,28.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.09,,,76.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,76.09,,,76.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,76.09,,,76.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,76.09,,,76.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2426 - INJ INVEGA SUSTENNA 1 MGG         I,J2426,HCPCS,,,JZ,Outpatient,1,ME,,,14.03,21.8,,,,,,,,16.85,,,16.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.33,,,18.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.8,,,21.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,16.85,,,16.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,14.73,,,14.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,14.32,,,14.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,,,,,,21.57,,,21.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.85,,,16.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,14.52,,,14.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.66,,,14.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.17,,,14.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.03,,,14.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.17,,,14.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.45,,,14.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.7,,,14.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.5,,,21.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.5,,,21.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.5,,,21.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,21.5,,,21.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2506 - INJ PEGFILGRAST EX BIO 0.5MG,J2506,HCPCS,,,JZ,Outpatient,0.5,ME,1851.29,462.8225,19.98,1573.6,,,,,,,,62.93,,,62.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.91,,,68.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46,,,46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1214.45,Percent of Total Billed Charges, ,62.93,,,62.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1295.9,Percent of Total Billed Charges, ,,85,,1573.6,Percent of Total Billed Charges, ,19.98,,,19.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1258.88,Percent of Total Billed Charges,0,50.68,,,50.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1110.77,Percent of Total Billed Charges, ,45.53,,,45.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.93,,,62.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.65,,,30.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.94,,,30.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.91,,,29.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.61,,,29.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.91,,,29.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.5,,,30.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.02,,,31.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,540.63,,,540.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.63,,,540.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.63,,,540.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.63,,,540.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2506 - INJ PEGFILGRAST EX BIO 0.5MG,J2506,HCPCS,,,JG,Outpatient,0.5,ME,1426.32,356.58,19.98,1212.37,,,,,,,,62.93,,,62.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,68.91,,,68.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46,,,46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,935.67,Percent of Total Billed Charges, ,62.93,,,62.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,998.42,Percent of Total Billed Charges, ,,85,,1212.37,Percent of Total Billed Charges, ,19.98,,,19.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,969.9,Percent of Total Billed Charges,0,50.68,,,50.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,855.79,Percent of Total Billed Charges, ,45.53,,,45.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.93,,,62.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.65,,,30.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.94,,,30.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.91,,,29.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.61,,,29.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.91,,,29.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.5,,,30.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.02,,,31.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,540.63,,,540.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.63,,,540.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.63,,,540.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,540.63,,,540.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2597 - INJ DESMOPRESSIN ACETATE,J2597,HCPCS,,,JW,Outpatient,1,GR,14.73,3.6825,4.95,66.85,,,,,,,,6.18,,,6.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.95,,,6.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8,,,8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.66,Percent of Total Billed Charges, ,6.18,,,6.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.31,Percent of Total Billed Charges, ,,85,,12.52,Percent of Total Billed Charges, ,4.95,,,4.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.02,Percent of Total Billed Charges,0,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,8.84,Percent of Total Billed Charges, ,7.92,,,7.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.18,,,6.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.33,,,5.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.38,,,5.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.2,,,5.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.15,,,5.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.2,,,5.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.3,,,5.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.39,,,5.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.85,,,66.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,66.85,,,66.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,66.85,,,66.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,66.85,,,66.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2597 - INJ DESMOPRESSIN ACETATE,J2597,HCPCS,,,JG,Outpatient,1,GR,44.54,11.135,4.95,66.85,,,,,,,,6.18,,,6.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.95,,,6.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8,,,8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29.22,Percent of Total Billed Charges, ,6.18,,,6.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31.18,Percent of Total Billed Charges, ,,85,,37.86,Percent of Total Billed Charges, ,4.95,,,4.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30.29,Percent of Total Billed Charges,0,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,26.72,Percent of Total Billed Charges, ,7.92,,,7.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.18,,,6.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.33,,,5.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.38,,,5.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.2,,,5.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.15,,,5.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.2,,,5.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.3,,,5.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.39,,,5.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.85,,,66.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,66.85,,,66.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,66.85,,,66.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,66.85,,,66.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2598 - INJ VASOPRESSIN 1 UNITT           I,J2598,HCPCS,,,JG,Outpatient,1,UN,10.51,2.6275,0.01,8.93,,,,,,,,1.85,,,1.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.41,,,2.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.89,Percent of Total Billed Charges, ,1.85,,,1.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7.36,Percent of Total Billed Charges, ,,85,,8.93,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7.15,Percent of Total Billed Charges,0,1.82,,,1.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6.31,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.85,,,1.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.67,,,8.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,8.67,,,8.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,8.67,,,8.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,8.67,,,8.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2599 - INJ VASOPRESSIN (AM REG) 1 U      I,J2599,HCPCS,,,JG,Outpatient,1,UN,9.23,2.3075,0.01,7.85,,,,,,,,1.52,,,1.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.96,,,1.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.05,Percent of Total Billed Charges, ,1.52,,,1.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6.46,Percent of Total Billed Charges, ,,85,,7.85,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6.28,Percent of Total Billed Charges,0,0.46,,,0.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,5.54,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.52,,,1.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2720 - INJ PROTAMINE SULFATE-10 MG,J2720,HCPCS,,,AY,Outpatient,10,ME,6.21,1.5525,0.01,16.81,,,,,,,,1.23,,,1.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.11,,,1.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.07,Percent of Total Billed Charges, ,1.23,,,1.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4.35,Percent of Total Billed Charges, ,,85,,5.28,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4.22,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.73,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.23,,,1.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.81,,,16.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2760 - PHENTOLAINE MESYLATE INJ,J2760,HCPCS,,,JZ,Outpatient,5,ME,337.35,84.3375,81.29,542.19,,,,,,,,419.07,,,419.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,499.16,,,499.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,542.19,,,542.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,221.3,Percent of Total Billed Charges, ,419.07,,,419.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,236.15,Percent of Total Billed Charges, ,,85,,286.75,Percent of Total Billed Charges, ,394.63,,,394.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,229.4,Percent of Total Billed Charges,0,446.8,,,446.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,202.41,Percent of Total Billed Charges, ,536.65,,,536.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,419.07,,,419.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,361.26,,,361.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,364.75,,,364.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,352.53,,,352.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,349.04,,,349.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,352.53,,,352.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,359.51,,,359.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,365.62,,,365.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.29,,,81.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,81.29,,,81.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,81.29,,,81.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,81.29,,,81.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2795 - ROPIVACAINE HCL INJECTION,J2795,HCPCS,,,AY,Outpatient,1,ME,0.28,0.07,0.01,0.24,,,,,,,,0.07,,,0.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.09,,,0.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.18,Percent of Total Billed Charges, ,0.07,,,0.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.2,Percent of Total Billed Charges, ,,85,,0.24,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,0.19,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.17,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.07,,,0.07,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J2796 - ROMIPLOSTIM INJECTION,J2796,HCPCS,,,JZ,Outpatient,,,148.51,37.1275,0.01,129.49,,,,,,,,115.36,,,115.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.01,,,126.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,97.42,Percent of Total Billed Charges, ,115.36,,,115.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,103.96,Percent of Total Billed Charges, ,,85,,126.23,Percent of Total Billed Charges, ,,,,,,,,68,,100.99,Percent of Total Billed Charges,0,96.03,,,96.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,89.11,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.36,,,115.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2796 - ROMIPLOSTIM INJECTION,J2796,HCPCS,,,JW,Outpatient,,,118.28,29.57,0.01,129.49,,,,,,,,115.36,,,115.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.01,,,126.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,77.59,Percent of Total Billed Charges, ,115.36,,,115.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,82.8,Percent of Total Billed Charges, ,,85,,100.54,Percent of Total Billed Charges, ,,,,,,,,68,,80.43,Percent of Total Billed Charges,0,96.03,,,96.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,70.97,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.36,,,115.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2796 - ROMIPLOSTIM INJECTION,J2796,HCPCS,,,JG,Outpatient,,,193.3,48.325,0.01,164.31,,,,,,,,115.36,,,115.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.01,,,126.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,126.8,Percent of Total Billed Charges, ,115.36,,,115.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,135.31,Percent of Total Billed Charges, ,,85,,164.31,Percent of Total Billed Charges, ,,,,,,,,68,,131.44,Percent of Total Billed Charges,0,96.03,,,96.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,115.98,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,115.36,,,115.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,129.49,,,129.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2997 - ALTEPLASE RECOMBINANT,J2997,HCPCS,,,JZ,Outpatient,1,ME,190.66,47.665,86.96,162.06,,,,,,,,104.41,,,104.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,114.18,,,114.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.09,,,135.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,125.07,Percent of Total Billed Charges, ,104.41,,,104.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,133.46,Percent of Total Billed Charges, ,,85,,162.06,Percent of Total Billed Charges, ,91.48,,,91.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,129.65,Percent of Total Billed Charges,0,88.97,,,88.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,114.4,Percent of Total Billed Charges, ,133.7,,,133.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.41,,,104.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,90,,,90,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.87,,,90.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.83,,,87.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.96,,,86.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.83,,,87.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.57,,,89.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.09,,,91.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2997 - ALTEPLASE RECOMBINANT,J2997,HCPCS,,,JW,Outpatient,1,ME,105.85,26.4625,63.51,135.09,,,,,,,,104.41,,,104.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,114.18,,,114.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.09,,,135.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,69.44,Percent of Total Billed Charges, ,104.41,,,104.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,74.1,Percent of Total Billed Charges, ,,85,,89.97,Percent of Total Billed Charges, ,91.48,,,91.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,71.98,Percent of Total Billed Charges,0,88.97,,,88.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,63.51,Percent of Total Billed Charges, ,133.7,,,133.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.41,,,104.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,90,,,90,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.87,,,90.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.83,,,87.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.96,,,86.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.83,,,87.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.57,,,89.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.09,,,91.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J2997 - ALTEPLASE RECOMBINANT,J2997,HCPCS,,,JG,Outpatient,1,ME,157,39.25,86.96,135.09,,,,,,,,104.41,,,104.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,114.18,,,114.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,135.09,,,135.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,102.99,Percent of Total Billed Charges, ,104.41,,,104.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,109.9,Percent of Total Billed Charges, ,,85,,133.45,Percent of Total Billed Charges, ,91.48,,,91.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,106.76,Percent of Total Billed Charges,0,88.97,,,88.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,94.2,Percent of Total Billed Charges, ,133.7,,,133.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.41,,,104.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,90,,,90,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.87,,,90.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.83,,,87.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.96,,,86.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.83,,,87.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.57,,,89.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.09,,,91.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.82,,,105.82,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3010 - FENTANYL CITRATE INJECTION,J3010,HCPCS,,,JW,Outpatient,0.1,ME,0.94,0.235,0.01,10.87,,,,,,,,1.03,,,1.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.05,,,1.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.62,Percent of Total Billed Charges, ,1.03,,,1.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.66,Percent of Total Billed Charges, ,,85,,0.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,0.64,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.56,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.03,,,1.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.87,,,10.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.87,,,10.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.87,,,10.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.87,,,10.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3010 - FENTANYL CITRATE INJECTION,J3010,HCPCS,,,AY,Outpatient,0.1,ME,6.5,1.625,0.01,10.87,,,,,,,,1.03,,,1.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.05,,,1.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.26,Percent of Total Billed Charges, ,1.03,,,1.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4.55,Percent of Total Billed Charges, ,,85,,5.53,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4.42,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.9,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.03,,,1.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.87,,,10.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.87,,,10.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.87,,,10.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10.87,,,10.87,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3032 - INJ. EPTINEZUMAB-JJMR 1 MG,J3032,HCPCS,,,JZ,Outpatient,1,ME,72.63,18.1575,17.77,61.74,,,,,,,,21.34,,,21.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.33,,,23.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.6,,,27.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,47.65,Percent of Total Billed Charges, ,21.34,,,21.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,50.84,Percent of Total Billed Charges, ,,85,,61.74,Percent of Total Billed Charges, ,19.32,,,19.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,49.39,Percent of Total Billed Charges,0,18.06,,,18.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,43.58,Percent of Total Billed Charges, ,27.32,,,27.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.34,,,21.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.39,,,18.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.95,,,17.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.77,,,17.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.95,,,17.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.3,,,18.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.61,,,18.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.61,,,50.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.61,,,50.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.61,,,50.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.61,,,50.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3032 - INJ. EPTINEZUMAB-JJMR 1 MG,J3032,HCPCS,,,JW,Outpatient,1,ME,21.21,5.3025,12.73,50.61,,,,,,,,21.34,,,21.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.33,,,23.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.6,,,27.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13.91,Percent of Total Billed Charges, ,21.34,,,21.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14.85,Percent of Total Billed Charges, ,,85,,18.03,Percent of Total Billed Charges, ,19.32,,,19.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.42,Percent of Total Billed Charges,0,18.06,,,18.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,12.73,Percent of Total Billed Charges, ,27.32,,,27.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.34,,,21.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.39,,,18.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.57,,,18.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.95,,,17.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.77,,,17.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.95,,,17.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.3,,,18.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.61,,,18.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.61,,,50.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.61,,,50.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.61,,,50.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.61,,,50.61,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3101 - TENECTEPLASE INJECTION,J3101,HCPCS,,,JZ,Outpatient,1,ME,305.27,76.3175,121.95,259.48,,,,,,,,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.84,,,196.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,232.94,,,232.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,200.26,Percent of Total Billed Charges, ,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,213.69,Percent of Total Billed Charges, ,,85,,259.48,Percent of Total Billed Charges, ,162.43,,,162.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,207.58,Percent of Total Billed Charges,0,153.11,,,153.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,183.16,Percent of Total Billed Charges, ,230.55,,,230.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.2,,,155.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.7,,,156.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.45,,,151.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,149.95,,,149.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.45,,,151.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.45,,,154.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.07,,,157.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3101 - TENECTEPLASE INJECTION,J3101,HCPCS,,,JW,Outpatient,1,ME,165.21,41.3025,99.13,232.94,,,,,,,,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.84,,,196.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,232.94,,,232.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,108.38,Percent of Total Billed Charges, ,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,115.65,Percent of Total Billed Charges, ,,85,,140.43,Percent of Total Billed Charges, ,162.43,,,162.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,112.34,Percent of Total Billed Charges,0,153.11,,,153.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,99.13,Percent of Total Billed Charges, ,230.55,,,230.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.2,,,155.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.7,,,156.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.45,,,151.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,149.95,,,149.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.45,,,151.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.45,,,154.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.07,,,157.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3101 - TENECTEPLASE INJECTION,J3101,HCPCS,,,JG,Outpatient,1,ME,220.02,55.005,121.95,232.94,,,,,,,,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.84,,,196.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,232.94,,,232.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,144.33,Percent of Total Billed Charges, ,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,154.01,Percent of Total Billed Charges, ,,85,,187.02,Percent of Total Billed Charges, ,162.43,,,162.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,149.61,Percent of Total Billed Charges,0,153.11,,,153.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,132.01,Percent of Total Billed Charges, ,230.55,,,230.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.2,,,155.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.7,,,156.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.45,,,151.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,149.95,,,149.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.45,,,151.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.45,,,154.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.07,,,157.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,121.95,,,121.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3111 - INJ. ROMOSOZUMAB-AQQG 1 MG,J3111,HCPCS,,,JZ,Outpatient,1,ME,59.71,14.9275,10.62,50.75,,,,,,,,12.75,,,12.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.95,,,13.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.5,,,16.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.17,Percent of Total Billed Charges, ,12.75,,,12.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,41.8,Percent of Total Billed Charges, ,,85,,50.75,Percent of Total Billed Charges, ,11.49,,,11.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.6,Percent of Total Billed Charges,0,10.73,,,10.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,35.83,Percent of Total Billed Charges, ,16.33,,,16.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.75,,,12.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.99,,,10.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.1,,,11.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.73,,,10.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.62,,,10.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.73,,,10.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10.94,,,10.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11.12,,,11.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27,,,27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27,,,27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27,,,27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27,,,27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3240 - THYROTROPIN INJECTION,J3240,HCPCS,,,JZ,Outpatient,0.9,ME,5313.08,1328.27,1471.93,4516.12,,,,,,,,2366.74,,,2366.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2582.3,,,2582.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3062.02,,,3062.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3485.38,Percent of Total Billed Charges, ,2366.74,,,2366.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3719.16,Percent of Total Billed Charges, ,,85,,4516.12,Percent of Total Billed Charges, ,2067.91,,,2067.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3612.89,Percent of Total Billed Charges,0,2021.17,,,2021.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3187.85,Percent of Total Billed Charges, ,3030.74,,,3030.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2366.74,,,2366.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2040.2,,,2040.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2059.91,,,2059.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1990.92,,,1990.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1971.21,,,1971.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1990.92,,,1990.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2030.35,,,2030.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2064.84,,,2064.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1471.93,,,1471.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1471.93,,,1471.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1471.93,,,1471.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1471.93,,,1471.93,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3246 - TIROFIBAN HCL,J3246,HCPCS,,,JG,Outpatient,0.25,ME,24.78,6.195,0.01,23.02,,,,,,,,4.37,,,4.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.95,,,4.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16.26,Percent of Total Billed Charges, ,4.37,,,4.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17.35,Percent of Total Billed Charges, ,,85,,21.06,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,16.85,Percent of Total Billed Charges,0,4.32,,,4.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,14.87,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.37,,,4.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.02,,,23.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,23.02,,,23.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,23.02,,,23.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,23.02,,,23.02,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3358 - USTEKINUMAB IV INJECT 1 MG,J3358,HCPCS,,,JZ,Outpatient,1,ME,48.84,12.21,12.33,41.51,,,,,,,,14.81,,,14.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16.1,,,16.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.14,,,19.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,32.04,Percent of Total Billed Charges, ,14.81,,,14.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,34.19,Percent of Total Billed Charges, ,,85,,41.51,Percent of Total Billed Charges, ,12.76,,,12.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,33.21,Percent of Total Billed Charges,0,12.62,,,12.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,29.3,Percent of Total Billed Charges, ,18.96,,,18.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.81,,,14.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.76,,,12.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.88,,,12.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.45,,,12.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.33,,,12.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.45,,,12.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.7,,,12.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.92,,,12.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.16,,,38.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.16,,,38.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.16,,,38.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,38.16,,,38.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3370 - VANCOMYCIN HCL INJECTION,J3370,HCPCS,,,AY,Outpatient,500,ME,21.58,5.395,0.01,27.92,,,,,,,,2.48,,,2.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.5,,,2.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,14.16,Percent of Total Billed Charges, ,2.48,,,2.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,15.11,Percent of Total Billed Charges, ,,85,,18.34,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.67,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,12.95,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.48,,,2.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.92,,,27.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.92,,,27.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.92,,,27.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,27.92,,,27.92,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3371 - INJ VANCOMYCIN HCL (MYLAN),J3371,HCPCS,,,JG,Outpatient,500,ME,17.82,4.455,0.01,19.01,,,,,,,,6.48,,,6.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.43,,,7.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11.69,Percent of Total Billed Charges, ,6.48,,,6.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12.47,Percent of Total Billed Charges, ,,85,,15.15,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12.12,Percent of Total Billed Charges,0,5.97,,,5.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,10.69,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.48,,,6.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.01,,,19.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.01,,,19.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.01,,,19.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.01,,,19.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3372 - INJ VANCOMYCIN HCL (XELLIA),J3372,HCPCS,,,JG,Outpatient,500,ME,17.38,4.345,0.01,19.28,,,,,,,,7.33,,,7.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.1,,,8.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,11.4,Percent of Total Billed Charges, ,7.33,,,7.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,12.17,Percent of Total Billed Charges, ,,85,,14.77,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,11.82,Percent of Total Billed Charges,0,6.58,,,6.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,10.43,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.33,,,7.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.28,,,19.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.28,,,19.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.28,,,19.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.28,,,19.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3380 - INJ VEDOLIZUMAB IV 1 MG           I,J3380,HCPCS,,,JZ,Outpatient,1,ME,63.2,15.8,21.16,53.72,,,,,,,,25.41,,,25.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.6,,,28.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.88,,,32.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,41.46,Percent of Total Billed Charges, ,25.41,,,25.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,44.24,Percent of Total Billed Charges, ,,85,,53.72,Percent of Total Billed Charges, ,21.67,,,21.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,42.98,Percent of Total Billed Charges,0,22.06,,,22.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,37.92,Percent of Total Billed Charges, ,32.53,,,32.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.41,,,25.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,21.9,,,21.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.11,,,22.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.37,,,21.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.16,,,21.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.37,,,21.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.79,,,21.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.17,,,22.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.58,,,50.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.58,,,50.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.58,,,50.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.58,,,50.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J3490 - DRUGS UNCLASSIFIED INJECTION,J3490,HCPCS,,,JW,Outpatient,,,0.33,0.0825,0.01,0.28,,,,,,,,,,,,,,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.22,Percent of Total Billed Charges, ,,,,,,,,70,,0.23,Percent of Total Billed Charges, ,,85,,0.28,Percent of Total Billed Charges, ,,,,,,,,66.7,,0.22,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7030 - NORMAL SALINE SOLUTION INFUS,J7030,HCPCS,,,AY,Outpatient,1000,UN,21.23,5.3075,0.01,18.05,,,,,,,,2.93,,,2.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.36,,,3.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,13.93,Percent of Total Billed Charges, ,2.93,,,2.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,14.86,Percent of Total Billed Charges, ,,85,,18.05,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,14.44,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,12.74,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.93,,,2.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J7040 - NORMAL SALINE SOLUTION INFUS,J7040,HCPCS,,,AY,Outpatient,500,ML,26.08,6.52,0.01,22.17,,,,,,,,1.46,,,1.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.69,,,1.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17.11,Percent of Total Billed Charges, ,1.46,,,1.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18.26,Percent of Total Billed Charges, ,,85,,22.17,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17.73,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,15.65,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.46,,,1.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J7050 - NORMAL SALINE SOLUTION INFUS,J7050,HCPCS,,,GA,Outpatient,250,UN,14.7,3.675,0.01,12.5,,,,,,,,0.74,,,0.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.84,,,0.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.64,Percent of Total Billed Charges, ,0.74,,,0.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.29,Percent of Total Billed Charges, ,,85,,12.5,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,8.82,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J7050 - NORMAL SALINE SOLUTION INFUS,J7050,HCPCS,,,AY,Outpatient,250,UN,30.13,7.5325,0.01,25.61,,,,,,,,0.74,,,0.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.84,,,0.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,19.77,Percent of Total Billed Charges, ,0.74,,,0.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,21.09,Percent of Total Billed Charges, ,,85,,25.61,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,20.49,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,18.08,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J7060 - 5PERCENT DEXTROSE-WATER,J7060,HCPCS,,,AY,Outpatient,500,ML,0.5,0.125,0.01,2.1,,,,,,,,2.08,,,2.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.1,,,2.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.33,Percent of Total Billed Charges, ,2.08,,,2.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.35,Percent of Total Billed Charges, ,,85,,0.43,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,0.34,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.3,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.08,,,2.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J7120 - RINGERS LACTATE INFUSION,J7120,HCPCS,,,AY,Outpatient,1000,UN,74.27,18.5675,0.01,63.13,,,,,,,,2.76,,,2.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.06,,,3.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.72,Percent of Total Billed Charges, ,2.76,,,2.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.99,Percent of Total Billed Charges, ,,85,,63.13,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.5,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,44.56,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.76,,,2.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J7168 - PROTHROMBIN COMPLEX KCENTRA,J7168,HCPCS,,,JZ,Outpatient,,,6.29,1.5725,2.13,6.24,,,,,,,,3.28,,,3.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.8,,,3.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.31,,,3.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.13,Percent of Total Billed Charges, ,3.28,,,3.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4.4,Percent of Total Billed Charges, ,,85,,5.35,Percent of Total Billed Charges, ,,,,,,,,68,,4.28,Percent of Total Billed Charges,0,2.28,,,2.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.77,Percent of Total Billed Charges, ,3.27,,,3.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.28,,,3.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.2,,,2.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.23,,,2.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.15,,,2.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.13,,,2.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.15,,,2.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.19,,,2.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.23,,,2.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7168 - PROTHROMBIN COMPLEX KCENTRA,J7168,HCPCS,,,JG,Outpatient,,,10.49,2.6225,2.13,8.92,,,,,,,,3.28,,,3.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.8,,,3.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.31,,,3.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.88,Percent of Total Billed Charges, ,3.28,,,3.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7.34,Percent of Total Billed Charges, ,,85,,8.92,Percent of Total Billed Charges, ,,,,,,,,68,,7.13,Percent of Total Billed Charges,0,2.28,,,2.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6.29,Percent of Total Billed Charges, ,3.27,,,3.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.28,,,3.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.2,,,2.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.23,,,2.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.15,,,2.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.13,,,2.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.15,,,2.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.19,,,2.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.23,,,2.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,6.24,,,6.24,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7187 - HUMATE-P INJ,J7187,HCPCS,,,JZ,Outpatient,1,F2,6.42,1.605,1.33,5.46,,,,,,,,1.59,,,1.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.75,,,1.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.07,,,2.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.21,Percent of Total Billed Charges, ,1.59,,,1.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4.49,Percent of Total Billed Charges, ,,85,,5.46,Percent of Total Billed Charges, ,1.45,,,1.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,4.37,Percent of Total Billed Charges,0,1.35,,,1.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.85,Percent of Total Billed Charges, ,2.04,,,2.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.59,,,1.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.38,,,1.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.39,,,1.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.34,,,1.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.33,,,1.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.34,,,1.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.37,,,1.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.39,,,1.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.64,,,2.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.64,,,2.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.64,,,2.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.64,,,2.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7198 - ANTI-INHIBITOR,J7198,HCPCS,,,JZ,Outpatient,1,F2,4.9,1.225,2.23,4.25,,,,,,,,2.67,,,2.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.95,,,2.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.47,,,3.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.21,Percent of Total Billed Charges, ,2.67,,,2.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.43,Percent of Total Billed Charges, ,,85,,4.17,Percent of Total Billed Charges, ,2.36,,,2.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.33,Percent of Total Billed Charges,0,2.27,,,2.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.94,Percent of Total Billed Charges, ,3.43,,,3.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.67,,,2.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.31,,,2.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.33,,,2.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.25,,,2.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.23,,,2.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.25,,,2.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.3,,,2.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.34,,,2.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4.25,,,4.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4.25,,,4.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4.25,,,4.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7198 - ANTI-INHIBITOR,J7198,HCPCS,,,JG,Outpatient,1,F2,13.58,3.395,2.23,11.54,,,,,,,,2.67,,,2.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.95,,,2.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.47,,,3.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8.91,Percent of Total Billed Charges, ,2.67,,,2.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9.51,Percent of Total Billed Charges, ,,85,,11.54,Percent of Total Billed Charges, ,2.36,,,2.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9.23,Percent of Total Billed Charges,0,2.27,,,2.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,8.15,Percent of Total Billed Charges, ,3.43,,,3.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.67,,,2.67,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.31,,,2.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.33,,,2.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.25,,,2.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.23,,,2.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.25,,,2.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.3,,,2.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.34,,,2.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.25,,,4.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4.25,,,4.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4.25,,,4.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4.25,,,4.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7202 - FACTOR IX IDELVION INJ,J7202,HCPCS,,,JZ,Outpatient,1,F2,10.94,2.735,4.8,14.4,,,,,,,,5.76,,,5.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7.18,Percent of Total Billed Charges, ,5.76,,,5.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7.66,Percent of Total Billed Charges, ,,85,,9.3,Percent of Total Billed Charges, ,5.21,,,5.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7.44,Percent of Total Billed Charges,0,4.94,,,4.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6.56,Percent of Total Billed Charges, ,7.38,,,7.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.76,,,5.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.02,,,5.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.85,,,4.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.8,,,4.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.85,,,4.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.94,,,4.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.03,,,5.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.4,,,14.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.4,,,14.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.4,,,14.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.4,,,14.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7202 - FACTOR IX IDELVION INJ,J7202,HCPCS,,,JG,Outpatient,1,F2,10.94,2.735,4.8,14.4,,,,,,,,5.76,,,5.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.33,,,6.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7.18,Percent of Total Billed Charges, ,5.76,,,5.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7.66,Percent of Total Billed Charges, ,,85,,9.3,Percent of Total Billed Charges, ,5.21,,,5.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7.44,Percent of Total Billed Charges,0,4.94,,,4.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6.56,Percent of Total Billed Charges, ,7.38,,,7.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.76,,,5.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.97,,,4.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.02,,,5.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.85,,,4.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.8,,,4.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.85,,,4.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.94,,,4.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.03,,,5.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.4,,,14.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.4,,,14.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.4,,,14.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,14.4,,,14.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9022 - INJ ATEZOLIZUMAB10 MG,J9022,HCPCS,,,JZ,Outpatient,10,ME,347.07,86.7675,81.99,295.01,,,,,,,,98.45,,,98.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,107.23,,,107.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,127.37,,,127.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,227.68,Percent of Total Billed Charges, ,98.45,,,98.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,242.95,Percent of Total Billed Charges, ,,85,,295.01,Percent of Total Billed Charges, ,88.22,,,88.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,236.01,Percent of Total Billed Charges,0,85.01,,,85.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,208.24,Percent of Total Billed Charges, ,126.06,,,126.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.45,,,98.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,84.86,,,84.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.68,,,85.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.81,,,82.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.99,,,81.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,82.81,,,82.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.45,,,84.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.88,,,85.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,225.1,,,225.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,225.1,,,225.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,225.1,,,225.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,225.1,,,225.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9023 - INJECTION AVELUMAB 10 MG,J9023,HCPCS,,,JZ,Outpatient,10,ME,473.01,118.2525,90.49,402.06,,,,,,,,108.65,,,108.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,118.41,,,118.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,140.56,,,140.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,310.29,Percent of Total Billed Charges, ,108.65,,,108.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,331.11,Percent of Total Billed Charges, ,,85,,402.06,Percent of Total Billed Charges, ,96.95,,,96.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,321.65,Percent of Total Billed Charges,0,92.37,,,92.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,283.81,Percent of Total Billed Charges, ,139.13,,,139.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,108.65,,,108.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.66,,,93.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.56,,,94.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.39,,,91.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.49,,,90.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.39,,,91.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.2,,,93.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.79,,,94.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,235.73,,,235.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,235.73,,,235.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,235.73,,,235.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,235.73,,,235.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9034 - INJ. BENDEKA 1 MG,J9034,HCPCS,,,JG,Outpatient,1,ME,52.3,13.075,12.31,70.36,,,,,,,,14.77,,,14.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17.01,,,17.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.11,,,19.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.31,Percent of Total Billed Charges, ,14.77,,,14.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,36.61,Percent of Total Billed Charges, ,,85,,44.46,Percent of Total Billed Charges, ,13.45,,,13.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,35.56,Percent of Total Billed Charges,0,14.76,,,14.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,31.38,Percent of Total Billed Charges, ,18.93,,,18.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,14.77,,,14.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.74,,,12.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.86,,,12.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.43,,,12.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.31,,,12.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.43,,,12.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.68,,,12.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.89,,,12.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.36,,,70.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,70.36,,,70.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,70.36,,,70.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,70.36,,,70.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9041 - INJECTION BORTEZOMIB 0.1MG,J9041,HCPCS,,,JZ,Outpatient,0.1,ME,10.32,2.58,0.01,84.29,,,,,,,,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.16,,,2.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.77,Percent of Total Billed Charges, ,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7.22,Percent of Total Billed Charges, ,,85,,8.77,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7.02,Percent of Total Billed Charges,0,1.96,,,1.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6.19,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9041 - INJECTION BORTEZOMIB 0.1MG,J9041,HCPCS,,,JW,Outpatient,0.1,ME,2.51,0.6275,0.01,84.29,,,,,,,,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.16,,,2.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.65,Percent of Total Billed Charges, ,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.76,Percent of Total Billed Charges, ,,85,,2.13,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,1.71,Percent of Total Billed Charges,0,1.96,,,1.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.51,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9041 - INJECTION BORTEZOMIB 0.1MG,J9041,HCPCS,,,JG,Outpatient,0.1,ME,7.19,1.7975,0.01,84.29,,,,,,,,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2.16,,,2.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.72,Percent of Total Billed Charges, ,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5.03,Percent of Total Billed Charges, ,,85,,6.11,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4.89,Percent of Total Billed Charges,0,1.96,,,1.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.31,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.29,,,84.29,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9042 - BRENTUXIMAB VEDOTIN INJ,J9042,HCPCS,,,JW,Outpatient,1,ME,282.47,70.6175,169.48,354.24,,,,,,,,273.8,,,273.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,299.5,,,299.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.24,,,354.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,185.3,Percent of Total Billed Charges, ,273.8,,,273.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,197.73,Percent of Total Billed Charges, ,,85,,240.1,Percent of Total Billed Charges, ,248.93,,,248.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,192.08,Percent of Total Billed Charges,0,230.61,,,230.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,169.48,Percent of Total Billed Charges, ,350.61,,,350.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,273.8,,,273.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.02,,,236.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.3,,,238.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.32,,,230.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.04,,,228.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.32,,,230.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.88,,,234.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.87,,,238.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,317.37,,,317.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,317.37,,,317.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,317.37,,,317.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,317.37,,,317.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9042 - BRENTUXIMAB VEDOTIN INJ,J9042,HCPCS,,,JG,Outpatient,1,ME,981.92,245.48,228.04,834.63,,,,,,,,273.8,,,273.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,299.5,,,299.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,354.24,,,354.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,644.14,Percent of Total Billed Charges, ,273.8,,,273.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,687.34,Percent of Total Billed Charges, ,,85,,834.63,Percent of Total Billed Charges, ,248.93,,,248.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,667.71,Percent of Total Billed Charges,0,230.61,,,230.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,589.15,Percent of Total Billed Charges, ,350.61,,,350.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,273.8,,,273.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.02,,,236.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.3,,,238.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.32,,,230.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,228.04,,,228.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,230.32,,,230.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,234.88,,,234.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,238.87,,,238.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,317.37,,,317.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,317.37,,,317.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,317.37,,,317.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,317.37,,,317.37,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9047 - INJECTION CARFILZOMIB 1 MG,J9047,HCPCS,,,TB,Outpatient,1,ME,65.51,16.3775,39.31,86.99,,,,,,,,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.04,,,62.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.22,,,73.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,42.97,Percent of Total Billed Charges, ,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,45.86,Percent of Total Billed Charges, ,,85,,55.68,Percent of Total Billed Charges, ,51.97,,,51.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,44.55,Percent of Total Billed Charges,0,47.09,,,47.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,39.31,Percent of Total Billed Charges, ,72.46,,,72.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.78,,,48.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.25,,,49.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.13,,,47.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.54,,,48.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.37,,,49.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9047 - INJECTION CARFILZOMIB 1 MG,J9047,HCPCS,,,JZ,Outpatient,1,ME,143.38,35.845,47.09,121.87,,,,,,,,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.04,,,62.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.22,,,73.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,94.06,Percent of Total Billed Charges, ,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,100.37,Percent of Total Billed Charges, ,,85,,121.87,Percent of Total Billed Charges, ,51.97,,,51.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,97.5,Percent of Total Billed Charges,0,47.09,,,47.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,86.03,Percent of Total Billed Charges, ,72.46,,,72.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.78,,,48.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.25,,,49.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.13,,,47.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.54,,,48.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.37,,,49.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9047 - INJECTION CARFILZOMIB 1 MG,J9047,HCPCS,,,JW,Outpatient,1,ME,58.46,14.615,35.08,86.99,,,,,,,,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.04,,,62.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.22,,,73.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,38.35,Percent of Total Billed Charges, ,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,40.92,Percent of Total Billed Charges, ,,85,,49.69,Percent of Total Billed Charges, ,51.97,,,51.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,39.75,Percent of Total Billed Charges,0,47.09,,,47.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,35.08,Percent of Total Billed Charges, ,72.46,,,72.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.78,,,48.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.25,,,49.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.13,,,47.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.54,,,48.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.37,,,49.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9047 - INJECTION CARFILZOMIB 1 MG,J9047,HCPCS,,,JG,Outpatient,1,ME,254.15,63.5375,47.09,216.03,,,,,,,,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.04,,,62.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.22,,,73.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,166.72,Percent of Total Billed Charges, ,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,177.91,Percent of Total Billed Charges, ,,85,,216.03,Percent of Total Billed Charges, ,51.97,,,51.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,172.82,Percent of Total Billed Charges,0,47.09,,,47.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,152.49,Percent of Total Billed Charges, ,72.46,,,72.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.6,,,56.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.78,,,48.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.25,,,49.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.13,,,47.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.54,,,48.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.37,,,49.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.99,,,86.99,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9055 - CETUXIMAB INJECTION,J9055,HCPCS,,,JZ,Outpatient,10,ME,169.27,42.3175,71.76,159.1,,,,,,,,86.16,,,86.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,94.54,,,94.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,111.47,,,111.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,111.04,Percent of Total Billed Charges, ,86.16,,,86.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,118.49,Percent of Total Billed Charges, ,,85,,143.88,Percent of Total Billed Charges, ,77.1,,,77.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,115.1,Percent of Total Billed Charges,0,73.72,,,73.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,101.56,Percent of Total Billed Charges, ,110.33,,,110.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.16,,,86.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,74.27,,,74.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.99,,,74.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.48,,,72.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.76,,,71.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.48,,,72.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.91,,,73.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.17,,,75.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9055 - CETUXIMAB INJECTION,J9055,HCPCS,,,JW,Outpatient,10,ME,96.5,24.125,57.9,159.1,,,,,,,,86.16,,,86.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,94.54,,,94.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,111.47,,,111.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,63.3,Percent of Total Billed Charges, ,86.16,,,86.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,67.55,Percent of Total Billed Charges, ,,85,,82.03,Percent of Total Billed Charges, ,77.1,,,77.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,65.62,Percent of Total Billed Charges,0,73.72,,,73.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,57.9,Percent of Total Billed Charges, ,110.33,,,110.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.16,,,86.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,74.27,,,74.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.99,,,74.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.48,,,72.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.76,,,71.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.48,,,72.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.91,,,73.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.17,,,75.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9055 - CETUXIMAB INJECTION,J9055,HCPCS,,,JG,Outpatient,10,ME,166.16,41.54,71.76,159.1,,,,,,,,86.16,,,86.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,94.54,,,94.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,111.47,,,111.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,109,Percent of Total Billed Charges, ,86.16,,,86.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,116.31,Percent of Total Billed Charges, ,,85,,141.24,Percent of Total Billed Charges, ,77.1,,,77.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,112.99,Percent of Total Billed Charges,0,73.72,,,73.72,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,99.7,Percent of Total Billed Charges, ,110.33,,,110.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.16,,,86.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,74.27,,,74.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.99,,,74.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.48,,,72.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.76,,,71.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,72.48,,,72.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.91,,,73.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.17,,,75.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,159.1,,,159.1,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9058 - INJ APOTEX-BENDAMUSTINE 1 MG      I,J9058,HCPCS,,,JW,Outpatient,,,39.1,9.775,0.01,108.64,,,,,,,,17.37,,,17.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.53,,,23.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,25.65,Percent of Total Billed Charges, ,17.37,,,17.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,27.37,Percent of Total Billed Charges, ,,85,,33.24,Percent of Total Billed Charges, ,,,,,,,,68,,26.59,Percent of Total Billed Charges,0,20.78,,,20.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,23.46,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.37,,,17.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,108.64,,,108.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,108.64,,,108.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,108.64,,,108.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,108.64,,,108.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9061 - INJ AMIVANTAMAB-VMJW,J9061,HCPCS,,,JZ,Outpatient,2,ME,2700.39,675.0975,19.65,2295.33,,,,,,,,23.6,,,23.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,25.71,,,25.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,30.53,,,30.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1771.46,Percent of Total Billed Charges, ,23.6,,,23.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1890.27,Percent of Total Billed Charges, ,,85,,2295.33,Percent of Total Billed Charges, ,21.56,,,21.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1836.27,Percent of Total Billed Charges,0,19.98,,,19.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1620.23,Percent of Total Billed Charges, ,30.21,,,30.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.6,,,23.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.34,,,20.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.53,,,20.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.85,,,19.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.65,,,19.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.85,,,19.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.24,,,20.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.58,,,20.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.19,,,53.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.19,,,53.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.19,,,53.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.19,,,53.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9063 - INJ ELAHERE 1 MGG                 I,J9063,HCPCS,,,TB,Outpatient,1,ME,336.29,84.0725,63.47,285.85,,,,,,,,76.21,,,76.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,83.59,,,83.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.6,,,98.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,220.61,Percent of Total Billed Charges, ,76.21,,,76.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,235.4,Percent of Total Billed Charges, ,,85,,285.85,Percent of Total Billed Charges, ,68.11,,,68.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,228.68,Percent of Total Billed Charges,0,65.71,,,65.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,201.77,Percent of Total Billed Charges, ,97.59,,,97.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.21,,,76.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,65.69,,,65.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.33,,,66.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.1,,,64.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.47,,,63.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.1,,,64.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.37,,,65.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.48,,,66.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.43,,,195.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,195.43,,,195.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,195.43,,,195.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,195.43,,,195.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9063 - INJ ELAHERE 1 MGG                 I,J9063,HCPCS,,,JG,Outpatient,1,ME,336.29,84.0725,63.47,285.85,,,,,,,,76.21,,,76.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,83.59,,,83.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,98.6,,,98.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,220.61,Percent of Total Billed Charges, ,76.21,,,76.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,235.4,Percent of Total Billed Charges, ,,85,,285.85,Percent of Total Billed Charges, ,68.11,,,68.11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,228.68,Percent of Total Billed Charges,0,65.71,,,65.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,201.77,Percent of Total Billed Charges, ,97.59,,,97.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.21,,,76.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,65.69,,,65.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.33,,,66.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.1,,,64.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.47,,,63.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.1,,,64.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.37,,,65.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.48,,,66.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.43,,,195.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,195.43,,,195.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,195.43,,,195.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,195.43,,,195.43,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9070 - CYCLOPHOSPHAMIDE 100 MG INJ,J9070,HCPCS,,,JZ,Outpatient,,,333.7,83.425,20.15,283.65,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,218.91,Percent of Total Billed Charges, ,,,,,,,,70,,233.59,Percent of Total Billed Charges, ,,85,,283.65,Percent of Total Billed Charges, ,,,,,,,,68,,226.92,Percent of Total Billed Charges,0,20.15,,,20.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,200.22,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9070 - CYCLOPHOSPHAMIDE 100 MG INJ,J9070,HCPCS,,,JW,Outpatient,,,89.24,22.31,20.15,148.89,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,58.54,Percent of Total Billed Charges, ,,,,,,,,70,,62.47,Percent of Total Billed Charges, ,,85,,75.85,Percent of Total Billed Charges, ,,,,,,,,68,,60.68,Percent of Total Billed Charges,0,20.15,,,20.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,53.54,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9070 - CYCLOPHOSPHAMIDE 100 MG INJ,J9070,HCPCS,,,JG,Outpatient,,,218.08,54.52,20.15,185.37,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,143.06,Percent of Total Billed Charges, ,,,,,,,,70,,152.66,Percent of Total Billed Charges, ,,85,,185.37,Percent of Total Billed Charges, ,,,,,,,,68,,148.29,Percent of Total Billed Charges,0,20.15,,,20.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,130.85,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,148.89,,,148.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9071 - INJ CYCLOPHOSPHAMD AUROMEDIC,J9071,HCPCS,,,TB,Outpatient,5,ME,4.73,1.1825,0.7,12.36,,,,,,,,1.32,,,1.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.56,,,1.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.72,,,1.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.1,Percent of Total Billed Charges, ,1.32,,,1.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.31,Percent of Total Billed Charges, ,,85,,4.02,Percent of Total Billed Charges, ,0.7,,,0.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,3.22,Percent of Total Billed Charges,0,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.84,Percent of Total Billed Charges, ,1.69,,,1.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.32,,,1.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.14,,,1.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.15,,,1.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.1,,,1.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.15,,,1.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.36,,,12.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.36,,,12.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.36,,,12.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.36,,,12.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9071 - INJ CYCLOPHOSPHAMD AUROMEDIC,J9071,HCPCS,,,JZ,Outpatient,5,ME,11.58,2.895,0.7,12.36,,,,,,,,1.32,,,1.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.56,,,1.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.72,,,1.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7.6,Percent of Total Billed Charges, ,1.32,,,1.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8.11,Percent of Total Billed Charges, ,,85,,9.84,Percent of Total Billed Charges, ,0.7,,,0.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7.87,Percent of Total Billed Charges,0,1.79,,,1.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6.95,Percent of Total Billed Charges, ,1.69,,,1.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.32,,,1.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.14,,,1.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.15,,,1.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.1,,,1.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.15,,,1.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.36,,,12.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.36,,,12.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.36,,,12.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,12.36,,,12.36,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9073 - INJ CYCLOPHOSPHAMD (INGENUS)      I,J9073,HCPCS,,,TB,Outpatient,5,ME,15.96,3.99,0.88,13.57,,,,,,,,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.37,,,1.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10.47,Percent of Total Billed Charges, ,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11.17,Percent of Total Billed Charges, ,,85,,13.57,Percent of Total Billed Charges, ,2.19,,,2.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.85,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,9.58,Percent of Total Billed Charges, ,1.35,,,1.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.91,,,0.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.92,,,0.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.89,,,0.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.88,,,0.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.89,,,0.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.91,,,0.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.92,,,0.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J9073 - INJ CYCLOPHOSPHAMD (INGENUS)      I,J9073,HCPCS,,,JZ,Outpatient,5,ME,18.99,4.7475,0.88,16.14,,,,,,,,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.37,,,1.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12.46,Percent of Total Billed Charges, ,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13.29,Percent of Total Billed Charges, ,,85,,16.14,Percent of Total Billed Charges, ,2.19,,,2.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,12.91,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,11.39,Percent of Total Billed Charges, ,1.35,,,1.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.91,,,0.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.92,,,0.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.89,,,0.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.88,,,0.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.89,,,0.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.91,,,0.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.92,,,0.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J9073 - INJ CYCLOPHOSPHAMD (INGENUS)      I,J9073,HCPCS,,,JW,Outpatient,5,ME,3.24,0.81,0.88,2.75,,,,,,,,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.37,,,1.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.13,Percent of Total Billed Charges, ,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.27,Percent of Total Billed Charges, ,,85,,2.75,Percent of Total Billed Charges, ,2.19,,,2.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,2.2,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,1.94,Percent of Total Billed Charges, ,1.35,,,1.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.91,,,0.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.92,,,0.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.89,,,0.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.88,,,0.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.89,,,0.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.91,,,0.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.92,,,0.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J9073 - INJ CYCLOPHOSPHAMD (INGENUS)      I,J9073,HCPCS,,,JG,Outpatient,5,ME,14.86,3.715,0.88,12.63,,,,,,,,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.99,,,0.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.37,,,1.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,9.75,Percent of Total Billed Charges, ,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.4,Percent of Total Billed Charges, ,,85,,12.63,Percent of Total Billed Charges, ,2.19,,,2.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.1,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,8.92,Percent of Total Billed Charges, ,1.35,,,1.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.06,,,1.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.91,,,0.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.92,,,0.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.89,,,0.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.88,,,0.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.89,,,0.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.91,,,0.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.92,,,0.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J9119 - INJ. CEMIPLIMAB-RWLC 1 MG,J9119,HCPCS,,,JZ,Outpatient,1,ME,151.54,37.885,26.85,128.81,,,,,,,,32.24,,,32.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.63,,,34.63,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,41.71,,,41.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,99.41,Percent of Total Billed Charges, ,32.24,,,32.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,106.08,Percent of Total Billed Charges, ,,85,,128.81,Percent of Total Billed Charges, ,28.21,,,28.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,103.05,Percent of Total Billed Charges,0,27.46,,,27.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,90.92,Percent of Total Billed Charges, ,41.28,,,41.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.24,,,32.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.79,,,27.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.06,,,28.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.12,,,27.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.85,,,26.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.12,,,27.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.66,,,27.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,28.13,,,28.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.47,,,81.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,81.47,,,81.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,81.47,,,81.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,81.47,,,81.47,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9144 - DARATUMUMAB HYALURONIDASE,J9144,HCPCS,,,JZ,Outpatient,10,ME,230.45,57.6125,48.88,195.88,,,,,,,,58.69,,,58.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.75,,,63.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,75.92,,,75.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,151.18,Percent of Total Billed Charges, ,58.69,,,58.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,161.32,Percent of Total Billed Charges, ,,85,,195.88,Percent of Total Billed Charges, ,51.39,,,51.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,156.71,Percent of Total Billed Charges,0,49.05,,,49.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,138.27,Percent of Total Billed Charges, ,75.15,,,75.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.69,,,58.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.59,,,50.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.08,,,51.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.37,,,49.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.88,,,48.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,49.37,,,49.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.35,,,50.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.2,,,51.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.23,,,130.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,130.23,,,130.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,130.23,,,130.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,130.23,,,130.23,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9145 - INJECTION DARATUMUMAB 10 MG,J9145,HCPCS,,,JW,Outpatient,10,ME,85.59,21.3975,51.35,139.35,,,,,,,,74.33,,,74.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,80.48,,,80.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,96.16,,,96.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,56.15,Percent of Total Billed Charges, ,74.33,,,74.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,59.91,Percent of Total Billed Charges, ,,85,,72.75,Percent of Total Billed Charges, ,65.32,,,65.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,58.2,Percent of Total Billed Charges,0,61.71,,,61.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,51.35,Percent of Total Billed Charges, ,95.19,,,95.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.33,,,74.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.08,,,64.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.7,,,64.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.53,,,62.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.91,,,61.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.53,,,62.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.77,,,63.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.85,,,64.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,139.35,,,139.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.35,,,139.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.35,,,139.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.35,,,139.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9145 - INJECTION DARATUMUMAB 10 MG,J9145,HCPCS,,,JG,Outpatient,10,ME,291.6,72.9,61.71,247.86,,,,,,,,74.33,,,74.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,80.48,,,80.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,96.16,,,96.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,191.29,Percent of Total Billed Charges, ,74.33,,,74.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,204.12,Percent of Total Billed Charges, ,,85,,247.86,Percent of Total Billed Charges, ,65.32,,,65.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,198.29,Percent of Total Billed Charges,0,61.71,,,61.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,174.96,Percent of Total Billed Charges, ,95.19,,,95.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.33,,,74.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.08,,,64.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.7,,,64.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.53,,,62.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.91,,,61.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.53,,,62.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.77,,,63.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.85,,,64.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,139.35,,,139.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.35,,,139.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.35,,,139.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,139.35,,,139.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9155 - DEGARELIX INJECTION,J9155,HCPCS,,,JZ,Outpatient,1,ME,13.49,3.3725,3.97,11.47,,,,,,,,4.76,,,4.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5.34,,,5.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.17,,,6.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8.85,Percent of Total Billed Charges, ,4.76,,,4.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9.44,Percent of Total Billed Charges, ,,85,,11.47,Percent of Total Billed Charges, ,4.28,,,4.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9.17,Percent of Total Billed Charges,0,4.19,,,4.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,8.09,Percent of Total Billed Charges, ,6.1,,,6.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.76,,,4.76,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.11,,,4.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.15,,,4.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.01,,,4.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.97,,,3.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.01,,,4.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.09,,,4.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.16,,,4.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.52,,,8.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,8.52,,,8.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,8.52,,,8.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,8.52,,,8.52,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9171 - DOCETAXEL INJECTION,J9171,HCPCS,,,JZ,Outpatient,1,ME,4.65,1.1625,0.01,52.33,,,,,,,,0.9,,,0.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.04,,,1.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.05,Percent of Total Billed Charges, ,0.9,,,0.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.26,Percent of Total Billed Charges, ,,85,,3.95,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.16,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.79,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.9,,,0.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.33,,,52.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.33,,,52.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.33,,,52.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.33,,,52.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9171 - DOCETAXEL INJECTION,J9171,HCPCS,,,JW,Outpatient,1,ME,3.61,0.9025,0.01,52.33,,,,,,,,0.9,,,0.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.04,,,1.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.37,Percent of Total Billed Charges, ,0.9,,,0.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.53,Percent of Total Billed Charges, ,,85,,3.07,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,2.45,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.17,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.9,,,0.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.33,,,52.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.33,,,52.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.33,,,52.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,52.33,,,52.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9173 - INJ. DURVALUMAB 10 MG,J9173,HCPCS,,,TB,Outpatient,10,ME,59.56,14.89,35.74,237.33,,,,,,,,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,102.34,,,102.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.82,,,120.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,39.07,Percent of Total Billed Charges, ,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,41.69,Percent of Total Billed Charges, ,,85,,50.63,Percent of Total Billed Charges, ,83.88,,,83.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,40.5,Percent of Total Billed Charges,0,80.71,,,80.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,35.74,Percent of Total Billed Charges, ,119.59,,,119.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,80.5,,,80.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.28,,,81.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.56,,,78.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.78,,,77.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.56,,,78.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.11,,,80.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.47,,,81.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9173 - INJ. DURVALUMAB 10 MG,J9173,HCPCS,,,JZ,Outpatient,10,ME,282.34,70.585,77.78,239.99,,,,,,,,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,102.34,,,102.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.82,,,120.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,185.22,Percent of Total Billed Charges, ,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,197.64,Percent of Total Billed Charges, ,,85,,239.99,Percent of Total Billed Charges, ,83.88,,,83.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,191.99,Percent of Total Billed Charges,0,80.71,,,80.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,169.4,Percent of Total Billed Charges, ,119.59,,,119.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,80.5,,,80.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.28,,,81.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.56,,,78.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.78,,,77.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.56,,,78.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.11,,,80.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.47,,,81.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9173 - INJ. DURVALUMAB 10 MG,J9173,HCPCS,,,JW,Outpatient,10,ME,91.05,22.7625,54.63,237.33,,,,,,,,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,102.34,,,102.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.82,,,120.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,59.73,Percent of Total Billed Charges, ,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,63.74,Percent of Total Billed Charges, ,,85,,77.39,Percent of Total Billed Charges, ,83.88,,,83.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,61.91,Percent of Total Billed Charges,0,80.71,,,80.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,54.63,Percent of Total Billed Charges, ,119.59,,,119.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,80.5,,,80.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.28,,,81.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.56,,,78.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.78,,,77.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.56,,,78.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.11,,,80.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.47,,,81.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9173 - INJ. DURVALUMAB 10 MG,J9173,HCPCS,,,JG,Outpatient,10,ME,245.23,61.3075,77.78,237.33,,,,,,,,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,102.34,,,102.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,120.82,,,120.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,160.87,Percent of Total Billed Charges, ,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,171.66,Percent of Total Billed Charges, ,,85,,208.45,Percent of Total Billed Charges, ,83.88,,,83.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,166.76,Percent of Total Billed Charges,0,80.71,,,80.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,147.14,Percent of Total Billed Charges, ,119.59,,,119.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.39,,,93.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,80.5,,,80.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.28,,,81.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.56,,,78.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.78,,,77.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,78.56,,,78.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,80.11,,,80.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,81.47,,,81.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,237.33,,,237.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9177 - INJ ENFORT VEDO-EJFV 0.25MG,J9177,HCPCS,,,JZ,Outpatient,0.25,ME,177.05,44.2625,34.93,150.49,,,,,,,,41.94,,,41.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.15,,,45.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.27,,,54.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,116.14,Percent of Total Billed Charges, ,41.94,,,41.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,123.94,Percent of Total Billed Charges, ,,85,,150.49,Percent of Total Billed Charges, ,36.65,,,36.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,120.39,Percent of Total Billed Charges,0,35.03,,,35.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,106.23,Percent of Total Billed Charges, ,53.7,,,53.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.94,,,41.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.15,,,36.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.5,,,36.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.28,,,35.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.93,,,34.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.28,,,35.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.59,,,36.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9177 - INJ ENFORT VEDO-EJFV 0.25MG,J9177,HCPCS,,,JW,Outpatient,0.25,ME,37.09,9.2725,22.25,83.04,,,,,,,,41.94,,,41.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.15,,,45.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.27,,,54.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24.33,Percent of Total Billed Charges, ,41.94,,,41.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,25.96,Percent of Total Billed Charges, ,,85,,31.53,Percent of Total Billed Charges, ,36.65,,,36.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25.22,Percent of Total Billed Charges,0,35.03,,,35.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,22.25,Percent of Total Billed Charges, ,53.7,,,53.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.94,,,41.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.15,,,36.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.5,,,36.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.28,,,35.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.93,,,34.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.28,,,35.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.59,,,36.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9177 - INJ ENFORT VEDO-EJFV 0.25MG,J9177,HCPCS,,,JG,Outpatient,0.25,ME,114.02,28.505,34.93,96.92,,,,,,,,41.94,,,41.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,45.15,,,45.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,54.27,,,54.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,74.8,Percent of Total Billed Charges, ,41.94,,,41.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,79.81,Percent of Total Billed Charges, ,,85,,96.92,Percent of Total Billed Charges, ,36.65,,,36.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,77.53,Percent of Total Billed Charges,0,35.03,,,35.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,68.41,Percent of Total Billed Charges, ,53.7,,,53.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.94,,,41.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.15,,,36.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.5,,,36.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.28,,,35.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.93,,,34.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.28,,,35.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.59,,,36.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,83.04,,,83.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9179 - ERIBULIN MESYLATE INJECTION,J9179,HCPCS,,,JW,Outpatient,0.1,ME,197.29,49.3225,118.37,267.45,,,,,,,,155,,,155,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,176.61,,,176.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.53,,,200.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,129.42,Percent of Total Billed Charges, ,155,,,155,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,138.1,Percent of Total Billed Charges, ,,85,,167.7,Percent of Total Billed Charges, ,133.32,,,133.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,134.16,Percent of Total Billed Charges,0,134.02,,,134.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,118.37,Percent of Total Billed Charges, ,198.49,,,198.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155,,,155,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,133.62,,,133.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,134.91,,,134.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.39,,,130.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.1,,,129.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.39,,,130.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.97,,,132.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.23,,,135.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,267.45,,,267.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,267.45,,,267.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,267.45,,,267.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,267.45,,,267.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9179 - ERIBULIN MESYLATE INJECTION,J9179,HCPCS,,,JG,Outpatient,0.1,ME,709.97,177.4925,129.1,603.47,,,,,,,,155,,,155,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,176.61,,,176.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.53,,,200.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,465.74,Percent of Total Billed Charges, ,155,,,155,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,496.98,Percent of Total Billed Charges, ,,85,,603.47,Percent of Total Billed Charges, ,133.32,,,133.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,482.78,Percent of Total Billed Charges,0,134.02,,,134.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,425.98,Percent of Total Billed Charges, ,198.49,,,198.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155,,,155,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,133.62,,,133.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,134.91,,,134.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.39,,,130.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.1,,,129.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.39,,,130.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.97,,,132.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.23,,,135.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,267.45,,,267.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,267.45,,,267.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,267.45,,,267.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,267.45,,,267.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9202 - GOSERELIN ACETATE IMPLANT,J9202,HCPCS,,,JZ,Outpatient,3.6,ME,775.1,193.775,465.06,996.55,,,,,,,,770.26,,,770.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,824.41,,,824.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,996.55,,,996.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.47,Percent of Total Billed Charges, ,770.26,,,770.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.57,Percent of Total Billed Charges, ,,85,,658.84,Percent of Total Billed Charges, ,703.06,,,703.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527.07,Percent of Total Billed Charges,0,609.01,,,609.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,465.06,Percent of Total Billed Charges, ,986.35,,,986.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,770.26,,,770.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,663.98,,,663.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,670.4,,,670.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,647.95,,,647.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,641.53,,,641.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,647.95,,,647.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,660.78,,,660.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,672,,,672,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,946.69,,,946.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,946.69,,,946.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,946.69,,,946.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,946.69,,,946.69,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9205 - INJ IRINOTECAN LIPOSOME 1 MG,J9205,HCPCS,,,JZ,Outpatient,1,ME,142.94,35.735,61.57,121.5,,,,,,,,73.93,,,73.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.23,,,79.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,95.65,,,95.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,93.77,Percent of Total Billed Charges, ,73.93,,,73.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,100.06,Percent of Total Billed Charges, ,,85,,121.5,Percent of Total Billed Charges, ,64.22,,,64.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,97.2,Percent of Total Billed Charges,0,62.02,,,62.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,85.76,Percent of Total Billed Charges, ,94.66,,,94.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.93,,,73.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.72,,,63.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.34,,,64.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.19,,,62.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.57,,,61.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.19,,,62.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.42,,,63.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.49,,,64.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9205 - INJ IRINOTECAN LIPOSOME 1 MG,J9205,HCPCS,,,JW,Outpatient,1,ME,79.12,19.78,47.47,117.34,,,,,,,,73.93,,,73.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.23,,,79.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,95.65,,,95.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.9,Percent of Total Billed Charges, ,73.93,,,73.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,55.38,Percent of Total Billed Charges, ,,85,,67.25,Percent of Total Billed Charges, ,64.22,,,64.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.8,Percent of Total Billed Charges,0,62.02,,,62.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,47.47,Percent of Total Billed Charges, ,94.66,,,94.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.93,,,73.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.72,,,63.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.34,,,64.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.19,,,62.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.57,,,61.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.19,,,62.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.42,,,63.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.49,,,64.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9205 - INJ IRINOTECAN LIPOSOME 1 MG,J9205,HCPCS,,,JG,Outpatient,1,ME,328.28,82.07,61.57,279.04,,,,,,,,73.93,,,73.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.23,,,79.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,95.65,,,95.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,215.35,Percent of Total Billed Charges, ,73.93,,,73.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,229.8,Percent of Total Billed Charges, ,,85,,279.04,Percent of Total Billed Charges, ,64.22,,,64.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,223.23,Percent of Total Billed Charges,0,62.02,,,62.02,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,196.97,Percent of Total Billed Charges, ,94.66,,,94.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.93,,,73.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.72,,,63.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.34,,,64.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.19,,,62.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.57,,,61.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.19,,,62.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.42,,,63.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.49,,,64.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,117.34,,,117.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9217 - LEUPROLIDE ACETATE SUSPNSION,J9217,HCPCS,,,JZ,Outpatient,7.5,ME,2210.06,552.515,167.82,1878.55,,,,,,,,201.49,,,201.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,225.68,,,225.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,260.68,,,260.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1449.8,Percent of Total Billed Charges, ,201.49,,,201.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1547.04,Percent of Total Billed Charges, ,,85,,1878.55,Percent of Total Billed Charges, ,180.79,,,180.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1502.84,Percent of Total Billed Charges,0,181.3,,,181.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1326.04,Percent of Total Billed Charges, ,258.02,,,258.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.49,,,201.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,173.69,,,173.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.37,,,175.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.5,,,169.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.82,,,167.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.5,,,169.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,172.85,,,172.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.79,,,175.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1559.78,,,1559.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1559.78,,,1559.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1559.78,,,1559.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1559.78,,,1559.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9217 - LEUPROLIDE ACETATE SUSPNSION,J9217,HCPCS,,,JB,Outpatient,7.5,ME,2341.57,585.3925,167.82,1990.33,,,,,,,,201.49,,,201.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,225.68,,,225.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,260.68,,,260.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1536.07,Percent of Total Billed Charges, ,201.49,,,201.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1639.1,Percent of Total Billed Charges, ,,85,,1990.33,Percent of Total Billed Charges, ,180.79,,,180.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1592.27,Percent of Total Billed Charges,0,181.3,,,181.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1404.94,Percent of Total Billed Charges, ,258.02,,,258.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.49,,,201.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,173.69,,,173.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.37,,,175.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.5,,,169.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.82,,,167.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.5,,,169.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,172.85,,,172.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.79,,,175.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1559.78,,,1559.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1559.78,,,1559.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1559.78,,,1559.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1559.78,,,1559.78,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9223 - INJ. LURBINECTEDIN 0.1 MG,J9223,HCPCS,,,TB,Outpatient,0.1,ME,1030.32,257.58,193.57,875.77,,,,,,,,232.42,,,232.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.45,,,253.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,300.7,,,300.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,675.89,Percent of Total Billed Charges, ,232.42,,,232.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,721.22,Percent of Total Billed Charges, ,,85,,875.77,Percent of Total Billed Charges, ,204.9,,,204.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,700.62,Percent of Total Billed Charges,0,200.01,,,200.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,618.19,Percent of Total Billed Charges, ,297.61,,,297.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.42,,,232.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.34,,,200.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.28,,,202.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.51,,,195.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.57,,,193.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.51,,,195.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.38,,,199.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.76,,,202.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9223 - INJ. LURBINECTEDIN 0.1 MG,J9223,HCPCS,,,JW,Outpatient,0.1,ME,238.5,59.625,143.1,561.45,,,,,,,,232.42,,,232.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.45,,,253.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,300.7,,,300.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,156.46,Percent of Total Billed Charges, ,232.42,,,232.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,166.95,Percent of Total Billed Charges, ,,85,,202.73,Percent of Total Billed Charges, ,204.9,,,204.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,162.18,Percent of Total Billed Charges,0,200.01,,,200.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,143.1,Percent of Total Billed Charges, ,297.61,,,297.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.42,,,232.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.34,,,200.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.28,,,202.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.51,,,195.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.57,,,193.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.51,,,195.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.38,,,199.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.76,,,202.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9223 - INJ. LURBINECTEDIN 0.1 MG,J9223,HCPCS,,,JG,Outpatient,0.1,ME,866.44,216.61,193.57,736.47,,,,,,,,232.42,,,232.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,253.45,,,253.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,300.7,,,300.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,568.38,Percent of Total Billed Charges, ,232.42,,,232.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,606.51,Percent of Total Billed Charges, ,,85,,736.47,Percent of Total Billed Charges, ,204.9,,,204.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,589.18,Percent of Total Billed Charges,0,200.01,,,200.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,519.86,Percent of Total Billed Charges, ,297.61,,,297.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.42,,,232.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.34,,,200.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.28,,,202.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.51,,,195.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.57,,,193.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.51,,,195.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.38,,,199.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,202.76,,,202.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,561.45,,,561.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9227 - INJ. ISATUXIMAB-IRFC 10 MG,J9227,HCPCS,,,JZ,Outpatient,10,ME,201.76,50.44,74.2,198.04,,,,,,,,89.09,,,89.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,97.49,,,97.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,115.28,,,115.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,132.35,Percent of Total Billed Charges, ,89.09,,,89.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,141.23,Percent of Total Billed Charges, ,,85,,171.5,Percent of Total Billed Charges, ,79.35,,,79.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,137.2,Percent of Total Billed Charges,0,76.5,,,76.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,121.06,Percent of Total Billed Charges, ,114.08,,,114.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.09,,,89.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,76.8,,,76.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.54,,,77.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.94,,,74.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.2,,,74.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.94,,,74.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.43,,,76.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.72,,,77.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9227 - INJ. ISATUXIMAB-IRFC 10 MG,J9227,HCPCS,,,JW,Outpatient,10,ME,104.88,26.22,62.93,198.04,,,,,,,,89.09,,,89.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,97.49,,,97.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,115.28,,,115.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,68.8,Percent of Total Billed Charges, ,89.09,,,89.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,73.42,Percent of Total Billed Charges, ,,85,,89.15,Percent of Total Billed Charges, ,79.35,,,79.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,71.32,Percent of Total Billed Charges,0,76.5,,,76.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,62.93,Percent of Total Billed Charges, ,114.08,,,114.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.09,,,89.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,76.8,,,76.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.54,,,77.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.94,,,74.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.2,,,74.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.94,,,74.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.43,,,76.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.72,,,77.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9227 - INJ. ISATUXIMAB-IRFC 10 MG,J9227,HCPCS,,,JG,Outpatient,10,ME,385.08,96.27,74.2,327.32,,,,,,,,89.09,,,89.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,97.49,,,97.49,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,115.28,,,115.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,252.61,Percent of Total Billed Charges, ,89.09,,,89.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,269.56,Percent of Total Billed Charges, ,,85,,327.32,Percent of Total Billed Charges, ,79.35,,,79.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,261.85,Percent of Total Billed Charges,0,76.5,,,76.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,231.05,Percent of Total Billed Charges, ,114.08,,,114.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,89.09,,,89.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,76.8,,,76.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.54,,,77.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.94,,,74.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.2,,,74.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.94,,,74.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.43,,,76.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.72,,,77.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,198.04,,,198.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9228 - IPILIMUMAB INJECTION,J9228,HCPCS,,,JZ,Outpatient,1,ME,873.94,218.485,168.17,742.85,,,,,,,,201.92,,,201.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,220.98,,,220.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.24,,,261.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,573.3,Percent of Total Billed Charges, ,201.92,,,201.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,611.76,Percent of Total Billed Charges, ,,85,,742.85,Percent of Total Billed Charges, ,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,594.28,Percent of Total Billed Charges,0,172.42,,,172.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,524.36,Percent of Total Billed Charges, ,258.56,,,258.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.92,,,201.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,174.06,,,174.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.74,,,175.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.85,,,169.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,168.17,,,168.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.85,,,169.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,173.22,,,173.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.16,,,176.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9228 - IPILIMUMAB INJECTION,J9228,HCPCS,,,JW,Outpatient,1,ME,211.23,52.8075,126.74,371.4,,,,,,,,201.92,,,201.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,220.98,,,220.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.24,,,261.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,138.57,Percent of Total Billed Charges, ,201.92,,,201.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,147.86,Percent of Total Billed Charges, ,,85,,179.55,Percent of Total Billed Charges, ,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,143.64,Percent of Total Billed Charges,0,172.42,,,172.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,126.74,Percent of Total Billed Charges, ,258.56,,,258.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.92,,,201.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,174.06,,,174.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.74,,,175.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.85,,,169.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,168.17,,,168.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.85,,,169.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,173.22,,,173.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.16,,,176.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9228 - IPILIMUMAB INJECTION,J9228,HCPCS,,,JG,Outpatient,1,ME,595.12,148.78,168.17,505.85,,,,,,,,201.92,,,201.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,220.98,,,220.98,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.24,,,261.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,390.4,Percent of Total Billed Charges, ,201.92,,,201.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,416.58,Percent of Total Billed Charges, ,,85,,505.85,Percent of Total Billed Charges, ,180.05,,,180.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,404.68,Percent of Total Billed Charges,0,172.42,,,172.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,357.07,Percent of Total Billed Charges, ,258.56,,,258.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,201.92,,,201.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,174.06,,,174.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,175.74,,,175.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.85,,,169.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,168.17,,,168.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,169.85,,,169.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,173.22,,,173.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,176.16,,,176.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,371.4,,,371.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9259 - PACLITAXEL (AMERICAN REGENT)      I,J9259,HCPCS,,,JZ,Outpatient,,,57.65,14.4125,0.01,53.34,,,,,,,,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.25,,,19.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,37.82,Percent of Total Billed Charges, ,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,40.36,Percent of Total Billed Charges, ,,85,,49,Percent of Total Billed Charges, ,,,,,,,,68,,39.2,Percent of Total Billed Charges,0,15.45,,,15.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,34.59,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9259 - PACLITAXEL (AMERICAN REGENT)      I,J9259,HCPCS,,,JW,Outpatient,,,19.36,4.84,0.01,53.34,,,,,,,,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.25,,,19.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,12.7,Percent of Total Billed Charges, ,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,13.55,Percent of Total Billed Charges, ,,85,,16.46,Percent of Total Billed Charges, ,,,,,,,,68,,13.16,Percent of Total Billed Charges,0,15.45,,,15.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,11.62,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9259 - PACLITAXEL (AMERICAN REGENT)      I,J9259,HCPCS,,,JG,Outpatient,,,67.93,16.9825,0.01,57.74,,,,,,,,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.25,,,19.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,44.56,Percent of Total Billed Charges, ,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,47.55,Percent of Total Billed Charges, ,,85,,57.74,Percent of Total Billed Charges, ,,,,,,,,68,,46.19,Percent of Total Billed Charges,0,15.45,,,15.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,40.76,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,17.58,,,17.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,53.34,,,53.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9271 - INJ PEMBROLIZUMAB,J9271,HCPCS,,,JZ,Outpatient,1,ME,250.61,62.6525,55.35,213.02,,,,,,,,66.45,,,66.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.83,,,70.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,85.97,,,85.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,164.4,Percent of Total Billed Charges, ,66.45,,,66.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,175.43,Percent of Total Billed Charges, ,,85,,213.02,Percent of Total Billed Charges, ,57.6,,,57.6,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,170.41,Percent of Total Billed Charges,0,55.73,,,55.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,150.37,Percent of Total Billed Charges, ,85.1,,,85.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,66.45,,,66.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,57.29,,,57.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.84,,,57.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.9,,,55.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.35,,,55.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.9,,,55.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.01,,,57.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.98,,,57.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,135.73,,,135.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,135.73,,,135.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,135.73,,,135.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,135.73,,,135.73,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9273 - INJ TISOTU VEDOTIN-TFTV 1MG,J9273,HCPCS,,,JW,Outpatient,1,ME,197.97,49.4925,118.78,498.13,,,,,,,,207.3,,,207.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,218.69,,,218.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,268.2,,,268.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,129.87,Percent of Total Billed Charges, ,207.3,,,207.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,138.58,Percent of Total Billed Charges, ,,85,,168.27,Percent of Total Billed Charges, ,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,134.62,Percent of Total Billed Charges,0,168.31,,,168.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,118.78,Percent of Total Billed Charges, ,265.45,,,265.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,207.3,,,207.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,178.69,,,178.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,180.42,,,180.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.38,,,174.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,172.65,,,172.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,174.38,,,174.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.83,,,177.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,180.85,,,180.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,498.13,,,498.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,498.13,,,498.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,498.13,,,498.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,498.13,,,498.13,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9280 - MITOMYCIN INJECTION,J9280,HCPCS,,,JZ,Outpatient,5,ME,373.58,93.395,40.41,327.77,,,,,,,,48.52,,,48.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.7,,,67.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.77,,,62.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,245.07,Percent of Total Billed Charges, ,48.52,,,48.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,261.51,Percent of Total Billed Charges, ,,85,,317.54,Percent of Total Billed Charges, ,46.35,,,46.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,254.03,Percent of Total Billed Charges,0,63.35,,,63.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,224.15,Percent of Total Billed Charges, ,62.13,,,62.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.52,,,48.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,41.82,,,41.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.23,,,42.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.81,,,40.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.41,,,40.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.81,,,40.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.62,,,41.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.33,,,42.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,327.77,,,327.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,327.77,,,327.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,327.77,,,327.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,327.77,,,327.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9280 - MITOMYCIN INJECTION,J9280,HCPCS,,,JG,Outpatient,5,ME,43.5,10.875,26.1,327.77,,,,,,,,48.52,,,48.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.7,,,67.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,62.77,,,62.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,28.54,Percent of Total Billed Charges, ,48.52,,,48.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,30.45,Percent of Total Billed Charges, ,,85,,36.98,Percent of Total Billed Charges, ,46.35,,,46.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,29.58,Percent of Total Billed Charges,0,63.35,,,63.35,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,26.1,Percent of Total Billed Charges, ,62.13,,,62.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,48.52,,,48.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,41.82,,,41.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.23,,,42.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.81,,,40.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.41,,,40.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.81,,,40.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,41.62,,,41.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,42.33,,,42.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,327.77,,,327.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,327.77,,,327.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,327.77,,,327.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,327.77,,,327.77,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9281 - MITOMYCIN INSTILLATION,J9281,HCPCS,,,JZ,Outpatient,1,ME,3403.72,850.93,292.2,2893.16,,,,,,,,350.83,,,350.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,383.33,,,383.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,453.9,,,453.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2232.84,Percent of Total Billed Charges, ,350.83,,,350.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2382.6,Percent of Total Billed Charges, ,,85,,2893.16,Percent of Total Billed Charges, ,311.36,,,311.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2314.53,Percent of Total Billed Charges,0,300.75,,,300.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2042.23,Percent of Total Billed Charges, ,449.26,,,449.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,350.83,,,350.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,302.43,,,302.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,305.35,,,305.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,295.12,,,295.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.2,,,292.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,295.12,,,295.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,300.97,,,300.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,306.08,,,306.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,838.04,,,838.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,838.04,,,838.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,838.04,,,838.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,838.04,,,838.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9281 - MITOMYCIN INSTILLATION,J9281,HCPCS,,,JW,Outpatient,1,ME,1034.21,258.5525,292.2,879.08,,,,,,,,350.83,,,350.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,383.33,,,383.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,453.9,,,453.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,678.44,Percent of Total Billed Charges, ,350.83,,,350.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,723.95,Percent of Total Billed Charges, ,,85,,879.08,Percent of Total Billed Charges, ,311.36,,,311.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,703.26,Percent of Total Billed Charges,0,300.75,,,300.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,620.53,Percent of Total Billed Charges, ,449.26,,,449.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,350.83,,,350.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,302.43,,,302.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,305.35,,,305.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,295.12,,,295.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,292.2,,,292.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,295.12,,,295.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,300.97,,,300.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,306.08,,,306.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,838.04,,,838.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,838.04,,,838.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,838.04,,,838.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,838.04,,,838.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9298 - INJ NIVOL RELATLIMAB 3MG-1MG,J9298,HCPCS,,,TB,Outpatient,3,ME,714.49,178.6225,181.08,607.32,,,,,,,,217.42,,,217.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,238.13,,,238.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,281.29,,,281.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,468.71,Percent of Total Billed Charges, ,217.42,,,217.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,500.14,Percent of Total Billed Charges, ,,85,,607.32,Percent of Total Billed Charges, ,193.86,,,193.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,485.85,Percent of Total Billed Charges,0,187.15,,,187.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,428.69,Percent of Total Billed Charges, ,278.41,,,278.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,217.42,,,217.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,187.42,,,187.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,189.23,,,189.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.89,,,182.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.08,,,181.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.89,,,182.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,186.51,,,186.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,189.68,,,189.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,536.5,,,536.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,536.5,,,536.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,536.5,,,536.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,536.5,,,536.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9298 - INJ NIVOL RELATLIMAB 3MG-1MG,J9298,HCPCS,,,JZ,Outpatient,3,ME,535.36,133.84,181.08,536.5,,,,,,,,217.42,,,217.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,238.13,,,238.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,281.29,,,281.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,351.2,Percent of Total Billed Charges, ,217.42,,,217.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,374.75,Percent of Total Billed Charges, ,,85,,455.06,Percent of Total Billed Charges, ,193.86,,,193.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,364.04,Percent of Total Billed Charges,0,187.15,,,187.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,321.22,Percent of Total Billed Charges, ,278.41,,,278.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,217.42,,,217.42,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,187.42,,,187.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,189.23,,,189.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.89,,,182.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.08,,,181.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.89,,,182.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,186.51,,,186.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,189.68,,,189.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,536.5,,,536.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,536.5,,,536.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,536.5,,,536.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,536.5,,,536.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9299 - INJECTION NIVOLUMAB,J9299,HCPCS,,,JZ,Outpatient,1,ME,129.03,32.2575,30.19,109.68,,,,,,,,36.25,,,36.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.5,,,39.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.89,,,46.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,84.64,Percent of Total Billed Charges, ,36.25,,,36.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,90.32,Percent of Total Billed Charges, ,,85,,109.68,Percent of Total Billed Charges, ,32.3,,,32.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,87.74,Percent of Total Billed Charges,0,31.09,,,31.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,77.42,Percent of Total Billed Charges, ,46.42,,,46.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.25,,,36.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.25,,,31.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.55,,,31.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.49,,,30.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.19,,,30.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.49,,,30.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.1,,,31.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.62,,,31.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9299 - INJECTION NIVOLUMAB,J9299,HCPCS,,,JW,Outpatient,1,ME,37.95,9.4875,22.77,75.35,,,,,,,,36.25,,,36.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.5,,,39.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.89,,,46.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24.9,Percent of Total Billed Charges, ,36.25,,,36.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26.57,Percent of Total Billed Charges, ,,85,,32.26,Percent of Total Billed Charges, ,32.3,,,32.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25.81,Percent of Total Billed Charges,0,31.09,,,31.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,22.77,Percent of Total Billed Charges, ,46.42,,,46.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.25,,,36.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.25,,,31.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.55,,,31.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.49,,,30.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.19,,,30.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.49,,,30.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.1,,,31.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.62,,,31.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9299 - INJECTION NIVOLUMAB,J9299,HCPCS,,,JG,Outpatient,1,ME,119.96,29.99,30.19,101.97,,,,,,,,36.25,,,36.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.5,,,39.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.89,,,46.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,78.69,Percent of Total Billed Charges, ,36.25,,,36.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,83.97,Percent of Total Billed Charges, ,,85,,101.97,Percent of Total Billed Charges, ,32.3,,,32.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,81.57,Percent of Total Billed Charges,0,31.09,,,31.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,71.98,Percent of Total Billed Charges, ,46.42,,,46.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.25,,,36.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.25,,,31.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.55,,,31.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.49,,,30.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.19,,,30.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.49,,,30.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.1,,,31.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.62,,,31.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,75.35,,,75.35,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9301 - OBINUTUZUMAB INJ,J9301,HCPCS,,,JZ,Outpatient,10,ME,364.35,91.0875,70.34,309.7,,,,,,,,85.14,,,85.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,92.69,,,92.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,110.16,,,110.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,239.01,Percent of Total Billed Charges, ,85.14,,,85.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,255.05,Percent of Total Billed Charges, ,,85,,309.7,Percent of Total Billed Charges, ,74.83,,,74.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,247.76,Percent of Total Billed Charges,0,70.34,,,70.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,218.61,Percent of Total Billed Charges, ,109.02,,,109.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.14,,,85.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.39,,,73.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.1,,,74.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.62,,,71.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.91,,,70.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.62,,,71.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.04,,,73.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.28,,,74.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9301 - OBINUTUZUMAB INJ,J9301,HCPCS,,,JW,Outpatient,10,ME,98.9,24.725,59.34,161.09,,,,,,,,85.14,,,85.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,92.69,,,92.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,110.16,,,110.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,64.88,Percent of Total Billed Charges, ,85.14,,,85.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,69.23,Percent of Total Billed Charges, ,,85,,84.07,Percent of Total Billed Charges, ,74.83,,,74.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,67.25,Percent of Total Billed Charges,0,70.34,,,70.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,59.34,Percent of Total Billed Charges, ,109.02,,,109.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.14,,,85.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.39,,,73.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.1,,,74.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.62,,,71.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.91,,,70.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.62,,,71.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.04,,,73.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.28,,,74.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9301 - OBINUTUZUMAB INJ,J9301,HCPCS,,,JG,Outpatient,10,ME,263.08,65.77,70.34,223.62,,,,,,,,85.14,,,85.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,92.69,,,92.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,110.16,,,110.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,172.58,Percent of Total Billed Charges, ,85.14,,,85.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,184.16,Percent of Total Billed Charges, ,,85,,223.62,Percent of Total Billed Charges, ,74.83,,,74.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,178.89,Percent of Total Billed Charges,0,70.34,,,70.34,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,157.85,Percent of Total Billed Charges, ,109.02,,,109.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,85.14,,,85.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,73.39,,,73.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.1,,,74.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.62,,,71.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.91,,,70.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.62,,,71.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.04,,,73.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.28,,,74.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,161.09,,,161.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9303 - PANITUMUMAB INJECTION,J9303,HCPCS,,,JZ,Outpatient,10,ME,816.7,204.175,150.66,694.2,,,,,,,,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,198.36,,,198.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,235.3,,,235.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,535.76,Percent of Total Billed Charges, ,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,571.69,Percent of Total Billed Charges, ,,85,,694.2,Percent of Total Billed Charges, ,165.71,,,165.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,555.36,Percent of Total Billed Charges,0,150.66,,,150.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,490.02,Percent of Total Billed Charges, ,232.9,,,232.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,156.78,,,156.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,158.3,,,158.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.99,,,152.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.48,,,151.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.99,,,152.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.02,,,156.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,158.68,,,158.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9303 - PANITUMUMAB INJECTION,J9303,HCPCS,,,JW,Outpatient,10,ME,207.93,51.9825,124.76,246.12,,,,,,,,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,198.36,,,198.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,235.3,,,235.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,136.4,Percent of Total Billed Charges, ,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,145.55,Percent of Total Billed Charges, ,,85,,176.74,Percent of Total Billed Charges, ,165.71,,,165.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,141.39,Percent of Total Billed Charges,0,150.66,,,150.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,124.76,Percent of Total Billed Charges, ,232.9,,,232.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,156.78,,,156.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,158.3,,,158.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.99,,,152.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.48,,,151.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.99,,,152.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.02,,,156.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,158.68,,,158.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9303 - PANITUMUMAB INJECTION,J9303,HCPCS,,,JG,Outpatient,10,ME,614.4,153.6,150.66,522.24,,,,,,,,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,198.36,,,198.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,235.3,,,235.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,403.05,Percent of Total Billed Charges, ,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,430.08,Percent of Total Billed Charges, ,,85,,522.24,Percent of Total Billed Charges, ,165.71,,,165.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,417.79,Percent of Total Billed Charges,0,150.66,,,150.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,368.64,Percent of Total Billed Charges, ,232.9,,,232.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,181.87,,,181.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,156.78,,,156.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,158.3,,,158.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.99,,,152.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.48,,,151.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.99,,,152.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.02,,,156.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,158.68,,,158.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,246.12,,,246.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9305 - INJ. PEMETREXED NOS 10MG,J9305,HCPCS,,,KP,Outpatient,10,ME,15.55,3.8875,3.98,120.4,,,,,,,,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.03,,,7.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.19,,,6.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10.2,Percent of Total Billed Charges, ,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,10.89,Percent of Total Billed Charges, ,,85,,13.22,Percent of Total Billed Charges, ,5.27,,,5.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,10.57,Percent of Total Billed Charges,0,4.37,,,4.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,9.33,Percent of Total Billed Charges, ,6.12,,,6.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.12,,,4.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.16,,,4.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.02,,,4.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.98,,,3.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.02,,,4.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.1,,,4.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.17,,,4.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9305 - INJ. PEMETREXED NOS 10MG,J9305,HCPCS,,,JZ,Outpatient,10,ME,7.27,1.8175,3.98,120.4,,,,,,,,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.03,,,7.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.19,,,6.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4.77,Percent of Total Billed Charges, ,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5.09,Percent of Total Billed Charges, ,,85,,6.18,Percent of Total Billed Charges, ,5.27,,,5.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4.94,Percent of Total Billed Charges,0,4.37,,,4.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,4.36,Percent of Total Billed Charges, ,6.12,,,6.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.12,,,4.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.16,,,4.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.02,,,4.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.98,,,3.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.02,,,4.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.1,,,4.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.17,,,4.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9305 - INJ. PEMETREXED NOS 10MG,J9305,HCPCS,,,JW,Outpatient,10,ME,3.16,0.79,1.9,120.4,,,,,,,,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.03,,,7.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.19,,,6.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.07,Percent of Total Billed Charges, ,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.21,Percent of Total Billed Charges, ,,85,,2.69,Percent of Total Billed Charges, ,5.27,,,5.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2.15,Percent of Total Billed Charges,0,4.37,,,4.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.9,Percent of Total Billed Charges, ,6.12,,,6.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.12,,,4.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.16,,,4.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.02,,,4.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.98,,,3.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.02,,,4.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.1,,,4.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.17,,,4.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9305 - INJ. PEMETREXED NOS 10MG,J9305,HCPCS,,,JG,Outpatient,10,ME,9.91,2.4775,3.98,120.4,,,,,,,,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.03,,,7.03,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6.19,,,6.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6.5,Percent of Total Billed Charges, ,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6.94,Percent of Total Billed Charges, ,,85,,8.42,Percent of Total Billed Charges, ,5.27,,,5.27,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6.74,Percent of Total Billed Charges,0,4.37,,,4.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,5.95,Percent of Total Billed Charges, ,6.12,,,6.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.77,,,4.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4.12,,,4.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.16,,,4.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.02,,,4.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.98,,,3.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.02,,,4.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.1,,,4.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4.17,,,4.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,120.4,,,120.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9306 - INJECTION PERTUZUMAB 1 MG,J9306,HCPCS,,,JZ,Outpatient,1,ME,61.49,15.3725,15.32,52.27,,,,,,,,18.4,,,18.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,19.94,,,19.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.8,,,23.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,40.34,Percent of Total Billed Charges, ,18.4,,,18.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,43.04,Percent of Total Billed Charges, ,,85,,52.27,Percent of Total Billed Charges, ,16.19,,,16.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,41.81,Percent of Total Billed Charges,0,15.43,,,15.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,36.89,Percent of Total Billed Charges, ,23.55,,,23.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.4,,,18.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.86,,,15.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.01,,,16.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.47,,,15.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.32,,,15.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.47,,,15.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,15.78,,,15.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.05,,,16.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.07,,,31.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,31.07,,,31.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,31.07,,,31.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,31.07,,,31.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9307 - PRALATREXATE INJECTION,J9307,HCPCS,,,JZ,Outpatient,1,ME,1828.3,457.075,289.14,1554.06,,,,,,,,426.66,,,426.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,373.91,,,373.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,552,,,552,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1199.36,Percent of Total Billed Charges, ,426.66,,,426.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1279.81,Percent of Total Billed Charges, ,,85,,1554.06,Percent of Total Billed Charges, ,373.77,,,373.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1243.24,Percent of Total Billed Charges,0,289.14,,,289.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1096.98,Percent of Total Billed Charges, ,546.37,,,546.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,426.66,,,426.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,367.8,,,367.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,371.35,,,371.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.91,,,358.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.36,,,355.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.91,,,358.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,366.02,,,366.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,372.24,,,372.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,491.89,,,491.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.89,,,491.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.89,,,491.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.89,,,491.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9307 - PRALATREXATE INJECTION,J9307,HCPCS,,,JW,Outpatient,1,ME,426.82,106.705,256.09,552,,,,,,,,426.66,,,426.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,373.91,,,373.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,552,,,552,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,279.99,Percent of Total Billed Charges, ,426.66,,,426.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,298.77,Percent of Total Billed Charges, ,,85,,362.8,Percent of Total Billed Charges, ,373.77,,,373.77,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,290.24,Percent of Total Billed Charges,0,289.14,,,289.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,256.09,Percent of Total Billed Charges, ,546.37,,,546.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,426.66,,,426.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,367.8,,,367.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,371.35,,,371.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.91,,,358.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,355.36,,,355.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,358.91,,,358.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,366.02,,,366.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,372.24,,,372.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,491.89,,,491.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.89,,,491.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.89,,,491.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,491.89,,,491.89,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9309 - INJ POLATUZUMAB VEDOTIN 1MG,J9309,HCPCS,,,JZ,Outpatient,1,ME,585.62,146.405,123.39,497.78,,,,,,,,148.15,,,148.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,162.45,,,162.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,191.67,,,191.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,384.17,Percent of Total Billed Charges, ,148.15,,,148.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,409.93,Percent of Total Billed Charges, ,,85,,497.78,Percent of Total Billed Charges, ,132.92,,,132.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,398.22,Percent of Total Billed Charges,0,124.29,,,124.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,351.37,Percent of Total Billed Charges, ,189.71,,,189.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.15,,,148.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,127.71,,,127.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.94,,,128.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.62,,,124.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.39,,,123.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.62,,,124.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.09,,,127.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.25,,,129.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9309 - INJ POLATUZUMAB VEDOTIN 1MG,J9309,HCPCS,,,JW,Outpatient,1,ME,156.5,39.125,93.9,336.74,,,,,,,,148.15,,,148.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,162.45,,,162.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,191.67,,,191.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,102.66,Percent of Total Billed Charges, ,148.15,,,148.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,109.55,Percent of Total Billed Charges, ,,85,,133.03,Percent of Total Billed Charges, ,132.92,,,132.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,106.42,Percent of Total Billed Charges,0,124.29,,,124.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,93.9,Percent of Total Billed Charges, ,189.71,,,189.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.15,,,148.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,127.71,,,127.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.94,,,128.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.62,,,124.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.39,,,123.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.62,,,124.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.09,,,127.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.25,,,129.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9309 - INJ POLATUZUMAB VEDOTIN 1MG,J9309,HCPCS,,,JG,Outpatient,1,ME,618.48,154.62,123.39,525.71,,,,,,,,148.15,,,148.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,162.45,,,162.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,191.67,,,191.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,405.72,Percent of Total Billed Charges, ,148.15,,,148.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,432.94,Percent of Total Billed Charges, ,,85,,525.71,Percent of Total Billed Charges, ,132.92,,,132.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,420.57,Percent of Total Billed Charges,0,124.29,,,124.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,371.09,Percent of Total Billed Charges, ,189.71,,,189.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.15,,,148.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,127.71,,,127.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.94,,,128.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.62,,,124.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.39,,,123.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.62,,,124.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.09,,,127.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,129.25,,,129.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,336.74,,,336.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9312 - INJ. RITUXIMAB 10 MG,J9312,HCPCS,,,JZ,Outpatient,10,ME,487.05,121.7625,73.51,413.99,,,,,,,,88.25,,,88.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,97.1,,,97.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,114.18,,,114.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,319.5,Percent of Total Billed Charges, ,88.25,,,88.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,340.94,Percent of Total Billed Charges, ,,85,,413.99,Percent of Total Billed Charges, ,76.73,,,76.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,331.19,Percent of Total Billed Charges,0,79.2,,,79.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,292.23,Percent of Total Billed Charges, ,113.02,,,113.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.25,,,88.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,76.08,,,76.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.82,,,76.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.51,,,73.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.72,,,75.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77,,,77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.34,,,283.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,283.34,,,283.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,283.34,,,283.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,283.34,,,283.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9312 - INJ. RITUXIMAB 10 MG,J9312,HCPCS,,,JW,Outpatient,10,ME,112.75,28.1875,67.65,283.34,,,,,,,,88.25,,,88.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,97.1,,,97.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,114.18,,,114.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,73.96,Percent of Total Billed Charges, ,88.25,,,88.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,78.93,Percent of Total Billed Charges, ,,85,,95.84,Percent of Total Billed Charges, ,76.73,,,76.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,76.67,Percent of Total Billed Charges,0,79.2,,,79.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,67.65,Percent of Total Billed Charges, ,113.02,,,113.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,88.25,,,88.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,76.08,,,76.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,76.82,,,76.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.51,,,73.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,75.72,,,75.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77,,,77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.34,,,283.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,283.34,,,283.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,283.34,,,283.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,283.34,,,283.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9316 - PERTUZU TRASTUZU 10 MG,J9316,HCPCS,,,JZ,Outpatient,10,ME,49913.05,12478.2625,61.39,42426.09,,,,,,,,73.71,,,73.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,82.9,,,82.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,95.37,,,95.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,32742.96,Percent of Total Billed Charges, ,73.71,,,73.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,34939.14,Percent of Total Billed Charges, ,,85,,42426.09,Percent of Total Billed Charges, ,63.88,,,63.88,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,33940.87,Percent of Total Billed Charges,0,67.05,,,67.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,29947.83,Percent of Total Billed Charges, ,94.39,,,94.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,73.71,,,73.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,63.54,,,63.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.15,,,64.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62,,,62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,61.39,,,61.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62,,,62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,63.23,,,63.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,64.31,,,64.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,239,,,239,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,239,,,239,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,239,,,239,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,239,,,239,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9317 - SACITUZUMAB GOVITECAN-HZIY,J9317,HCPCS,,,JW,Outpatient,2.5,ME,41.07,10.2675,24.64,87.64,,,,,,,,39.58,,,39.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.66,,,43.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,51.2,,,51.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,26.94,Percent of Total Billed Charges, ,39.58,,,39.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,28.75,Percent of Total Billed Charges, ,,85,,34.91,Percent of Total Billed Charges, ,35.44,,,35.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,27.93,Percent of Total Billed Charges,0,34.08,,,34.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,24.64,Percent of Total Billed Charges, ,50.68,,,50.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.58,,,39.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.11,,,34.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.44,,,34.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.29,,,33.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.96,,,32.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.29,,,33.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.95,,,33.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.53,,,34.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.64,,,87.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,87.64,,,87.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,87.64,,,87.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,87.64,,,87.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9317 - SACITUZUMAB GOVITECAN-HZIY,J9317,HCPCS,,,JG,Outpatient,2.5,ME,159.23,39.8075,32.96,135.35,,,,,,,,39.58,,,39.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,43.66,,,43.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,51.2,,,51.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,104.45,Percent of Total Billed Charges, ,39.58,,,39.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,111.46,Percent of Total Billed Charges, ,,85,,135.35,Percent of Total Billed Charges, ,35.44,,,35.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,108.28,Percent of Total Billed Charges,0,34.08,,,34.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,95.54,Percent of Total Billed Charges, ,50.68,,,50.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.58,,,39.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.11,,,34.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.44,,,34.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.29,,,33.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.96,,,32.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.29,,,33.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.95,,,33.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.53,,,34.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,87.64,,,87.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,87.64,,,87.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,87.64,,,87.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,87.64,,,87.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9332 - INJ EFGARTIGIMOD 2MG,J9332,HCPCS,,,TB,Outpatient,2,ME,64.82,16.205,30.96,93.64,,,,,,,,37.18,,,37.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.15,,,40.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.1,,,48.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,42.52,Percent of Total Billed Charges, ,37.18,,,37.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,45.37,Percent of Total Billed Charges, ,,85,,55.1,Percent of Total Billed Charges, ,32.45,,,32.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,44.08,Percent of Total Billed Charges,0,32.08,,,32.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,38.89,Percent of Total Billed Charges, ,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.18,,,37.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.04,,,32.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.35,,,32.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.27,,,31.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.96,,,30.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.27,,,31.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.89,,,31.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.43,,,32.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.64,,,93.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,93.64,,,93.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,93.64,,,93.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,93.64,,,93.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9332 - INJ EFGARTIGIMOD 2MG,J9332,HCPCS,,,JZ,Outpatient,2,ME,65.24,16.31,30.96,93.64,,,,,,,,37.18,,,37.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.15,,,40.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.1,,,48.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,42.8,Percent of Total Billed Charges, ,37.18,,,37.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,45.67,Percent of Total Billed Charges, ,,85,,55.45,Percent of Total Billed Charges, ,32.45,,,32.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,44.36,Percent of Total Billed Charges,0,32.08,,,32.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,39.14,Percent of Total Billed Charges, ,47.6,,,47.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.18,,,37.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.04,,,32.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.35,,,32.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.27,,,31.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.96,,,30.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.27,,,31.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.89,,,31.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.43,,,32.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,93.64,,,93.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,93.64,,,93.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,93.64,,,93.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,93.64,,,93.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9334 - INJ EFGART-ALFA 2MG HYA-QVFC      I,J9334,HCPCS,,,JZ,Outpatient,2,ME,66.1,16.525,31.5,105.94,,,,,,,,37.82,,,37.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,41.41,,,41.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.92,,,48.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.36,Percent of Total Billed Charges, ,37.82,,,37.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.27,Percent of Total Billed Charges, ,,85,,56.19,Percent of Total Billed Charges, ,33.1,,,33.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,44.95,Percent of Total Billed Charges,0,32.24,,,32.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,39.66,Percent of Total Billed Charges, ,48.43,,,48.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.82,,,37.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.6,,,32.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.92,,,32.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.82,,,31.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.5,,,31.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.82,,,31.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.45,,,32.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33,,,33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.94,,,105.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.94,,,105.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.94,,,105.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,105.94,,,105.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9347 - INJ TREMELIMUMAB-ACTL 1 MGG       I,J9347,HCPCS,,,TB,Outpatient,1,ME,680.66,170.165,128.78,578.56,,,,,,,,154.62,,,154.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,169.45,,,169.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.04,,,200.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,446.51,Percent of Total Billed Charges, ,154.62,,,154.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,476.46,Percent of Total Billed Charges, ,,85,,578.56,Percent of Total Billed Charges, ,138.43,,,138.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,462.85,Percent of Total Billed Charges,0,136.09,,,136.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,408.4,Percent of Total Billed Charges, ,198,,,198,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.62,,,154.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,133.29,,,133.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,134.58,,,134.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.07,,,130.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.78,,,128.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.07,,,130.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.64,,,132.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,134.9,,,134.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,405.58,,,405.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,405.58,,,405.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,405.58,,,405.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,405.58,,,405.58,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9354 - INJ ADO-TRASTUZUMAB EMT 1MG,J9354,HCPCS,,,JZ,Outpatient,1,ME,193.44,48.36,38.37,164.42,,,,,,,,46.17,,,46.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.05,,,50.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.74,,,59.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,126.9,Percent of Total Billed Charges, ,46.17,,,46.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,135.41,Percent of Total Billed Charges, ,,85,,164.42,Percent of Total Billed Charges, ,40.97,,,40.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,131.54,Percent of Total Billed Charges,0,38.37,,,38.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,116.06,Percent of Total Billed Charges, ,59.12,,,59.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.17,,,46.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.8,,,39.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.18,,,40.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.83,,,38.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.45,,,38.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.83,,,38.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.6,,,39.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.28,,,40.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9354 - INJ ADO-TRASTUZUMAB EMT 1MG,J9354,HCPCS,,,JW,Outpatient,1,ME,45.56,11.39,27.34,86.63,,,,,,,,46.17,,,46.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.05,,,50.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.74,,,59.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,29.89,Percent of Total Billed Charges, ,46.17,,,46.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,31.89,Percent of Total Billed Charges, ,,85,,38.73,Percent of Total Billed Charges, ,40.97,,,40.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,30.98,Percent of Total Billed Charges,0,38.37,,,38.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,27.34,Percent of Total Billed Charges, ,59.12,,,59.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.17,,,46.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.8,,,39.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.18,,,40.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.83,,,38.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.45,,,38.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.83,,,38.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.6,,,39.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.28,,,40.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9354 - INJ ADO-TRASTUZUMAB EMT 1MG,J9354,HCPCS,,,JG,Outpatient,1,ME,156.08,39.02,38.37,132.67,,,,,,,,46.17,,,46.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.05,,,50.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.74,,,59.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,102.39,Percent of Total Billed Charges, ,46.17,,,46.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,109.26,Percent of Total Billed Charges, ,,85,,132.67,Percent of Total Billed Charges, ,40.97,,,40.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,106.13,Percent of Total Billed Charges,0,38.37,,,38.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,93.65,Percent of Total Billed Charges, ,59.12,,,59.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.17,,,46.17,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.8,,,39.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.18,,,40.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.83,,,38.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.45,,,38.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.83,,,38.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.6,,,39.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,40.28,,,40.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,86.63,,,86.63,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9358 - INJ FAM-TRASTU DERU-NXKI 1MG,J9358,HCPCS,,,JZ,Outpatient,1,ME,58.29,14.5725,26.44,71.84,,,,,,,,31.75,,,31.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.69,,,34.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,41.07,,,41.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,38.24,Percent of Total Billed Charges, ,31.75,,,31.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,40.8,Percent of Total Billed Charges, ,,85,,49.55,Percent of Total Billed Charges, ,28.81,,,28.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,39.64,Percent of Total Billed Charges,0,27.24,,,27.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,34.97,Percent of Total Billed Charges, ,40.65,,,40.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.75,,,31.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.37,,,27.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.63,,,27.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.7,,,26.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.44,,,26.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.7,,,26.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.23,,,27.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.7,,,27.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9358 - INJ FAM-TRASTU DERU-NXKI 1MG,J9358,HCPCS,,,JW,Outpatient,1,ME,28.39,7.0975,17.03,71.84,,,,,,,,31.75,,,31.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.69,,,34.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,41.07,,,41.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,18.62,Percent of Total Billed Charges, ,31.75,,,31.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,19.87,Percent of Total Billed Charges, ,,85,,24.13,Percent of Total Billed Charges, ,28.81,,,28.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,19.31,Percent of Total Billed Charges,0,27.24,,,27.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,17.03,Percent of Total Billed Charges, ,40.65,,,40.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.75,,,31.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.37,,,27.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.63,,,27.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.7,,,26.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.44,,,26.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.7,,,26.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.23,,,27.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.7,,,27.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9358 - INJ FAM-TRASTU DERU-NXKI 1MG,J9358,HCPCS,,,JG,Outpatient,1,ME,74.02,18.505,26.44,71.84,,,,,,,,31.75,,,31.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.69,,,34.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,41.07,,,41.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,48.56,Percent of Total Billed Charges, ,31.75,,,31.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,51.81,Percent of Total Billed Charges, ,,85,,62.92,Percent of Total Billed Charges, ,28.81,,,28.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,50.33,Percent of Total Billed Charges,0,27.24,,,27.24,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,44.41,Percent of Total Billed Charges, ,40.65,,,40.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.75,,,31.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.37,,,27.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.63,,,27.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.7,,,26.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.44,,,26.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.7,,,26.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.23,,,27.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.7,,,27.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.84,,,71.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J9395 - INJECTION FULVESTRANT,J9395,HCPCS,,,JZ,Outpatient,25,ME,273.67,68.4175,6.66,239.56,,,,,,,,8.57,,,8.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,10.91,,,10.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.08,,,11.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,179.53,Percent of Total Billed Charges, ,8.57,,,8.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,191.57,Percent of Total Billed Charges, ,,85,,232.62,Percent of Total Billed Charges, ,6.66,,,6.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,186.1,Percent of Total Billed Charges,0,8.45,,,8.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,164.2,Percent of Total Billed Charges, ,10.98,,,10.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.57,,,8.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.39,,,7.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.21,,,7.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.14,,,7.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.21,,,7.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.35,,,7.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.48,,,7.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,239.56,,,239.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,239.56,,,239.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,239.56,,,239.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,239.56,,,239.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
P9045 - ALBUMIN (HUMAN) 5PERCENT 250 ML,P9045,HCPCS,,,JW,Outpatient,250,ML,190.1,47.525,50.46,162.4,,,,,,,,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.36,,,59.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,78.39,,,78.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,124.71,Percent of Total Billed Charges, ,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,133.07,Percent of Total Billed Charges, ,,85,,161.59,Percent of Total Billed Charges, ,53.08,,,53.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,129.27,Percent of Total Billed Charges,0,53.08,,,53.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,114.06,Percent of Total Billed Charges, ,77.58,,,77.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.23,,,52.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.73,,,52.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.96,,,50.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.46,,,50.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.96,,,50.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.97,,,51.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.86,,,52.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.4,,,162.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,162.4,,,162.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,162.4,,,162.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,162.4,,,162.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
P9045 - ALBUMIN (HUMAN) 5PERCENT 250 ML,P9045,HCPCS,,,JG,Outpatient,250,ML,103.89,25.9725,50.46,162.4,,,,,,,,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,59.36,,,59.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,78.39,,,78.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,68.15,Percent of Total Billed Charges, ,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,72.72,Percent of Total Billed Charges, ,,85,,88.31,Percent of Total Billed Charges, ,53.08,,,53.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,70.65,Percent of Total Billed Charges,0,53.08,,,53.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,62.33,Percent of Total Billed Charges, ,77.58,,,77.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,52.23,,,52.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.73,,,52.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.96,,,50.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.46,,,50.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.96,,,50.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.97,,,51.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.86,,,52.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,162.4,,,162.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,162.4,,,162.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,162.4,,,162.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,162.4,,,162.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
P9047 - ALBUMIN (HUMAN) 25PERCENT 50ML,P9047,HCPCS,,,TB,Outpatient,50,ML,300.03,75.0075,0.01,255.03,,,,,,,,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,57.38,,,57.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,196.82,Percent of Total Billed Charges, ,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,210.02,Percent of Total Billed Charges, ,,85,,255.03,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,204.02,Percent of Total Billed Charges,0,53.08,,,53.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,180.02,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.06,,,152.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,152.06,,,152.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,152.06,,,152.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,152.06,,,152.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
P9047 - ALBUMIN (HUMAN) 25PERCENT 50ML,P9047,HCPCS,,,JG,Outpatient,50,ML,214.16,53.54,0.01,182.04,,,,,,,,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,57.38,,,57.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,140.49,Percent of Total Billed Charges, ,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,149.91,Percent of Total Billed Charges, ,,85,,182.04,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,145.63,Percent of Total Billed Charges,0,53.08,,,53.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,128.5,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,60.59,,,60.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.06,,,152.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,152.06,,,152.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,152.06,,,152.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,152.06,,,152.06,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q0138 - FERUMOXYTOL NON-ESRD,Q0138,HCPCS,,,JZ,Outpatient,1,ME,8.38,2.095,0.32,7.12,,,,,,,,0.39,,,0.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.41,,,0.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.49,,,0.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5.5,Percent of Total Billed Charges, ,0.39,,,0.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5.87,Percent of Total Billed Charges, ,,85,,7.12,Percent of Total Billed Charges, ,0.38,,,0.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5.7,Percent of Total Billed Charges,0,0.36,,,0.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,5.03,Percent of Total Billed Charges, ,0.49,,,0.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.39,,,0.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.33,,,0.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.33,,,0.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.32,,,0.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.32,,,0.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.32,,,0.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.33,,,0.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q2009 - FOSPHENYTOIN INJ PE,Q2009,HCPCS,,,JZ,Outpatient,,,26.09,6.5225,0.01,22.18,,,,,,,,3.97,,,3.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.19,,,3.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17.12,Percent of Total Billed Charges, ,3.97,,,3.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18.26,Percent of Total Billed Charges, ,,85,,22.18,Percent of Total Billed Charges, ,,,,,,,,68,,17.74,Percent of Total Billed Charges,0,4.8,,,4.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,15.65,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.97,,,3.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.16,,,16.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.16,,,16.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.16,,,16.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.16,,,16.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q2009 - FOSPHENYTOIN INJ PE,Q2009,HCPCS,,,JW,Outpatient,,,4.35,1.0875,0.01,16.16,,,,,,,,3.97,,,3.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3.19,,,3.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.85,Percent of Total Billed Charges, ,3.97,,,3.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.05,Percent of Total Billed Charges, ,,85,,3.7,Percent of Total Billed Charges, ,,,,,,,,68,,2.96,Percent of Total Billed Charges,0,4.8,,,4.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.61,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.97,,,3.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.16,,,16.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.16,,,16.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.16,,,16.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,16.16,,,16.16,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q2050 - DOXORUBICIN INJ 10MG,Q2050,HCPCS,,,JZ,Outpatient,10,ME,1393.16,348.29,85.48,10435.04,,,,,,,,151.91,,,151.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,170.29,,,170.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.54,,,196.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,913.91,Percent of Total Billed Charges, ,151.91,,,151.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,975.21,Percent of Total Billed Charges, ,,85,,1184.19,Percent of Total Billed Charges, ,136.05,,,136.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,947.35,Percent of Total Billed Charges,0,85.48,,,85.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,835.9,Percent of Total Billed Charges, ,194.52,,,194.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.91,,,151.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.95,,,130.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.21,,,132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.79,,,127.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.52,,,126.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.79,,,127.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.32,,,130.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.53,,,132.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q2050 - DOXORUBICIN INJ 10MG,Q2050,HCPCS,,,JW,Outpatient,10,ME,324,81,85.48,10435.04,,,,,,,,151.91,,,151.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,170.29,,,170.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.54,,,196.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,212.54,Percent of Total Billed Charges, ,151.91,,,151.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,226.8,Percent of Total Billed Charges, ,,85,,275.4,Percent of Total Billed Charges, ,136.05,,,136.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,220.32,Percent of Total Billed Charges,0,85.48,,,85.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,194.4,Percent of Total Billed Charges, ,194.52,,,194.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.91,,,151.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.95,,,130.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.21,,,132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.79,,,127.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.52,,,126.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.79,,,127.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.32,,,130.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.53,,,132.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q2050 - DOXORUBICIN INJ 10MG,Q2050,HCPCS,,,JG,Outpatient,10,ME,959.04,239.76,85.48,10435.04,,,,,,,,151.91,,,151.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,170.29,,,170.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,196.54,,,196.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,629.13,Percent of Total Billed Charges, ,151.91,,,151.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,671.33,Percent of Total Billed Charges, ,,85,,815.18,Percent of Total Billed Charges, ,136.05,,,136.05,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,652.15,Percent of Total Billed Charges,0,85.48,,,85.48,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,575.42,Percent of Total Billed Charges, ,194.52,,,194.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.91,,,151.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,130.95,,,130.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.21,,,132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.79,,,127.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.52,,,126.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127.79,,,127.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.32,,,130.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.53,,,132.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,10435.04,,,10435.04,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5101 - INJECTION ZARXIO,Q5101,HCPCS,,,TB,Outpatient,1,GR,4.74,1.185,0.31,4.03,,,,,,,,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.31,,,0.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.54,,,0.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.11,Percent of Total Billed Charges, ,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.32,Percent of Total Billed Charges, ,,85,,4.03,Percent of Total Billed Charges, ,0.36,,,0.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,3.22,Percent of Total Billed Charges,0,0.32,,,0.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.84,Percent of Total Billed Charges, ,0.52,,,0.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.35,,,0.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.36,,,0.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.35,,,0.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.36,,,0.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5101 - INJECTION ZARXIO,Q5101,HCPCS,,,JZ,Outpatient,1,GR,4.74,1.185,0.31,4.03,,,,,,,,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.31,,,0.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.54,,,0.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.11,Percent of Total Billed Charges, ,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.32,Percent of Total Billed Charges, ,,85,,4.03,Percent of Total Billed Charges, ,0.36,,,0.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,3.22,Percent of Total Billed Charges,0,0.32,,,0.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.84,Percent of Total Billed Charges, ,0.52,,,0.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.35,,,0.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.36,,,0.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.35,,,0.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.36,,,0.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5101 - INJECTION ZARXIO,Q5101,HCPCS,,,JG,Outpatient,1,GR,4.17,1.0425,0.31,3.54,,,,,,,,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.31,,,0.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.54,,,0.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.74,Percent of Total Billed Charges, ,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.92,Percent of Total Billed Charges, ,,85,,3.54,Percent of Total Billed Charges, ,0.36,,,0.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,2.84,Percent of Total Billed Charges,0,0.32,,,0.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.5,Percent of Total Billed Charges, ,0.52,,,0.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.35,,,0.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.36,,,0.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.35,,,0.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.36,,,0.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5101 - INJECTION ZARXIO,Q5101,HCPCS,,,JB,Outpatient,1,GR,4.42,1.105,0.31,3.76,,,,,,,,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.31,,,0.31,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.54,,,0.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.9,Percent of Total Billed Charges, ,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.09,Percent of Total Billed Charges, ,,85,,3.76,Percent of Total Billed Charges, ,0.36,,,0.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,3.01,Percent of Total Billed Charges,0,0.32,,,0.32,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.65,Percent of Total Billed Charges, ,0.52,,,0.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.37,,,0.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.35,,,0.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.36,,,0.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.34,,,0.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.35,,,0.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.36,,,0.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.88,,,2.88,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5103 - INJECTION INFLECTRA,Q5103,HCPCS,,,JZ,Outpatient,10,ME,200,50,11.55,170.12,,,,,,,,13.54,,,13.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.33,,,13.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.11,,,20.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.2,Percent of Total Billed Charges, ,13.54,,,13.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140,Percent of Total Billed Charges, ,,85,,170,Percent of Total Billed Charges, ,11.55,,,11.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,136,Percent of Total Billed Charges,0,14.29,,,14.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,120,Percent of Total Billed Charges, ,19.91,,,19.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.54,,,13.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,13.4,,,13.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.53,,,13.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.08,,,13.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,12.95,,,12.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.08,,,13.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.34,,,13.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,13.57,,,13.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.12,,,170.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.12,,,170.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.12,,,170.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.12,,,170.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5104 - INJECTION RENFLEXIS,Q5104,HCPCS,,,JZ,Outpatient,10,ME,253.4,63.35,25.84,215.39,,,,,,,,29.95,,,29.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,37.39,,,37.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.15,,,40.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,166.23,Percent of Total Billed Charges, ,29.95,,,29.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,177.38,Percent of Total Billed Charges, ,,85,,215.39,Percent of Total Billed Charges, ,26.26,,,26.26,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,172.31,Percent of Total Billed Charges,0,31.5,,,31.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,152.04,Percent of Total Billed Charges, ,39.73,,,39.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,29.95,,,29.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.74,,,26.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27,,,27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.1,,,26.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.84,,,25.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.1,,,26.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.62,,,26.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,27.07,,,27.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,183.84,,,183.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,183.84,,,183.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,183.84,,,183.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,183.84,,,183.84,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JZ,Outpatient,100,UN,4.96,1.24,0.72,4.22,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.25,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.47,Percent of Total Billed Charges, ,,85,,4.22,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,3.37,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.98,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JW,Outpatient,100,UN,1.29,0.3225,0.72,3.39,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.85,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.9,Percent of Total Billed Charges, ,,85,,1.1,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.2,,0.88,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.77,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JG,Outpatient,100,UN,2.58,0.645,0.72,3.39,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.69,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.81,Percent of Total Billed Charges, ,,85,,2.19,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.8,,1.75,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.55,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JB,Outpatient,100,UN,5.72,1.43,0.72,4.86,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.75,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4,Percent of Total Billed Charges, ,,85,,4.86,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.89,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.43,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5105 - INJ RETACRIT ESRD ON DIALYSI,Q5105,HCPCS,,,JA,Outpatient,100,UN,4.41,1.1025,0.72,3.75,,,,,,,,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.85,,,0.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.13,,,1.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.89,Percent of Total Billed Charges, ,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.09,Percent of Total Billed Charges, ,,85,,3.75,Percent of Total Billed Charges, ,0.75,,,0.75,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3,Percent of Total Billed Charges,0,0.78,,,0.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.65,Percent of Total Billed Charges, ,1.11,,,1.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.87,,,0.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.72,,,0.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.73,,,0.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.74,,,0.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.75,,,0.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,3.39,,,3.39,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,JZ,Outpatient,1000,UN,42.14,10.535,7.24,35.82,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.64,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.5,Percent of Total Billed Charges, ,,85,,35.82,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.66,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,25.28,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,JW,Outpatient,1000,UN,13.24,3.31,7.24,33.74,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8.69,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9.27,Percent of Total Billed Charges, ,,85,,11.25,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,9,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,7.94,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,JG,Outpatient,1000,UN,26.43,6.6075,7.24,33.74,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,17.34,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,18.5,Percent of Total Billed Charges, ,,85,,22.47,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,17.97,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,15.86,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,EC,Outpatient,1000,UN,37.51,9.3775,7.24,33.74,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,24.61,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,26.26,Percent of Total Billed Charges, ,,85,,31.88,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,25.51,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,22.51,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5106 - INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,,,EA,Outpatient,1000,UN,42.58,10.645,7.24,36.19,,,,,,,,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.53,,,8.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.26,,,11.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.93,Percent of Total Billed Charges, ,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.81,Percent of Total Billed Charges, ,,85,,36.19,Percent of Total Billed Charges, ,7.47,,,7.47,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,28.95,Percent of Total Billed Charges,0,7.82,,,7.82,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,25.55,Percent of Total Billed Charges, ,11.13,,,11.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.7,,,8.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7.49,,,7.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.24,,,7.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.31,,,7.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.46,,,7.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.58,,,7.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,33.74,,,33.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5107 - INJ MVASI 10 MG,Q5107,HCPCS,,,JZ,Outpatient,10,ME,255.27,63.8175,25.28,216.98,,,,,,,,25.53,,,25.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.25,,,33.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.26,,,39.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,167.46,Percent of Total Billed Charges, ,25.53,,,25.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,178.69,Percent of Total Billed Charges, ,,85,,216.98,Percent of Total Billed Charges, ,28.73,,,28.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,173.58,Percent of Total Billed Charges,0,25.62,,,25.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,153.16,Percent of Total Billed Charges, ,38.87,,,38.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.53,,,25.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.16,,,26.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.42,,,26.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.53,,,25.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.28,,,25.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.53,,,25.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.04,,,26.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.48,,,26.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5107 - INJ MVASI 10 MG,Q5107,HCPCS,,,JW,Outpatient,10,ME,78.99,19.7475,25.28,207.22,,,,,,,,25.53,,,25.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.25,,,33.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.26,,,39.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.82,Percent of Total Billed Charges, ,25.53,,,25.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,55.29,Percent of Total Billed Charges, ,,85,,67.14,Percent of Total Billed Charges, ,28.73,,,28.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.71,Percent of Total Billed Charges,0,25.62,,,25.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,47.39,Percent of Total Billed Charges, ,38.87,,,38.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.53,,,25.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.16,,,26.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.42,,,26.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.53,,,25.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.28,,,25.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.53,,,25.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.04,,,26.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.48,,,26.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5107 - INJ MVASI 10 MG,Q5107,HCPCS,,,JG,Outpatient,10,ME,206.46,51.615,25.28,207.22,,,,,,,,25.53,,,25.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.25,,,33.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.26,,,39.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,135.44,Percent of Total Billed Charges, ,25.53,,,25.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,144.52,Percent of Total Billed Charges, ,,85,,175.49,Percent of Total Billed Charges, ,28.73,,,28.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,140.39,Percent of Total Billed Charges,0,25.62,,,25.62,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,123.88,Percent of Total Billed Charges, ,38.87,,,38.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.53,,,25.53,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.16,,,26.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.42,,,26.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.53,,,25.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.28,,,25.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,25.53,,,25.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.04,,,26.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,26.48,,,26.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.22,,,207.22,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5108 - INJECTION FULPHILA,Q5108,HCPCS,,,JZ,Outpatient,0.5,ME,805.18,201.295,122.54,1064.3,,,,,,,,161.87,,,161.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,184.7,,,184.7,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,200.17,,,200.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,528.2,Percent of Total Billed Charges, ,161.87,,,161.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,563.63,Percent of Total Billed Charges, ,,85,,684.4,Percent of Total Billed Charges, ,125.3,,,125.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,547.52,Percent of Total Billed Charges,0,122.54,,,122.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,483.11,Percent of Total Billed Charges, ,198.12,,,198.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,161.87,,,161.87,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,133.37,,,133.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,134.66,,,134.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.15,,,130.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.86,,,128.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,130.15,,,130.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,132.73,,,132.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,134.98,,,134.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1064.3,,,1064.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1064.3,,,1064.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1064.3,,,1064.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1064.3,,,1064.3,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5111 - INJECTION UDENYCA 0.5 MG,Q5111,HCPCS,,,JZ,Outpatient,0.5,ME,1135.6,283.9,122.1,999.46,,,,,,,,171.36,,,171.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,207.56,,,207.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,211.74,,,211.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,744.95,Percent of Total Billed Charges, ,171.36,,,171.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,794.92,Percent of Total Billed Charges, ,,85,,965.26,Percent of Total Billed Charges, ,135.55,,,135.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,772.21,Percent of Total Billed Charges,0,122.1,,,122.1,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,681.36,Percent of Total Billed Charges, ,209.58,,,209.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,171.36,,,171.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,141.08,,,141.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,142.44,,,142.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,137.67,,,137.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,136.31,,,136.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,137.67,,,137.67,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,140.4,,,140.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,142.78,,,142.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,999.46,,,999.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,999.46,,,999.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,999.46,,,999.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,999.46,,,999.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5112 - INJ ONTRUZANT 10 MG,Q5112,HCPCS,,,JZ,Outpatient,10,ME,388.24,97.06,0.01,330,,,,,,,,34.22,,,34.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.58,,,40.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.45,,,50.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,254.69,Percent of Total Billed Charges, ,34.22,,,34.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,271.77,Percent of Total Billed Charges, ,,85,,330,Percent of Total Billed Charges, ,26.37,,,26.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,264,Percent of Total Billed Charges,0,38.94,,,38.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,232.94,Percent of Total Billed Charges, ,49.94,,,49.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.22,,,34.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.62,,,33.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.8,,,32.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.48,,,32.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.8,,,32.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.45,,,33.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.02,,,34.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5112 - INJ ONTRUZANT 10 MG,Q5112,HCPCS,,,JW,Outpatient,10,ME,109.08,27.27,0.01,92.72,,,,,,,,34.22,,,34.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.58,,,40.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.45,,,50.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,71.56,Percent of Total Billed Charges, ,34.22,,,34.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,76.36,Percent of Total Billed Charges, ,,85,,92.72,Percent of Total Billed Charges, ,26.37,,,26.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,74.17,Percent of Total Billed Charges,0,38.94,,,38.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,65.45,Percent of Total Billed Charges, ,49.94,,,49.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.22,,,34.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.62,,,33.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.8,,,32.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.48,,,32.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.8,,,32.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.45,,,33.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.02,,,34.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5112 - INJ ONTRUZANT 10 MG,Q5112,HCPCS,,,JG,Outpatient,10,ME,357.16,89.29,0.01,303.59,,,,,,,,34.22,,,34.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,40.58,,,40.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,50.45,,,50.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,234.3,Percent of Total Billed Charges, ,34.22,,,34.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,250.01,Percent of Total Billed Charges, ,,85,,303.59,Percent of Total Billed Charges, ,26.37,,,26.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,242.87,Percent of Total Billed Charges,0,38.94,,,38.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,214.3,Percent of Total Billed Charges, ,49.94,,,49.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.22,,,34.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.62,,,33.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.94,,,33.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.8,,,32.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.48,,,32.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.8,,,32.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.45,,,33.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.02,,,34.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5114 - INJ OGIVRI 10 MG,Q5114,HCPCS,,,JW,Outpatient,10,ME,78.14,19.535,44.43,298.07,,,,,,,,58.41,,,58.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,69.73,,,69.73,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.98,,,79.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,51.26,Percent of Total Billed Charges, ,58.41,,,58.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,54.7,Percent of Total Billed Charges, ,,85,,66.42,Percent of Total Billed Charges, ,51.84,,,51.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,53.14,Percent of Total Billed Charges,0,44.43,,,44.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,46.88,Percent of Total Billed Charges, ,79.17,,,79.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.41,,,58.41,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.29,,,53.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.81,,,53.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52,,,52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.49,,,51.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52,,,52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.03,,,53.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.94,,,53.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,298.07,,,298.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,298.07,,,298.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,298.07,,,298.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,298.07,,,298.07,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5115 - INJ TRUXIMA 10 MG,Q5115,HCPCS,,,JZ,Outpatient,10,ME,170.89,42.7225,31.83,286.31,,,,,,,,33.59,,,33.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.13,,,42.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,49.61,,,49.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.1,Percent of Total Billed Charges, ,33.59,,,33.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,119.62,Percent of Total Billed Charges, ,,85,,145.26,Percent of Total Billed Charges, ,31.83,,,31.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.21,Percent of Total Billed Charges,0,35.89,,,35.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,102.53,Percent of Total Billed Charges, ,49.11,,,49.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.59,,,33.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.06,,,33.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.38,,,33.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.26,,,32.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.94,,,31.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.26,,,32.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.9,,,32.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.46,,,33.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5115 - INJ TRUXIMA 10 MG,Q5115,HCPCS,,,JW,Outpatient,10,ME,97.74,24.435,31.83,286.31,,,,,,,,33.59,,,33.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.13,,,42.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,49.61,,,49.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,64.12,Percent of Total Billed Charges, ,33.59,,,33.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,68.42,Percent of Total Billed Charges, ,,85,,83.08,Percent of Total Billed Charges, ,31.83,,,31.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,66.46,Percent of Total Billed Charges,0,35.89,,,35.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,58.64,Percent of Total Billed Charges, ,49.11,,,49.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.59,,,33.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.06,,,33.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.38,,,33.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.26,,,32.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.94,,,31.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.26,,,32.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.9,,,32.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.46,,,33.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5115 - INJ TRUXIMA 10 MG,Q5115,HCPCS,,,JG,Outpatient,10,ME,147.03,36.7575,31.83,286.31,,,,,,,,33.59,,,33.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,42.13,,,42.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,49.61,,,49.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,96.45,Percent of Total Billed Charges, ,33.59,,,33.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,102.92,Percent of Total Billed Charges, ,,85,,124.98,Percent of Total Billed Charges, ,31.83,,,31.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,99.98,Percent of Total Billed Charges,0,35.89,,,35.89,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,88.22,Percent of Total Billed Charges, ,49.11,,,49.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.59,,,33.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.06,,,33.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.38,,,33.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.26,,,32.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.94,,,31.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.26,,,32.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.9,,,32.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,33.46,,,33.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,286.31,,,286.31,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5116 - INJ. TRAZIMERA 10 MG,Q5116,HCPCS,,,JG,Outpatient,10,ME,417.51,104.3775,0.01,354.88,,,,,,,,16.08,,,16.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,15.8,,,15.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,28.32,,,28.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,273.89,Percent of Total Billed Charges, ,16.08,,,16.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,292.26,Percent of Total Billed Charges, ,,85,,354.88,Percent of Total Billed Charges, ,18.97,,,18.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,283.91,Percent of Total Billed Charges,0,16.37,,,16.37,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,250.51,Percent of Total Billed Charges, ,28.03,,,28.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16.08,,,16.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,18.87,,,18.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.05,,,19.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.41,,,18.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.23,,,18.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.41,,,18.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.78,,,18.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.1,,,19.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5117 - INJ. KANJINTI 10 MG,Q5117,HCPCS,,,JG,Outpatient,10,ME,424.84,106.21,0.01,361.11,,,,,,,,22.33,,,22.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.18,,,24.18,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.93,,,35.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,278.7,Percent of Total Billed Charges, ,22.33,,,22.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,297.39,Percent of Total Billed Charges, ,,85,,361.11,Percent of Total Billed Charges, ,34.69,,,34.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,288.89,Percent of Total Billed Charges,0,13.45,,,13.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,254.9,Percent of Total Billed Charges, ,35.56,,,35.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.33,,,22.33,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.94,,,23.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.17,,,24.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.36,,,23.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.13,,,23.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.36,,,23.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.82,,,23.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,24.23,,,24.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5118 - INJ. ZIRABEV 10 MG,Q5118,HCPCS,,,JZ,Outpatient,10,ME,288.26,72.065,0.01,245.02,,,,,,,,21.9,,,21.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.21,,,26.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.84,,,34.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,189.1,Percent of Total Billed Charges, ,21.9,,,21.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,201.78,Percent of Total Billed Charges, ,,85,,245.02,Percent of Total Billed Charges, ,23,,,23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,196.02,Percent of Total Billed Charges,0,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,172.96,Percent of Total Billed Charges, ,34.47,,,34.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.9,,,21.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.2,,,23.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.43,,,23.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.64,,,22.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.42,,,22.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.64,,,22.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.09,,,23.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.48,,,23.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5118 - INJ. ZIRABEV 10 MG,Q5118,HCPCS,,,JW,Outpatient,10,ME,64.68,16.17,0.01,54.98,,,,,,,,21.9,,,21.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.21,,,26.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.84,,,34.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,42.43,Percent of Total Billed Charges, ,21.9,,,21.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,45.28,Percent of Total Billed Charges, ,,85,,54.98,Percent of Total Billed Charges, ,23,,,23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,43.98,Percent of Total Billed Charges,0,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,38.81,Percent of Total Billed Charges, ,34.47,,,34.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.9,,,21.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.2,,,23.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.43,,,23.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.64,,,22.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.42,,,22.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.64,,,22.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.09,,,23.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.48,,,23.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5118 - INJ. ZIRABEV 10 MG,Q5118,HCPCS,,,JG,Outpatient,10,ME,262.9,65.725,0.01,223.47,,,,,,,,21.9,,,21.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,26.21,,,26.21,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,34.84,,,34.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,172.46,Percent of Total Billed Charges, ,21.9,,,21.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,184.03,Percent of Total Billed Charges, ,,85,,223.47,Percent of Total Billed Charges, ,23,,,23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,178.77,Percent of Total Billed Charges,0,21.51,,,21.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,157.74,Percent of Total Billed Charges, ,34.47,,,34.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.9,,,21.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.2,,,23.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.43,,,23.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.64,,,22.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.42,,,22.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.64,,,22.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.09,,,23.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,23.48,,,23.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5119 - INJ RUXIENCE 10 MG,Q5119,HCPCS,,,TB,Outpatient,10,ME,360.88,90.22,20.09,306.75,,,,,,,,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.06,,,24.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.14,,,33.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,236.74,Percent of Total Billed Charges, ,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,252.62,Percent of Total Billed Charges, ,,85,,306.75,Percent of Total Billed Charges, ,23.59,,,23.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,245.4,Percent of Total Billed Charges,0,20.45,,,20.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,216.53,Percent of Total Billed Charges, ,32.79,,,32.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.08,,,22.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.29,,,22.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.97,,,21.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.34,,,22.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5119 - INJ RUXIENCE 10 MG,Q5119,HCPCS,,,JZ,Outpatient,10,ME,323.24,80.81,20.09,274.75,,,,,,,,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.06,,,24.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.14,,,33.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,212.05,Percent of Total Billed Charges, ,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,226.27,Percent of Total Billed Charges, ,,85,,274.75,Percent of Total Billed Charges, ,23.59,,,23.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,219.8,Percent of Total Billed Charges,0,20.45,,,20.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,193.94,Percent of Total Billed Charges, ,32.79,,,32.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.08,,,22.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.29,,,22.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.97,,,21.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.34,,,22.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5119 - INJ RUXIENCE 10 MG,Q5119,HCPCS,,,JW,Outpatient,10,ME,79.45,19.8625,20.09,219.28,,,,,,,,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.06,,,24.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.14,,,33.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,52.12,Percent of Total Billed Charges, ,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,55.62,Percent of Total Billed Charges, ,,85,,67.53,Percent of Total Billed Charges, ,23.59,,,23.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,54.03,Percent of Total Billed Charges,0,20.45,,,20.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,47.67,Percent of Total Billed Charges, ,32.79,,,32.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.08,,,22.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.29,,,22.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.97,,,21.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.34,,,22.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5119 - INJ RUXIENCE 10 MG,Q5119,HCPCS,,,JG,Outpatient,10,ME,300.2,75.05,20.09,255.17,,,,,,,,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,24.06,,,24.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,33.14,,,33.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,196.93,Percent of Total Billed Charges, ,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,210.14,Percent of Total Billed Charges, ,,85,,255.17,Percent of Total Billed Charges, ,23.59,,,23.59,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,204.14,Percent of Total Billed Charges,0,20.45,,,20.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,180.12,Percent of Total Billed Charges, ,32.79,,,32.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.09,,,20.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,22.08,,,22.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.29,,,22.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.33,,,21.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.54,,,21.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.97,,,21.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.34,,,22.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,219.28,,,219.28,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5121 - INJ. AVSOLA 10 MG,Q5121,HCPCS,,,JZ,Outpatient,10,ME,158.1,39.525,0.01,134.39,,,,,,,,22.81,,,22.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,27.36,,,27.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.45,,,31.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,103.71,Percent of Total Billed Charges, ,22.81,,,22.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,110.67,Percent of Total Billed Charges, ,,85,,134.39,Percent of Total Billed Charges, ,19.83,,,19.83,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,107.51,Percent of Total Billed Charges,0,25.56,,,25.56,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,94.86,Percent of Total Billed Charges, ,31.12,,,31.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,22.81,,,22.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,20.95,,,20.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.15,,,21.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.44,,,20.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.24,,,20.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.44,,,20.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,20.85,,,20.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.2,,,21.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5122 - INJ NYVEPRIA,Q5122,HCPCS,,,JZ,Outpatient,0.5,ME,1695.6,423.9,62.38,1441.26,,,,,,,,114.69,,,114.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,99.5,,,99.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,142.59,,,142.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1112.31,Percent of Total Billed Charges, ,114.69,,,114.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1186.92,Percent of Total Billed Charges, ,,85,,1441.26,Percent of Total Billed Charges, ,117.01,,,117.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1153.01,Percent of Total Billed Charges,0,62.38,,,62.38,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1017.36,Percent of Total Billed Charges, ,141.13,,,141.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,114.69,,,114.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,95,,,95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,95.92,,,95.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.71,,,92.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,91.79,,,91.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,92.71,,,92.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,94.54,,,94.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,96.15,,,96.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1107.45,,,1107.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1107.45,,,1107.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1107.45,,,1107.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1107.45,,,1107.45,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5125 - INJ RELEUKO 1 MCG,Q5125,HCPCS,,,JZ,Outpatient,1,GR,1.22,0.305,0.45,2.55,,,,,,,,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.7,,,0.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.8,Percent of Total Billed Charges, ,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.85,Percent of Total Billed Charges, ,,85,,1.04,Percent of Total Billed Charges, ,0.45,,,0.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,0.83,Percent of Total Billed Charges,0,0.54,,,0.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.73,Percent of Total Billed Charges, ,0.69,,,0.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.47,,,0.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.47,,,0.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.45,,,0.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.45,,,0.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.45,,,0.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.46,,,0.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.47,,,0.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2.55,,,2.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.55,,,2.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.55,,,2.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,2.55,,,2.55,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5126 - INJ ALYMSYS 10 MG,Q5126,HCPCS,,,JZ,Outpatient,10,ME,315.55,78.8875,54.06,268.22,,,,,,,,62.16,,,62.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,72.15,,,72.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,83.97,,,83.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,207,Percent of Total Billed Charges, ,62.16,,,62.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,220.89,Percent of Total Billed Charges, ,,85,,268.22,Percent of Total Billed Charges, ,58.23,,,58.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,214.57,Percent of Total Billed Charges,0,60.58,,,60.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,189.33,Percent of Total Billed Charges, ,83.12,,,83.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.16,,,62.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.95,,,55.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.49,,,56.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.6,,,54.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.06,,,54.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.6,,,54.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.68,,,55.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.63,,,56.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.75,,,170.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.75,,,170.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.75,,,170.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.75,,,170.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5126 - INJ ALYMSYS 10 MG,Q5126,HCPCS,,,JW,Outpatient,10,ME,97.34,24.335,54.06,170.75,,,,,,,,62.16,,,62.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,72.15,,,72.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,83.97,,,83.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,63.86,Percent of Total Billed Charges, ,62.16,,,62.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,68.14,Percent of Total Billed Charges, ,,85,,82.74,Percent of Total Billed Charges, ,58.23,,,58.23,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,66.19,Percent of Total Billed Charges,0,60.58,,,60.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,58.4,Percent of Total Billed Charges, ,83.12,,,83.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.16,,,62.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.95,,,55.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.49,,,56.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.6,,,54.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.06,,,54.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.6,,,54.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,55.68,,,55.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.63,,,56.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,170.75,,,170.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.75,,,170.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.75,,,170.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,170.75,,,170.75,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q5130 - INJ FYLNETRA 0.5 MGG              I,Q5130,HCPCS,,,JZ,Outpatient,0.5,ME,440,110,177.01,705.38,,,,,,,,223.16,,,223.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,242.58,,,242.58,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,274.97,,,274.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,288.64,Percent of Total Billed Charges, ,223.16,,,223.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,308,Percent of Total Billed Charges, ,,85,,374,Percent of Total Billed Charges, ,183.52,,,183.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,299.2,Percent of Total Billed Charges,0,201.97,,,201.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,264,Percent of Total Billed Charges, ,272.15,,,272.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,223.16,,,223.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,183.21,,,183.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,184.98,,,184.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,178.78,,,178.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.01,,,177.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,178.78,,,178.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,182.32,,,182.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,185.42,,,185.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,705.38,,,705.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,705.38,,,705.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,705.38,,,705.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,705.38,,,705.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q9950 - INJ SULF HEXA LIPID MICROSPH,Q9950,HCPCS,,,JZ,Outpatient,1,ML,81.8,20.45,0.01,69.53,,,,,,,,21.29,,,21.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,23.8,,,23.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,53.66,Percent of Total Billed Charges, ,21.29,,,21.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,57.26,Percent of Total Billed Charges, ,,85,,69.53,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,55.62,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,49.08,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,21.29,,,21.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q9968 - VISUALIZATION ADJUNCT,Q9968,HCPCS,,,JZ,Outpatient,,,4.82,1.205,2.89,12.61,,,,,,,,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.91,,,11.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.61,,,12.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.16,Percent of Total Billed Charges, ,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3.37,Percent of Total Billed Charges, ,,85,,4.1,Percent of Total Billed Charges, ,,,,,,,,68,,3.28,Percent of Total Billed Charges,0,7.95,,,7.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.89,Percent of Total Billed Charges, ,12.47,,,12.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.39,,,8.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.47,,,8.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.19,,,8.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.11,,,8.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.19,,,8.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.35,,,8.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.5,,,8.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q9968 - VISUALIZATION ADJUNCT,Q9968,HCPCS,,,JW,Outpatient,,,2.49,0.6225,1.49,12.61,,,,,,,,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.91,,,11.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.61,,,12.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.63,Percent of Total Billed Charges, ,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.74,Percent of Total Billed Charges, ,,85,,2.12,Percent of Total Billed Charges, ,,,,,,,,67.9,,1.69,Percent of Total Billed Charges,0,7.95,,,7.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.49,Percent of Total Billed Charges, ,12.47,,,12.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.39,,,8.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.47,,,8.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.19,,,8.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.11,,,8.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.19,,,8.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.35,,,8.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.5,,,8.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q9968 - VISUALIZATION ADJUNCT,Q9968,HCPCS,,,JG,Outpatient,,,42.55,10.6375,5.16,36.17,,,,,,,,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11.91,,,11.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,12.61,,,12.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,27.91,Percent of Total Billed Charges, ,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,29.79,Percent of Total Billed Charges, ,,85,,36.17,Percent of Total Billed Charges, ,,,,,,,,68,,28.93,Percent of Total Billed Charges,0,7.95,,,7.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,25.53,Percent of Total Billed Charges, ,12.47,,,12.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5.16,,,5.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8.39,,,8.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.47,,,8.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.19,,,8.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.11,,,8.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.19,,,8.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.35,,,8.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8.5,,,8.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q9969 - NON-HEU TC-99M ADD-ON-DOSE,Q9969,HCPCS,,,GA,Outpatient,,,25,6.25,0.01,21.25,,,,,,,,11,,,11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,14.77,,,14.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16.4,Percent of Total Billed Charges, ,11,,,11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17.5,Percent of Total Billed Charges, ,,85,,21.25,Percent of Total Billed Charges, ,,,,,,,,68,,17,Percent of Total Billed Charges,0,10,,,10,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,15,Percent of Total Billed Charges, ,14.62,,,14.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11,,,11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.84,,,9.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.94,,,9.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.61,,,9.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.51,,,9.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.61,,,9.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.8,,,9.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.96,,,9.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
Q9969 - NON-HEU TC-99M ADD-ON-DOSE,Q9969,HCPCS,,,52,Outpatient,,,25,6.25,0.01,21.25,,,,,,,,11,,,11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,14.77,,,14.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,16.4,Percent of Total Billed Charges, ,11,,,11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,17.5,Percent of Total Billed Charges, ,,85,,21.25,Percent of Total Billed Charges, ,,,,,,,,68,,17,Percent of Total Billed Charges,0,10,,,10,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,15,Percent of Total Billed Charges, ,14.62,,,14.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11,,,11,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,9.84,,,9.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.94,,,9.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.61,,,9.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.51,,,9.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.61,,,9.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.8,,,9.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.96,,,9.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING,0636,RC,,,,Outpatient,,,97.27,24.3175,58.36,82.68,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,63.81,Percent of Total Billed Charges, ,,,,,,,,70,,68.09,Percent of Total Billed Charges, ,,85,,82.68,Percent of Total Billed Charges, ,,,,,,,,68,,66.14,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,58.36,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
J1815 - INSULIN INJECTION,J1815,HCPCS,,,GY,Outpatient,,,1.48,0.37,0.01,9.59,,,,,,,,1.09,,,1.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.29,,,0.29,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.97,Percent of Total Billed Charges, ,1.09,,,1.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.04,Percent of Total Billed Charges, ,,85,,1.26,Percent of Total Billed Charges, ,,,,,,,,68.2,,1.01,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.89,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.09,,,1.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,9.59,,,9.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.59,,,9.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.59,,,9.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,9.59,,,9.59,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7509 - METHYLPREDNISOLONE ORAL,J7509,HCPCS,,,GY,Outpatient,4,ME,5.71,1.4275,0.01,4.85,,,,,,,,0.28,,,0.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.3,,,0.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3.75,Percent of Total Billed Charges, ,0.28,,,0.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4,Percent of Total Billed Charges, ,,85,,4.85,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3.88,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,3.43,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.28,,,0.28,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.46,,,1.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.46,,,1.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.46,,,1.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1.46,,,1.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7510 - PREDNISOLONE ORAL PER 5 MG,J7510,HCPCS,,,GY,Outpatient,5,ME,2.1,0.525,0.01,1.79,,,,,,,,0.44,,,0.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.3,,,0.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1.38,Percent of Total Billed Charges, ,0.44,,,0.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1.47,Percent of Total Billed Charges, ,,85,,1.79,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.1,,1.43,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1.26,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.44,,,0.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.12,,,0.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.12,,,0.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.12,,,0.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,0.12,,,0.12,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7517 - MYCOPHENOLATE MOFETIL ORAL,J7517,HCPCS,,,GY,Outpatient,250,ME,3.4,0.85,0.01,7.57,,,,,,,,0.2,,,0.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.2,,,0.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.23,Percent of Total Billed Charges, ,0.2,,,0.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.38,Percent of Total Billed Charges, ,,85,,2.89,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,67.9,,2.31,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.04,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.2,,,0.2,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.57,,,7.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,7.57,,,7.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,7.57,,,7.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,7.57,,,7.57,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7518 - MYCOPHENOLIC ACID,J7518,HCPCS,,,GY,Outpatient,180,ME,12.96,3.24,0.01,11.02,,,,,,,,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.46,,,0.46,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8.5,Percent of Total Billed Charges, ,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,9.07,Percent of Total Billed Charges, ,,85,,11.02,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8.81,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,7.78,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,7.19,,,7.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,7.19,,,7.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,7.19,,,7.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,7.19,,,7.19,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J7520 - SIROLIMUS ORAL,J7520,HCPCS,,,GY,Outpatient,1,ME,82.45,20.6125,0.01,70.08,,,,,,,,1.52,,,1.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1.68,,,1.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,54.09,Percent of Total Billed Charges, ,1.52,,,1.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,57.72,Percent of Total Billed Charges, ,,85,,70.08,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,56.07,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,49.47,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1.52,,,1.52,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,18.95,,,18.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.95,,,18.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.95,,,18.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,18.95,,,18.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
J8540 - ORAL DEXAMETHASONE,J8540,HCPCS,,,GY,Outpatient,0.25,ME,0.19,0.0475,0.01,0.16,,,,,,,,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.09,,,0.09,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,0.12,Percent of Total Billed Charges, ,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,0.13,Percent of Total Billed Charges, ,,85,,0.16,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68.4,,0.13,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,0.11,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.04,,,0.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
J8610 - METHOTREXATE ORAL 2.5 MG,J8610,HCPCS,,,GY,Outpatient,2.5,ME,12.37,3.0925,0.01,10.51,,,,,,,,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.3,,,0.3,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,8.11,Percent of Total Billed Charges, ,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,8.66,Percent of Total Billed Charges, ,,85,,10.51,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,8.41,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,7.42,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.25,,,0.25,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
Q0164 - PROCHLORPERAZINE MALEATE 5MG,Q0164,HCPCS,,,GY,Outpatient,,,3.8,0.95,0.01,3.23,,,,,,,,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,0.45,,,0.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2.49,Percent of Total Billed Charges, ,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2.66,Percent of Total Billed Charges, ,,85,,3.23,Percent of Total Billed Charges, ,,,,,,,,67.9,,2.58,Percent of Total Billed Charges,0,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,2.28,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,0.51,,,0.51,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS,0637,RC,,,,Outpatient,,,0.98,0.245,0.59,0.83,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,0.64,Percent of Total Billed Charges, ,,,,,,,,70,,0.69,Percent of Total Billed Charges, ,,85,,0.83,Percent of Total Billed Charges, ,,,,,,,,68.4,,0.67,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,0.59,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
59025 - FETAL NONSTRESS TEST,59025,HCPCS,,,XU,Outpatient,,,1155,288.75,191.26,981.75,,,46,,531.3,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,288.95,,,288.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,650,,,650,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,297.09,,,297.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,757.68,Percent of Total Billed Charges, ,288.95,,,288.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,808.5,Percent of Total Billed Charges, ,,85,,981.75,Percent of Total Billed Charges, ,,50,,577.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,785.4,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,646.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,693,Percent of Total Billed Charges, ,294.06,,,294.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,279.89,,,279.89,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,197.95,,,197.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.87,,,199.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.17,,,193.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,191.26,,,191.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.17,,,193.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197,,,197,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.34,,,200.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
59412 - EXTERNAL CEPHALIC VERSION W-WO TOCOLYSIS,59412,HCPCS,,,74,Outpatient,,,6509,1627.25,742.5,5532.65,,,46,,2994.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4695.7,,,4695.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4269.9,Percent of Total Billed Charges, ,4586.58,,,4586.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4556.3,Percent of Total Billed Charges, ,,85,,5532.65,Percent of Total Billed Charges, ,,50,,3254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4426.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3645.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3905.4,Percent of Total Billed Charges, ,4647.72,,,4647.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4442.8,,,4442.8,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3128.71,,,3128.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3158.94,,,3158.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.91,,,3022.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3053.14,,,3053.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3113.6,,,3113.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3166.5,,,3166.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0720 - LABOR ROOM-DELIVERY - GENERAL CLASSIFICATION,0720,RC,,,,Outpatient,,,2225.8,556.45,1335.48,1891.93,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,1460.12,Percent of Total Billed Charges, ,,,,,,,,70,,1558.06,Percent of Total Billed Charges, ,,85,,1891.93,Percent of Total Billed Charges, ,,,,,,,,68,,1513.54,Percent of Total Billed Charges,0,1519,,,1519,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1335.48,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
93005 - ECG ROUTINE ECG W-LEAST 12 LDS TRCG ONLY W-O IANDR,93005,HCPCS,,,XU,Outpatient,,,109.74,27.435,50.48,93.28,,,46,,50.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,51.03,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,71.99,Percent of Total Billed Charges, ,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,76.82,Percent of Total Billed Charges, ,,85,,93.28,Percent of Total Billed Charges, ,,50,,54.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,74.62,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,61.45,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,65.84,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.15,,,77.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93005 - ECG ROUTINE ECG W-LEAST 12 LDS TRCG ONLY W-O IANDR,93005,HCPCS,,,XE,Outpatient,,,119.57,29.8925,50.49,101.63,,,46,,55,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,55.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,78.44,Percent of Total Billed Charges, ,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,83.7,Percent of Total Billed Charges, ,,85,,101.63,Percent of Total Billed Charges, ,,50,,59.79,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,81.31,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,66.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,71.74,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.15,,,77.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93005 - ECG ROUTINE ECG W-LEAST 12 LDS TRCG ONLY W-O IANDR,93005,HCPCS,,,77,Outpatient,,,106.13,26.5325,48.82,90.21,,,46,,48.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,49.35,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,69.62,Percent of Total Billed Charges, ,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,74.29,Percent of Total Billed Charges, ,,85,,90.21,Percent of Total Billed Charges, ,,50,,53.07,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,72.17,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,59.43,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,63.68,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.15,,,77.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93005 - ECG ROUTINE ECG W-LEAST 12 LDS TRCG ONLY W-O IANDR,93005,HCPCS,,,76,Outpatient,,,101.24,25.31,46.57,87.72,,,46,,46.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,47.08,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,66.41,Percent of Total Billed Charges, ,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70.87,Percent of Total Billed Charges, ,,85,,86.05,Percent of Total Billed Charges, ,,50,,50.62,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68.84,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,56.69,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60.74,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.15,,,77.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93005 - ECG ROUTINE ECG W-LEAST 12 LDS TRCG ONLY W-O IANDR,93005,HCPCS,,,59,Outpatient,,,100,25,46,87.72,,,46,,46,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,46.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,65.6,Percent of Total Billed Charges, ,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,70,Percent of Total Billed Charges, ,,85,,85,Percent of Total Billed Charges, ,,50,,50,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,68,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,60,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.15,,,77.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,50.49,,,50.49,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0730 - EKG-ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION,0730,RC,,,,Outpatient,,,107.32,26.83,64.39,483,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,70.4,Percent of Total Billed Charges, ,,,,,,,,70,,75.12,Percent of Total Billed Charges, ,,85,,91.22,Percent of Total Billed Charges, ,,,,,,,,68,,72.98,Percent of Total Billed Charges,0,483,,,483,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,64.39,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
93246 - EXTERNAL ECG RECGREATER THAN 7DLESS THAN 15D RECORDING,93246,HCPCS,,,XU,Outpatient,,,128,32,37.32,108.8,,,46,,58.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,59.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,57.97,,,57.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,83.97,Percent of Total Billed Charges, ,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,89.6,Percent of Total Billed Charges, ,,85,,108.8,Percent of Total Billed Charges, ,,50,,64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,87.04,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,71.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,76.8,Percent of Total Billed Charges, ,57.38,,,57.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.15,,,77.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,38.63,,,38.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39,,,39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.69,,,37.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.32,,,37.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.69,,,37.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,38.44,,,38.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.09,,,39.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93270 - XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS,93270,HCPCS,,,GT,Outpatient,,,350,87.5,35.45,297.5,,,46,,161,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.5,,,48.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,162.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.08,,,55.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,229.6,Percent of Total Billed Charges, ,48.5,,,48.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,245,Percent of Total Billed Charges, ,,85,,297.5,Percent of Total Billed Charges, ,,50,,175,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,238,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,196,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,210,Percent of Total Billed Charges, ,54.5,,,54.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.97,,,46.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.69,,,36.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.05,,,37.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.45,,,35.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.51,,,36.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.13,,,37.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.33,,,143.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,143.33,,,143.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,143.33,,,143.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,143.33,,,143.33,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0731 - EKG-ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR,0731,RC,,,,Outpatient,,,313,78.25,187.8,674,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,205.33,Percent of Total Billed Charges, ,,,,,,,,70,,219.1,Percent of Total Billed Charges, ,,85,,266.05,Percent of Total Billed Charges, ,,,,,,,,68,,212.84,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,187.8,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
93293 - TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL,93293,HCPCS,,,TC,Outpatient,,,77,19.25,35.42,167.6,,,46,,35.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.5,,,48.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,35.81,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.08,,,55.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,50.51,Percent of Total Billed Charges, ,48.5,,,48.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,53.9,Percent of Total Billed Charges, ,,85,,65.45,Percent of Total Billed Charges, ,,50,,38.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,52.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,43.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,46.2,Percent of Total Billed Charges, ,54.5,,,54.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,46.97,,,46.97,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,36.69,,,36.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.05,,,37.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.45,,,35.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.51,,,36.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.13,,,37.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,167.6,,,167.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,167.6,,,167.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,167.6,,,167.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,167.6,,,167.6,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0732 - EKG-ECG (ELECTROCARDIOGRAM) - TELEMETRY,0732,RC,,,,Outpatient,,,77,19.25,46.2,674,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,50.51,Percent of Total Billed Charges, ,,,,,,,,70,,53.9,Percent of Total Billed Charges, ,,85,,65.45,Percent of Total Billed Charges, ,,,,,,,,68,,52.36,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,46.2,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
95816 - ELECTROENCEPHALOGRAM W-REC AWAKEANDDROWSY,95816,HCPCS,,,XU,Outpatient,,,1250,312.5,74.25,1062.5,,,46,,575,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,581.25,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,820,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,875,Percent of Total Billed Charges, ,,85,,1062.5,Percent of Total Billed Charges, ,,50,,625,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,850,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,700,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,750,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,74.25,,,74.25,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
95819 - ELECTROENCEPHALOGRAM W-REC AWAKEANDASLEEP,95819,HCPCS,,,XP,Outpatient,,,1281,320.25,190.08,1088.85,,,46,,589.26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,595.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,840.34,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,896.7,Percent of Total Billed Charges, ,,85,,1088.85,Percent of Total Billed Charges, ,,50,,640.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,871.08,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,717.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,768.6,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.08,,,190.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,190.08,,,190.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,190.08,,,190.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,190.08,,,190.08,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION,0740,RC,,,,Outpatient,,,1257.75,314.4375,642,1069.09,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,825.08,Percent of Total Billed Charges, ,,,,,,,,70,,880.43,Percent of Total Billed Charges, ,,85,,1069.09,Percent of Total Billed Charges, ,,,,,,,,68,,855.27,Percent of Total Billed Charges,0,642,,,642,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,754.65,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
31623 - BRNCHSC BRUSHING-PROTECTED BRUSHINGS,31623,HCPCS,,,RT,Outpatient,,,1976,494,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1296.26,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1383.2,Percent of Total Billed Charges, ,,85,,1679.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1343.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1106.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1185.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31623 - BRNCHSC BRUSHING-PROTECTED BRUSHINGS,31623,HCPCS,,,LT,Outpatient,,,1976,494,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1296.26,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1383.2,Percent of Total Billed Charges, ,,85,,1679.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1343.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1106.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1185.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,RT,Outpatient,,,1976,494,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1296.26,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1383.2,Percent of Total Billed Charges, ,,85,,1679.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1343.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1106.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1185.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,50,Outpatient,,,1976,494,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1296.26,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1383.2,Percent of Total Billed Charges, ,,85,,1679.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1343.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1106.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1185.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43235 - ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,43235,HCPCS,,,XU,Outpatient,,,1800,450,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43235 - ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,43235,HCPCS,,,74,Outpatient,,,1800,450,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43235 - ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,43235,HCPCS,,,52,Outpatient,,,1800,450,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43236 - ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION,43236,HCPCS,,,XU,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43239 - EGD TRANSORAL BIOPSY SINGLE-MULTIPLE,43239,HCPCS,,,XU,Outpatient,,,4200,1050,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2755.2,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2940,Percent of Total Billed Charges, ,,85,,3570,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2856,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2352,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2520,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43239 - EGD TRANSORAL BIOPSY SINGLE-MULTIPLE,43239,HCPCS,,,XS,Outpatient,,,4200,1050,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2755.2,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2940,Percent of Total Billed Charges, ,,85,,3570,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2856,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2352,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2520,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43239 - EGD TRANSORAL BIOPSY SINGLE-MULTIPLE,43239,HCPCS,,,XP,Outpatient,,,4200,1050,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2755.2,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2940,Percent of Total Billed Charges, ,,85,,3570,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2856,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2352,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2520,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43239 - EGD TRANSORAL BIOPSY SINGLE-MULTIPLE,43239,HCPCS,,,74,Outpatient,,,4200,1050,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2755.2,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2940,Percent of Total Billed Charges, ,,85,,3570,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2856,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2352,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2520,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43239 - EGD TRANSORAL BIOPSY SINGLE-MULTIPLE,43239,HCPCS,,,59,Outpatient,,,4200,1050,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2755.2,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2940,Percent of Total Billed Charges, ,,85,,3570,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2856,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2352,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2520,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43242 - EGD INTRMURAL NEEDLE ASPIR-BIOP ALTERED ANATOMY,43242,HCPCS,,,XU,Outpatient,,,2488,622,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43244 - EGD BAND LIGATION ESOPHGEAL-GASTRIC VARICES,43244,HCPCS,,,74,Outpatient,,,2569,642.25,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1685.26,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1798.3,Percent of Total Billed Charges, ,,85,,2183.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1746.92,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1438.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1541.4,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43247 - EGD FLEXIBLE FOREIGN BODY REMOVAL,43247,HCPCS,,,52,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43249 - EGD BALLOON DILATION ESOPHAGUS LESS THAN 30 MM DIAM,43249,HCPCS,,,XU,Outpatient,,,2488,622,1078.11,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43249 - EGD BALLOON DILATION ESOPHAGUS LESS THAN 30 MM DIAM,43249,HCPCS,,,XS,Outpatient,,,2488,622,1078.11,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43250 - EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS,43250,HCPCS,,,XU,Outpatient,,,2488,622,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43251 - EGD REMOVAL TUMOR POLYP-OTHER LESION SNARE TECH,43251,HCPCS,,,XU,Outpatient,,,2488,622,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43251 - EGD REMOVAL TUMOR POLYP-OTHER LESION SNARE TECH,43251,HCPCS,,,XS,Outpatient,,,2488,622,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43254 - EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION,43254,HCPCS,,,XU,Outpatient,,,4608,1152,742.5,9153,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3133.44,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2580.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2764.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43255 - EGD TRANSORAL CONTROL BLEEDING ANY METHOD,43255,HCPCS,,,XU,Outpatient,,,2488,622,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43255 - EGD TRANSORAL CONTROL BLEEDING ANY METHOD,43255,HCPCS,,,XS,Outpatient,,,2488,622,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43261 - ERCP W-BIOPSY SINGLE-MULTIPLE,43261,HCPCS,,,XU,Outpatient,,,5409,1352.25,742.5,5618.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5618.74,,,5618.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3548.3,Percent of Total Billed Charges, ,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3786.3,Percent of Total Billed Charges, ,,85,,4597.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3678.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3029.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3245.4,Percent of Total Billed Charges, ,5561.32,,,5561.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5123.58,,,5123.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3743.72,,,3743.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3779.89,,,3779.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3617.12,,,3617.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3725.63,,,3725.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3788.93,,,3788.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43262 - ERCP W-SPHINCTEROTOMY-PAPILLOTOMY,43262,HCPCS,,,XU,Outpatient,,,5409,1352.25,882.09,5618.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5618.74,,,5618.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3548.3,Percent of Total Billed Charges, ,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3786.3,Percent of Total Billed Charges, ,,85,,4597.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3678.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3029.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3245.4,Percent of Total Billed Charges, ,5561.32,,,5561.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5123.58,,,5123.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3743.72,,,3743.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3779.89,,,3779.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3617.12,,,3617.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3725.63,,,3725.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3788.93,,,3788.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43262 - ERCP W-SPHINCTEROTOMY-PAPILLOTOMY,43262,HCPCS,,,74,Outpatient,,,5409,1352.25,882.09,5618.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5618.74,,,5618.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3548.3,Percent of Total Billed Charges, ,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3786.3,Percent of Total Billed Charges, ,,85,,4597.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3678.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3029.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3245.4,Percent of Total Billed Charges, ,5561.32,,,5561.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5123.58,,,5123.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3743.72,,,3743.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3779.89,,,3779.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3617.12,,,3617.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3725.63,,,3725.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3788.93,,,3788.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43264 - ERCP REMOVE CALCULI-DEBRIS BILIARY-PANCREAS DUCT,43264,HCPCS,,,74,Outpatient,,,5409,1352.25,882.09,5618.74,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5618.74,,,5618.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3548.3,Percent of Total Billed Charges, ,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3786.3,Percent of Total Billed Charges, ,,85,,4597.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3678.12,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3029.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3245.4,Percent of Total Billed Charges, ,5561.32,,,5561.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5123.58,,,5123.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3743.72,,,3743.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3779.89,,,3779.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3617.12,,,3617.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3725.63,,,3725.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3788.93,,,3788.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43274 - ERCP STENT PLACEMENT BILIARY-PANCREATIC DUCT,43274,HCPCS,,,XU,Outpatient,,,10220,2555,882.09,9153,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8501.33,,,8501.33,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8791.44,,,8791.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6704.32,Percent of Total Billed Charges, ,8501.33,,,8501.33,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7154,Percent of Total Billed Charges, ,,85,,8687,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6949.6,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5723.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6132,Percent of Total Billed Charges, ,8701.59,,,8701.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8234.83,,,8234.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5857.65,,,5857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5914.25,,,5914.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5716.17,,,5716.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5659.57,,,5659.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5716.17,,,5716.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5829.36,,,5829.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5928.4,,,5928.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43275 - ERCP REMOVE FOREIGN BODY-STENT BILIARY-PANC DUCT,43275,HCPCS,,,XU,Outpatient,,,9601,2400.25,742.5,9153,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5123.58,,,5123.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43277 - ERCP BALLOON DILATE BILIARY-PANC DUCT-AMPULLA EA,43277,HCPCS,,,XU,Outpatient,,,9601,2400.25,882.09,9153,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5618.74,,,5618.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5289.39,,,5289.39,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5561.32,,,5561.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5123.58,,,5123.58,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3743.72,,,3743.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3779.89,,,3779.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3617.12,,,3617.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3653.29,,,3653.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3725.63,,,3725.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3788.93,,,3788.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44364 - ENTEROSCOPY GREATER THAN 2ND PRTN W-RMVL LESION SNARE,44364,HCPCS,,,XU,Outpatient,,,2488,622,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44389 - COLONOSCOPY STOMA W-BIOPSY SINGLE-MULTIPLE,44389,HCPCS,,,XU,Outpatient,,,2089,522.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1370.38,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1462.3,Percent of Total Billed Charges, ,,85,,1775.65,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1420.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1169.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1253.4,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44389 - COLONOSCOPY STOMA W-BIOPSY SINGLE-MULTIPLE,44389,HCPCS,,,XS,Outpatient,,,2089,522.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1370.38,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1462.3,Percent of Total Billed Charges, ,,85,,1775.65,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1420.52,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1169.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1253.4,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
44394 - COLONOSCOPY STOMA W-RMVL TUM POLYP-OTH LES SNARE,44394,HCPCS,,,PT,Outpatient,,,1800,450,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45330 - SIGMOIDOSCOPY FLX DX W-COLLJ SPEC BR-WA IF PFRMD,45330,HCPCS,,,XU,Outpatient,,,1800,450,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45330 - SIGMOIDOSCOPY FLX DX W-COLLJ SPEC BR-WA IF PFRMD,45330,HCPCS,,,PT,Outpatient,,,1800,450,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45330 - SIGMOIDOSCOPY FLX DX W-COLLJ SPEC BR-WA IF PFRMD,45330,HCPCS,,,52,Outpatient,,,1800,450,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45331 - SIGMOIDOSCOPY FLX W-BIOPSY SINGLE-MULTIPLE,45331,HCPCS,,,XU,Outpatient,,,1800,450,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45333 - SIGMOIDOSCOPY FLX W-RMVL TUMOR BY HOT BX FORCEPS,45333,HCPCS,,,XU,Outpatient,,,1242,310.5,695.52,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,814.75,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,869.4,Percent of Total Billed Charges, ,,85,,1055.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,844.56,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,695.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,745.2,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45338 - SGMDSC FLX RMVL TUM POLYP-OTH LES SNARE TQ,45338,HCPCS,,,XU,Outpatient,,,1987,496.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1303.47,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1390.9,Percent of Total Billed Charges, ,,85,,1688.95,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1351.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1112.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1192.2,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45338 - SGMDSC FLX RMVL TUM POLYP-OTH LES SNARE TQ,45338,HCPCS,,,PT,Outpatient,,,,,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,,,,,,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45378 - COLONOSCOPY FLX DX W-COLLJ SPEC WHEN PFRMD,45378,HCPCS,,,PT,Outpatient,,,4144.76,1036.19,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2718.96,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2901.33,Percent of Total Billed Charges, ,,85,,3523.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2818.44,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2321.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2486.86,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45378 - COLONOSCOPY FLX DX W-COLLJ SPEC WHEN PFRMD,45378,HCPCS,,,GA,Outpatient,,,4195,1048.75,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2751.92,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2936.5,Percent of Total Billed Charges, ,,85,,3565.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2852.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2349.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2517,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45378 - COLONOSCOPY FLX DX W-COLLJ SPEC WHEN PFRMD,45378,HCPCS,,,74,Outpatient,,,4195,1048.75,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2751.92,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2936.5,Percent of Total Billed Charges, ,,85,,3565.75,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2852.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2349.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2517,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45378 - COLONOSCOPY FLX DX W-COLLJ SPEC WHEN PFRMD,45378,HCPCS,,,33,Outpatient,,,3775.5,943.875,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2476.73,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2642.85,Percent of Total Billed Charges, ,,85,,3209.18,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2567.34,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2114.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2265.3,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,XU,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,XS,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,XP,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,PT,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,KX,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,74,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45380 - COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE,45380,HCPCS,,,59,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45381 - COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST,45381,HCPCS,,,XU,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45381 - COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST,45381,HCPCS,,,XS,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45381 - COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST,45381,HCPCS,,,PT,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45382 - COLSC FLEXIBLE W-CONTROL BLEEDING ANY METHOD,45382,HCPCS,,,XU,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45382 - COLSC FLEXIBLE W-CONTROL BLEEDING ANY METHOD,45382,HCPCS,,,XS,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45382 - COLSC FLEXIBLE W-CONTROL BLEEDING ANY METHOD,45382,HCPCS,,,59,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45384 - COLSC FLX W-REMOVAL LESION BY HOT BX FORCEPS,45384,HCPCS,,,XU,Outpatient,,,2306.49,576.6225,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1513.06,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1614.54,Percent of Total Billed Charges, ,,85,,1960.52,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1568.41,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1291.63,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1383.89,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45384 - COLSC FLX W-REMOVAL LESION BY HOT BX FORCEPS,45384,HCPCS,,,XS,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45384 - COLSC FLX W-REMOVAL LESION BY HOT BX FORCEPS,45384,HCPCS,,,PT,Outpatient,,,2320,580,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45385 - COLSC FLX W-RMVL OF TUMOR POLYP LESION SNARE TQ,45385,HCPCS,,,XU,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45385 - COLSC FLX W-RMVL OF TUMOR POLYP LESION SNARE TQ,45385,HCPCS,,,XS,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45385 - COLSC FLX W-RMVL OF TUMOR POLYP LESION SNARE TQ,45385,HCPCS,,,PT,Outpatient,,,2730.65,682.6625,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1791.31,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911.46,Percent of Total Billed Charges, ,,85,,2321.05,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1529.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638.39,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45385 - COLSC FLX W-RMVL OF TUMOR POLYP LESION SNARE TQ,45385,HCPCS,,,KX,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45385 - COLSC FLX W-RMVL OF TUMOR POLYP LESION SNARE TQ,45385,HCPCS,,,74,Outpatient,,,2730,682.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1790.88,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1911,Percent of Total Billed Charges, ,,85,,2320.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1856.4,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1528.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1638,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45388 - COLONOSCOPY FLX ABLATION TUMOR POLYP-OTHER LES,45388,HCPCS,,,XU,Outpatient,,,6349,1587.25,742.5,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.94,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4444.3,Percent of Total Billed Charges, ,,85,,5396.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4317.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3555.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3809.4,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45388 - COLONOSCOPY FLX ABLATION TUMOR POLYP-OTHER LES,45388,HCPCS,,,PT,Outpatient,,,6349,1587.25,742.5,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1741.34,,,1741.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.94,Percent of Total Billed Charges, ,1756.65,,,1756.65,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4444.3,Percent of Total Billed Charges, ,,85,,5396.65,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4317.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3555.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3809.4,Percent of Total Billed Charges, ,1723.54,,,1723.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1701.59,,,1701.59,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1160.24,,,1160.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1171.45,,,1171.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1121,,,1121,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1132.21,,,1132.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1154.63,,,1154.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1174.25,,,1174.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45390 - COLONOSCOPY FLX W-ENDOSCOPIC MUCOSAL RESECTION,45390,HCPCS,,,XU,Outpatient,,,6349,1587.25,882.09,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4050.11,,,4050.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.94,Percent of Total Billed Charges, ,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4444.3,Percent of Total Billed Charges, ,,85,,5396.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4317.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3555.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3809.4,Percent of Total Billed Charges, ,4008.72,,,4008.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4037.44,,,4037.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2698.56,,,2698.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2724.63,,,2724.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2607.3,,,2607.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2685.52,,,2685.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2731.15,,,2731.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45390 - COLONOSCOPY FLX W-ENDOSCOPIC MUCOSAL RESECTION,45390,HCPCS,,,XS,Outpatient,,,6349,1587.25,882.09,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4050.11,,,4050.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.94,Percent of Total Billed Charges, ,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4444.3,Percent of Total Billed Charges, ,,85,,5396.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4317.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3555.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3809.4,Percent of Total Billed Charges, ,4008.72,,,4008.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4037.44,,,4037.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2698.56,,,2698.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2724.63,,,2724.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2607.3,,,2607.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2685.52,,,2685.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2731.15,,,2731.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45390 - COLONOSCOPY FLX W-ENDOSCOPIC MUCOSAL RESECTION,45390,HCPCS,,,PT,Outpatient,,,6349,1587.25,882.09,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4050.11,,,4050.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.94,Percent of Total Billed Charges, ,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4444.3,Percent of Total Billed Charges, ,,85,,5396.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4317.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3555.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3809.4,Percent of Total Billed Charges, ,4008.72,,,4008.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4037.44,,,4037.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2698.56,,,2698.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2724.63,,,2724.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2607.3,,,2607.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2685.52,,,2685.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2731.15,,,2731.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45390 - COLONOSCOPY FLX W-ENDOSCOPIC MUCOSAL RESECTION,45390,HCPCS,,,74,Outpatient,,,6349,1587.25,882.09,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4050.11,,,4050.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.94,Percent of Total Billed Charges, ,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4444.3,Percent of Total Billed Charges, ,,85,,5396.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4317.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3555.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3809.4,Percent of Total Billed Charges, ,4008.72,,,4008.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4037.44,,,4037.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2698.56,,,2698.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2724.63,,,2724.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2607.3,,,2607.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2685.52,,,2685.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2731.15,,,2731.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
45390 - COLONOSCOPY FLX W-ENDOSCOPIC MUCOSAL RESECTION,45390,HCPCS,,,52,Outpatient,,,6349,1587.25,882.09,6015,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4050.11,,,4050.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4164.94,Percent of Total Billed Charges, ,4168.1,,,4168.1,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4444.3,Percent of Total Billed Charges, ,,85,,5396.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4317.32,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3555.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3809.4,Percent of Total Billed Charges, ,4008.72,,,4008.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4037.44,,,4037.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2698.56,,,2698.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2724.63,,,2724.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2607.3,,,2607.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2633.37,,,2633.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2685.52,,,2685.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2731.15,,,2731.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49083 - ABDOM PARACENTESIS DX-THER W-IMAGING GUIDANCE,49083,HCPCS,,,73,Outpatient,,,2471,617.75,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1620.98,Percent of Total Billed Charges, ,1339.13,,,1339.13,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1729.7,Percent of Total Billed Charges, ,,85,,2100.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1680.28,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1383.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1482.6,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1297.15,,,1297.15,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
49440 - INSERT GASTROSTOMY TUBE PERCUTANEOUS,49440,HCPCS,,,74,Outpatient,,,2488,622,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1632.13,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1741.6,Percent of Total Billed Charges, ,,85,,2114.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1691.84,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1393.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1492.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
91110 - GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W-IANDR,91110,HCPCS,,,GA,Outpatient,,,1600,400,891.38,1996.2,,,,,,,Service Paid at Rev Code level,1144.06,,,1144.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,1384.64,,,1384.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1049.6,Percent of Total Billed Charges, ,1144.06,,,1144.06,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1120,Percent of Total Billed Charges, ,,85,,1360,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1088,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,896,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,960,Percent of Total Billed Charges, ,1370.5,,,1370.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1108.01,,,1108.01,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,922.58,,,922.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,931.49,,,931.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,891.38,,,891.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,900.29,,,900.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,918.12,,,918.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,933.72,,,933.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1996.2,,,1996.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1996.2,,,1996.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1996.2,,,1996.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1996.2,,,1996.2,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
G0105 - COLORECTAL SCRN; HI RISK IND,G0105,HCPCS,,,KX,Outpatient,,,2320,580,866.8,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0105 - COLORECTAL SCRN; HI RISK IND,G0105,HCPCS,,,74,Outpatient,,,2320,580,866.8,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0105 - COLORECTAL SCRN; HI RISK IND,G0105,HCPCS,,,52,Outpatient,,,2320,580,866.8,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0121 - COLON CA SCRN NOT HI RSK IND,G0121,HCPCS,,,KX,Outpatient,,,2320,580,866.8,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0121 - COLON CA SCRN NOT HI RSK IND,G0121,HCPCS,,,74,Outpatient,,,2320,580,866.8,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1346.46,,,1346.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,1348.08,,,1348.08,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,1332.71,,,1332.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1305.82,,,1305.82,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,897.14,,,897.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,905.81,,,905.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,866.8,,,866.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,875.47,,,875.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,892.8,,,892.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,907.97,,,907.97,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0750 - GASTRO - INTESTINAL (GI) SERVICES - GENERAL CLASSIFICATION,0750,RC,,,,Outpatient,,,3111.55,777.8875,1442,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,2041.18,Percent of Total Billed Charges, ,,,,,,,,70,,2178.09,Percent of Total Billed Charges, ,,85,,2644.82,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2115.85,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1866.93,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,79,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,25,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29445 - APPLICATION RIGID TOTAL CONTACT LEG CAST,29445,HCPCS,,,XU,Outpatient,,,1450,362.5,0.01,1232.5,,,46,,667,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,951.2,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1015,Percent of Total Billed Charges, ,,85,,1232.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,986,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,870,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29445 - APPLICATION RIGID TOTAL CONTACT LEG CAST,29445,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,435,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29580 - STRAPPING UNNA BOOT,29580,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29580 - STRAPPING UNNA BOOT,29580,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29580 - STRAPPING UNNA BOOT,29580,HCPCS,,,50,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W-ANKLE FOOT,29581,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,9153,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W-ANKLE FOOT,29581,HCPCS,,,50,Outpatient,,,725,181.25,0.01,9153,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31623 - BRNCHSC BRUSHING-PROTECTED BRUSHINGS,31623,HCPCS,,,RT,Outpatient,,,3246.25,811.5625,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2129.54,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2272.38,Percent of Total Billed Charges, ,,85,,2759.31,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2207.45,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1947.75,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,RT,Outpatient,,,2689.5,672.375,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1764.31,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1882.65,Percent of Total Billed Charges, ,,85,,2286.08,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1828.86,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1613.7,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,LT,Outpatient,,,1976,494,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1296.26,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1383.2,Percent of Total Billed Charges, ,,85,,1679.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1343.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1185.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31628 - BRONCHOSCOPY W-TRANSBRONCHIAL LUNG BX 1 LOBE,31628,HCPCS,,,RT,Outpatient,,,3403,850.75,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2232.37,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2382.1,Percent of Total Billed Charges, ,,85,,2892.55,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2314.04,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2041.8,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,RT,Outpatient,,,4470,1117.5,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2932.32,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3129,Percent of Total Billed Charges, ,,85,,3799.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3039.6,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2682,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,LT,Outpatient,,,3831,957.75,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2513.14,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2681.7,Percent of Total Billed Charges, ,,85,,3256.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2605.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2298.6,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,52,Outpatient,,,3831,957.75,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2513.14,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2681.7,Percent of Total Billed Charges, ,,85,,3256.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2605.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2298.6,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32556 - PERQ DRAINAGE PLEURA INSERT CATH W-O IMAGING,32556,HCPCS,,,RT,Outpatient,,,3303,825.75,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2166.77,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2312.1,Percent of Total Billed Charges, ,,85,,2807.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2246.04,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1981.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32557 - PERQ DRAINAGE PLEURA INSERT CATH W-IMAGING,32557,HCPCS,,,RT,Outpatient,,,2154,538.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1413.02,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1507.8,Percent of Total Billed Charges, ,,85,,1830.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1464.72,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1292.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36475 - ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN,36475,HCPCS,,,LT,Outpatient,,,9601,2400.25,882.09,13976,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,5760.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36589 - RMVL TUN CVC W-O SUBQ PORT-PMP,36589,HCPCS,,,RT,Outpatient,,,1800,450,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1080,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37252 - INTRAVASCULAR US NONCORONARY RSANDI INTIAL VESSEL,37252,HCPCS,,,LT,Outpatient,,,4366,1091.5,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2864.1,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3056.2,Percent of Total Billed Charges, ,,85,,3711.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2968.88,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2619.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37253 - INTRAVASCULAR US NONCORONARY RSANDI ADDL VESSEL,37253,HCPCS,,,LT,Outpatient,,,3969,992.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2603.66,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2778.3,Percent of Total Billed Charges, ,,85,,3373.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2698.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2381.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
42400 - BIOPSY SALIVARY GLAND NEEDLE,42400,HCPCS,,,52,Outpatient,,,1388,347,668.93,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,910.53,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,971.6,Percent of Total Billed Charges, ,,85,,1179.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,943.84,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,832.8,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50389 - RMVL NFROS TUBE REQ FLUORO GUIDANCE,50389,HCPCS,,,LT,Outpatient,,,1800,450,634.59,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1080,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50431 - NJX PX ANTEGRDE NFROSGRM AND-URTRGRM EXSTNG ACESS,50431,HCPCS,,,XU,Outpatient,,,4608,1152,634.59,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2764.8,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50431 - NJX PX ANTEGRDE NFROSGRM AND-URTRGRM EXSTNG ACESS,50431,HCPCS,,,LT,Outpatient,,,4608,1152,634.59,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2764.8,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50432 - PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RSANDI,50432,HCPCS,,,XP,Outpatient,,,7218,1804.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4735.01,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5052.6,Percent of Total Billed Charges, ,,85,,6135.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4908.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,4330.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50432 - PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RSANDI,50432,HCPCS,,,RT,Outpatient,,,7218,1804.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4735.01,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5052.6,Percent of Total Billed Charges, ,,85,,6135.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4908.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,4330.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50432 - PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RSANDI,50432,HCPCS,,,LT,Outpatient,,,7218,1804.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4735.01,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5052.6,Percent of Total Billed Charges, ,,85,,6135.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4908.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,4330.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W-IMG GID RSANDI,50435,HCPCS,,,XU,Outpatient,,,4608,1152,742.5,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2764.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W-IMG GID RSANDI,50435,HCPCS,,,LT,Outpatient,,,4608,1152,742.5,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2764.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W-IMG GID RSANDI,50435,HCPCS,,,50,Outpatient,,,4608,1152,742.5,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,2764.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50693 - PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT,50693,HCPCS,,,RT,Outpatient,,,9601,2400.25,742.5,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,5760.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50693 - PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT,50693,HCPCS,,,LT,Outpatient,,,9601,2400.25,742.5,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,5760.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50695 - PLMT URTRL STENT PRQ NEW ACCESS W-SEP NFROS CATH,50695,HCPCS,,,LT,Outpatient,,,9201,2300.25,742.5,10028,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6035.86,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6440.7,Percent of Total Billed Charges, ,,85,,7820.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6256.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,5520.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62322 - NJX DX-THER SBST INTRLMNR LMBR-SAC W-O IMG GDN,62322,HCPCS,,,XP,Outpatient,,,2328,582,846.43,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1527.17,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1629.6,Percent of Total Billed Charges, ,,85,,1978.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1583.04,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1396.8,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64405 - INJECTION AAAND-STRD GREATER OCCIPITAL NERVE,64405,HCPCS,,,RT,Outpatient,,,6840,1710,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4487.04,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4788,Percent of Total Billed Charges, ,,85,,5814,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4651.2,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,4104,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64445 - INJECTION AAAND-STRD SCIATIC NERVE W-IMG GDN,64445,HCPCS,,,59,Outpatient,,,2850,712.5,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1869.6,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1995,Percent of Total Billed Charges, ,,85,,2422.5,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1938,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,1710,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64454 - INJECTION AAAND-STRD GENICULAR NRV BRANCHES W-IMG,64454,HCPCS,,,XP,Outpatient,,,1400,350,658.41,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,918.4,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,980,Percent of Total Billed Charges, ,,85,,1190,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,952,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,840,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
64454 - INJECTION AAAND-STRD GENICULAR NRV BRANCHES W-IMG,64454,HCPCS,,,LT,Outpatient,,,1400,350,658.41,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,918.4,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,980,Percent of Total Billed Charges, ,,85,,1190,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,952,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,840,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
64999 - UNLISTED PROCEDURE NERVOUS SYSTEM,64999,HCPCS,,,XP,Outpatient,,,1140,285,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,747.84,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,798,Percent of Total Billed Charges, ,,85,,969,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,775.2,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,684,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97605 - NEGATIVE PRESSURE WOUND THERAPY DME LESS THAN = 50 SQ CM,97605,HCPCS,,,XU,Outpatient,,,275,68.75,90.41,293.45,,,46,,126.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,127.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,180.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,192.5,Percent of Total Billed Charges, ,,85,,233.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,187,Percent of Total Billed Charges,0,,50,,137.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,165,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.41,,,90.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.41,,,90.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.41,,,90.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.41,,,90.41,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
99202 - OFFICE-OUTPATIENT NEW SF MDM 15 MINUTES,99202,HCPCS,,,U1,Outpatient,,,254.85,63.7125,0.01,216.62,,,46,,117.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,118.51,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,167.18,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,178.4,Percent of Total Billed Charges, ,,85,,216.62,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,173.3,Percent of Total Billed Charges,0,,50,,127.43,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,152.91,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99202 - OFFICE-OUTPATIENT NEW SF MDM 15 MINUTES,99202,HCPCS,,,25,Outpatient,,,310,77.5,0.01,263.5,,,46,,142.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,144.15,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,203.36,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,217,Percent of Total Billed Charges, ,,85,,263.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,210.8,Percent of Total Billed Charges,0,,50,,155,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,186,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99203 - OFFICE-OUTPATIENT NEW LOW MDM 30 MINUTES,99203,HCPCS,,,U1,Outpatient,,,382,95.5,0.01,324.7,,,46,,175.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,177.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,250.59,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,267.4,Percent of Total Billed Charges, ,,85,,324.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,259.76,Percent of Total Billed Charges,0,,50,,191,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,229.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99203 - OFFICE-OUTPATIENT NEW LOW MDM 30 MINUTES,99203,HCPCS,,,25,Outpatient,,,382,95.5,0.01,324.7,,,46,,175.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,177.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,250.59,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,267.4,Percent of Total Billed Charges, ,,85,,324.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,259.76,Percent of Total Billed Charges,0,,50,,191,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,229.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99204 - OFFICE-OUTPATIENT NEW MODERATE MDM 45 MINUTES,99204,HCPCS,,,25,Outpatient,,,569,142.25,0.01,483.65,,,46,,261.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,264.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,373.26,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,398.3,Percent of Total Billed Charges, ,,85,,483.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,386.92,Percent of Total Billed Charges,0,,50,,284.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,341.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99211 - OFFICE-OUTPATIENT EST PT MAY NOT REQ PHYS-QHP,99211,HCPCS,,,U1,Outpatient,,,185.41,46.3525,0.01,157.6,,,46,,85.29,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,86.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,121.63,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,129.79,Percent of Total Billed Charges, ,,85,,157.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,126.08,Percent of Total Billed Charges,0,,50,,92.71,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,111.25,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99211 - OFFICE-OUTPATIENT EST PT MAY NOT REQ PHYS-QHP,99211,HCPCS,,,25,Outpatient,,,197.11,49.2775,0.01,167.54,,,46,,90.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,91.66,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,129.3,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,137.98,Percent of Total Billed Charges, ,,85,,167.54,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,134.03,Percent of Total Billed Charges,0,,50,,98.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,118.27,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99212 - OFFICE-OUTPATIENT ESTABLISHED SF MDM 10 MIN,99212,HCPCS,,,U1,Outpatient,,,228.24,57.06,0.01,194,,,46,,104.99,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,106.13,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,149.73,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,159.77,Percent of Total Billed Charges, ,,85,,194,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,155.2,Percent of Total Billed Charges,0,,50,,114.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,136.94,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99212 - OFFICE-OUTPATIENT ESTABLISHED SF MDM 10 MIN,99212,HCPCS,,,25,Outpatient,,,280,70,0.01,238,,,46,,128.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,130.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,183.68,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,196,Percent of Total Billed Charges, ,,85,,238,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,190.4,Percent of Total Billed Charges,0,,50,,140,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,168,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99213 - OFFICE-OUTPATIENT ESTABLISHED LOW MDM 20 MIN,99213,HCPCS,,,U1,Outpatient,,,311.6,77.9,0.01,264.86,,,46,,143.34,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,144.89,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,204.41,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,218.12,Percent of Total Billed Charges, ,,85,,264.86,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,211.89,Percent of Total Billed Charges,0,,50,,155.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,186.96,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99213 - OFFICE-OUTPATIENT ESTABLISHED LOW MDM 20 MIN,99213,HCPCS,,,25,Outpatient,,,380,95,0.01,323,,,46,,174.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,176.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,249.28,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,266,Percent of Total Billed Charges, ,,85,,323,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,258.4,Percent of Total Billed Charges,0,,50,,190,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,228,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99214 - OFFICE-OUTPATIENT ESTABLISHED MOD MDM 30 MIN,99214,HCPCS,,,25,Outpatient,,,509,127.25,0.01,432.65,,,46,,234.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,236.69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,346.12,Percent of Total Billed Charges,0,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
T1015 - CLINIC SERVICE,T1015,HCPCS,,,U1,Outpatient,,,266.47,66.6175,35.64,226.5,,,46,,122.58,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,123.91,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,174.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,186.53,Percent of Total Billed Charges, ,,85,,226.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,181.2,Percent of Total Billed Charges,0,,50,,133.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,159.88,Percent of Total Billed Charges, ,,,,,,,,,,,,Service Paid at Rev Code level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
T1015 - CLINIC SERVICE,T1015,HCPCS,,,25,Outpatient,,,337.65,84.4125,35.64,287,,,46,,155.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,46.5,,157.01,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,221.5,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,236.36,Percent of Total Billed Charges, ,,85,,287,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,229.6,Percent of Total Billed Charges,0,,50,,168.83,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,60,,202.59,Percent of Total Billed Charges, ,,,,,,,,,,,,Service Paid at Rev Code level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0760 - SPECIALTY SERVICES - GENERAL CLASSIFICATION,0760,RC,,,,Outpatient,,,324.27,81.0675,194.56,3800,,,,,,,,3800,,,3800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,65.6,,212.72,Percent of Total Billed Charges, ,3800,,,3800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,226.99,Percent of Total Billed Charges, ,,85,,275.63,Percent of Total Billed Charges, ,3461,,,3461,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,220.5,Percent of Total Billed Charges,0,,,,,,,,,,,,,2747,,,2747,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,194.56,Percent of Total Billed Charges, ,,,,,,,3800,,,3800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA-CYST,10160,HCPCS,,,XU,Outpatient,,,775,193.75,379.85,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA-CYST,10160,HCPCS,,,52,Outpatient,,,775,193.75,379.85,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,XU,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,XS,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,79,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,59,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM-LESS THAN,11042,HCPCS,,,25,Outpatient,,,2320,580,379.85,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11043 - DEBRIDEMENT MUSCLE AND-FASCIA 1ST 20 SQ CM-LESS THAN,11043,HCPCS,,,XU,Outpatient,,,2320,580,581.98,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,904.03,,,904.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,942.41,,,942.41,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,894.79,,,894.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,912.86,,,912.86,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,602.35,,,602.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,608.17,,,608.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,581.98,,,581.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,599.44,,,599.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.62,,,609.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11045 - DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM,11045,HCPCS,,,XU,Outpatient,,,966.67,241.6675,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,634.14,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,676.67,Percent of Total Billed Charges, ,,85,,821.67,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,657.34,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,541.34,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,580,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
11046 - DEBRIDEMENT MUSCLE AND-FASCIA EA ADDL 20 SQ CM,11046,HCPCS,,,XU,Outpatient,,,1450,362.5,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,951.2,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1015,Percent of Total Billed Charges, ,,85,,1232.5,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,986,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,812,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,870,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
11104 - PUNCH BIOPSY SKIN SINGLE LESION,11104,HCPCS,,,RT,Outpatient,,,775,193.75,356.5,9153,,,46,,356.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,590.05,,,590.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,605.17,,,605.17,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,584.02,,,584.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,586.2,,,586.2,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,393.14,,,393.14,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,396.94,,,396.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,379.85,,,379.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,383.65,,,383.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,391.25,,,391.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,397.89,,,397.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
11730 - AVULSION NAIL PLATE PARTIAL-COMPLETE SIMPLE 1,11730,HCPCS,,,TA,Outpatient,,,775,193.75,188.91,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,508.4,Percent of Total Billed Charges, ,292.94,,,292.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,542.5,Percent of Total Billed Charges, ,,85,,658.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,527,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,434,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,465,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.75,,,283.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
15275 - SUB GRFT F-S-N-H-F-G-M-D LESS THAN 100SQ CM 1ST 25 SQ CM,15275,HCPCS,,,79,Outpatient,,,9462,2365.5,1078.11,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6207.07,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6623.4,Percent of Total Billed Charges, ,,85,,8042.7,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6434.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5298.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5677.2,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
20606 - ARTHROCENTESIS ASPIRAND-INJ INTERM JT-BURS W-US,20606,HCPCS,,,RT,Outpatient,,,1373,343.25,658.41,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,900.69,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,961.1,Percent of Total Billed Charges, ,,85,,1167.05,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,933.64,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,768.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,823.8,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,T7,Outpatient,,,3144,786,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2062.46,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2200.8,Percent of Total Billed Charges, ,,85,,2672.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2137.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1760.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1886.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,T5,Outpatient,,,3144,786,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2062.46,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2200.8,Percent of Total Billed Charges, ,,85,,2672.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2137.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1760.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1886.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,T1,Outpatient,,,3144,786,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2062.46,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2200.8,Percent of Total Billed Charges, ,,85,,2672.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2137.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1760.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1886.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,28232,HCPCS,,,59,Outpatient,,,3144,786,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2363.57,,,2363.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2062.46,Percent of Total Billed Charges, ,2327.04,,,2327.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2200.8,Percent of Total Billed Charges, ,,85,,2672.4,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2137.92,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1760.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1886.4,Percent of Total Billed Charges, ,2339.41,,,2339.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2254.09,,,2254.09,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1574.82,,,1574.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1590.04,,,1590.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.57,,,1521.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1536.79,,,1536.79,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1567.22,,,1567.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1593.84,,,1593.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29445 - APPLICATION RIGID TOTAL CONTACT LEG CAST,29445,HCPCS,,,XS,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29445 - APPLICATION RIGID TOTAL CONTACT LEG CAST,29445,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,392.22,,,392.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,389.18,,,389.18,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,388.22,,,388.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,376.98,,,376.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,261.34,,,261.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,263.86,,,263.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,252.5,,,252.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,255.03,,,255.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,260.08,,,260.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,264.49,,,264.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29580 - STRAPPING UNNA BOOT,29580,HCPCS,,,XU,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29580 - STRAPPING UNNA BOOT,29580,HCPCS,,,XS,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29580 - STRAPPING UNNA BOOT,29580,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29580 - STRAPPING UNNA BOOT,29580,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29580 - STRAPPING UNNA BOOT,29580,HCPCS,,,50,Outpatient,,,725,181.25,0.01,775,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W-ANKLE FOOT,29581,HCPCS,,,XU,Outpatient,,,725,181.25,0.01,9153,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W-ANKLE FOOT,29581,HCPCS,,,RT,Outpatient,,,725,181.25,0.01,9153,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W-ANKLE FOOT,29581,HCPCS,,,LT,Outpatient,,,725,181.25,0.01,9153,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W-ANKLE FOOT,29581,HCPCS,,,50,Outpatient,,,725,181.25,0.01,9153,,,46,,333.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,233.03,,,233.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,236.44,,,236.44,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,230.66,,,230.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.03,,,229.03,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,155.27,,,155.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,156.77,,,156.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.02,,,150.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,151.52,,,151.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,154.52,,,154.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,157.15,,,157.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,,,,,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
30802 - ABLTJ SOF TISS INF TURBS UNI-BI SUPFC INTRAMURAL,30802,HCPCS,,,XP,Outpatient,,,3321,830.25,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2187.63,,,2187.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2178.58,Percent of Total Billed Charges, ,2251.81,,,2251.81,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2324.7,Percent of Total Billed Charges, ,,85,,2822.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2258.28,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1859.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1992.6,Percent of Total Billed Charges, ,2165.28,,,2165.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2181.22,,,2181.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1457.6,,,1457.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1471.68,,,1471.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1408.31,,,1408.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1422.39,,,1422.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1450.56,,,1450.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1475.2,,,1475.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31622 - BRNCHSC INCL FLUOR GDNCE DX W-CELL WASHG SPX,31622,HCPCS,,,74,Outpatient,,,2445,611.25,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1603.92,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1711.5,Percent of Total Billed Charges, ,,85,,2078.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1662.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1369.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1467,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31622 - BRNCHSC INCL FLUOR GDNCE DX W-CELL WASHG SPX,31622,HCPCS,,,59,Outpatient,,,2445,611.25,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1603.92,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1711.5,Percent of Total Billed Charges, ,,85,,2078.25,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1662.6,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1369.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1467,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31623 - BRNCHSC BRUSHING-PROTECTED BRUSHINGS,31623,HCPCS,,,RT,Outpatient,,,5484.52,1371.13,882.09,4661.84,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3597.85,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3839.16,Percent of Total Billed Charges, ,,85,,4661.84,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3729.47,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3071.33,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3290.71,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31623 - BRNCHSC BRUSHING-PROTECTED BRUSHINGS,31623,HCPCS,,,LT,Outpatient,,,5830.38,1457.595,882.09,4955.82,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3824.73,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4081.27,Percent of Total Billed Charges, ,,85,,4955.82,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3964.66,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3265.01,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3498.23,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31623 - BRNCHSC BRUSHING-PROTECTED BRUSHINGS,31623,HCPCS,,,50,Outpatient,,,2776,694,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1821.06,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1943.2,Percent of Total Billed Charges, ,,85,,2359.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1887.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1554.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1665.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,RT,Outpatient,,,3481.43,870.3575,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2283.82,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2437,Percent of Total Billed Charges, ,,85,,2959.22,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2367.37,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1949.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2088.86,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,LT,Outpatient,,,3004.33,751.0825,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1970.84,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2103.03,Percent of Total Billed Charges, ,,85,,2553.68,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2042.94,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1682.42,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1802.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31624 - BRNCHSC W-BRNCL ALVEOLAR LAVAGE,31624,HCPCS,,,50,Outpatient,,,1976,494,882.09,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1296.26,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1383.2,Percent of Total Billed Charges, ,,85,,1679.6,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1343.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1106.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1185.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31625 - BRONCHOSCOPY BRONCHIAL-ENDOBRNCL BX 1+ SITES,31625,HCPCS,,,XU,Outpatient,,,5960.5,1490.125,742.5,5066.43,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3910.09,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4172.35,Percent of Total Billed Charges, ,,85,,5066.43,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4053.14,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3337.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3576.3,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31625 - BRONCHOSCOPY BRONCHIAL-ENDOBRNCL BX 1+ SITES,31625,HCPCS,,,RT,Outpatient,,,9601,2400.25,742.5,8160.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31625 - BRONCHOSCOPY BRONCHIAL-ENDOBRNCL BX 1+ SITES,31625,HCPCS,,,LT,Outpatient,,,9601,2400.25,742.5,8160.85,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2546.8,,,2546.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,2593.12,,,2593.12,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,2520.76,,,2520.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2511.83,,,2511.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1696.9,,,1696.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1713.3,,,1713.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1639.52,,,1639.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1655.92,,,1655.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1688.71,,,1688.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1717.4,,,1717.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31628 - BRONCHOSCOPY W-TRANSBRONCHIAL LUNG BX 1 LOBE,31628,HCPCS,,,RT,Outpatient,,,4001.21,1000.3025,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2624.79,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2800.85,Percent of Total Billed Charges, ,,85,,3401.03,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2720.82,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2240.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2400.73,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31628 - BRONCHOSCOPY W-TRANSBRONCHIAL LUNG BX 1 LOBE,31628,HCPCS,,,LT,Outpatient,,,4234.06,1058.515,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2777.54,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2963.84,Percent of Total Billed Charges, ,,85,,3598.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2879.16,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2371.07,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2540.44,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31628 - BRONCHOSCOPY W-TRANSBRONCHIAL LUNG BX 1 LOBE,31628,HCPCS,,,50,Outpatient,,,5457,1364.25,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3579.79,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3819.9,Percent of Total Billed Charges, ,,85,,4638.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3710.76,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3055.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3274.2,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31629 - BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEMAND-BRON,31629,HCPCS,,,RT,Outpatient,,,5457,1364.25,742.5,5445.1,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3579.79,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3819.9,Percent of Total Billed Charges, ,,85,,4638.45,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3710.76,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3055.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3274.2,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31632 - BRONCHOSCOPY W-TRANSBRONCHIAL LUNG BX EACH LOBE,31632,HCPCS,,,RT,Outpatient,,,2776,694,0.01,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1821.06,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1943.2,Percent of Total Billed Charges, ,,85,,2359.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1887.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1554.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1665.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
31632 - BRONCHOSCOPY W-TRANSBRONCHIAL LUNG BX EACH LOBE,31632,HCPCS,,,LT,Outpatient,,,2320,580,0.01,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1521.92,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1624,Percent of Total Billed Charges, ,,85,,1972,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1577.6,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1299.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1392,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
31652 - BRNCHSC EBUS GUIDED SAMPL 1-2 NODE STATION-STRUX,31652,HCPCS,,,RT,Outpatient,,,7694.5,1923.625,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5047.59,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5386.15,Percent of Total Billed Charges, ,,85,,6540.33,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5232.26,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4308.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4616.7,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31652 - BRNCHSC EBUS GUIDED SAMPL 1-2 NODE STATION-STRUX,31652,HCPCS,,,74,Outpatient,,,9601,2400.25,882.09,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5445.1,,,5445.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5407.75,,,5407.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5389.44,,,5389.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5238.23,,,5238.23,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3628.02,,,3628.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3663.07,,,3663.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3505.33,,,3505.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3540.38,,,3540.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3610.49,,,3610.49,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3671.83,,,3671.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
31654 - BRNSCHSC TNDSC EBUS DX-TX INTERVENTION PERPH LES,31654,HCPCS,,,RT,Outpatient,,,2776,694,0.01,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1821.06,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1943.2,Percent of Total Billed Charges, ,,85,,2359.6,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1887.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1554.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1665.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32408 - CORE NEEDLE BX LUNG-MEDIASTINUM PERQ W-IMG,32408,HCPCS,,,RT,Outpatient,,,3151,787.75,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2067.06,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2205.7,Percent of Total Billed Charges, ,,85,,2678.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2142.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1764.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1890.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32408 - CORE NEEDLE BX LUNG-MEDIASTINUM PERQ W-IMG,32408,HCPCS,,,LT,Outpatient,,,3145.65,786.4125,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2063.55,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2201.96,Percent of Total Billed Charges, ,,85,,2673.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2139.04,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1761.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1887.39,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32408 - CORE NEEDLE BX LUNG-MEDIASTINUM PERQ W-IMG,32408,HCPCS,,,74,Outpatient,,,3151,787.75,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2067.06,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2205.7,Percent of Total Billed Charges, ,,85,,2678.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2142.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1764.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1890.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32408 - CORE NEEDLE BX LUNG-MEDIASTINUM PERQ W-IMG,32408,HCPCS,,,73,Outpatient,,,3151,787.75,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2067.06,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2205.7,Percent of Total Billed Charges, ,,85,,2678.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2142.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1764.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1890.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32408 - CORE NEEDLE BX LUNG-MEDIASTINUM PERQ W-IMG,32408,HCPCS,,,52,Outpatient,,,3151,787.75,742.5,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2392.85,,,2392.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2067.06,Percent of Total Billed Charges, ,2432.53,,,2432.53,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2205.7,Percent of Total Billed Charges, ,,85,,2678.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2142.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1764.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1890.6,Percent of Total Billed Charges, ,2368.41,,,2368.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2356.28,,,2356.28,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1594.35,,,1594.35,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1609.75,,,1609.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1540.43,,,1540.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1555.83,,,1555.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1586.64,,,1586.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1613.6,,,1613.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32550 - INSERTION INDWELLING TUNNELED PLEURAL CATHETER,32550,HCPCS,,,XU,Outpatient,,,9601,2400.25,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32550 - INSERTION INDWELLING TUNNELED PLEURAL CATHETER,32550,HCPCS,,,RT,Outpatient,,,9601,2400.25,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32550 - INSERTION INDWELLING TUNNELED PLEURAL CATHETER,32550,HCPCS,,,LT,Outpatient,,,7680.8,1920.2,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,5038.6,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5376.56,Percent of Total Billed Charges, ,,85,,6528.68,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,5222.94,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4301.25,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4608.48,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32550 - INSERTION INDWELLING TUNNELED PLEURAL CATHETER,32550,HCPCS,,,74,Outpatient,,,9601,2400.25,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32550 - INSERTION INDWELLING TUNNELED PLEURAL CATHETER,32550,HCPCS,,,73,Outpatient,,,9601,2400.25,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32550 - INSERTION INDWELLING TUNNELED PLEURAL CATHETER,32550,HCPCS,,,50,Outpatient,,,9601,2400.25,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32551 - TUBE THORACOSTOMY INCLUDES WATER SEAL,32551,HCPCS,,,XU,Outpatient,,,2154,538.5,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1413.02,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1507.8,Percent of Total Billed Charges, ,,85,,1830.9,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1464.72,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1206.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1292.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32552 - RMVL NDWELLG TUNNELED PLEURAL CATHETER W-CUFF,32552,HCPCS,,,RT,Outpatient,,,1394,348.5,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,775,,,775,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,914.46,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,975.8,Percent of Total Billed Charges, ,,85,,1184.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,947.92,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,780.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,836.4,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32554 - THORACENTESIS NEEDLE-CATH PLEURA W-O IMAGING,32554,HCPCS,,,LT,Outpatient,,,1800,450,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,RT,Outpatient,,,3918.14,979.535,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2570.3,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2742.7,Percent of Total Billed Charges, ,,85,,3330.42,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2664.34,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2194.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2350.88,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,LT,Outpatient,,,3958.8,989.7,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2596.97,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2771.16,Percent of Total Billed Charges, ,,85,,3364.98,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2691.98,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2216.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2375.28,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,74,Outpatient,,,3831,957.75,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2513.14,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2681.7,Percent of Total Billed Charges, ,,85,,3256.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2605.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2145.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2298.6,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,73,Outpatient,,,4789.5,1197.375,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3141.91,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3352.65,Percent of Total Billed Charges, ,,85,,4071.08,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3256.86,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2682.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2873.7,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,52,Outpatient,,,3831,957.75,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2513.14,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2681.7,Percent of Total Billed Charges, ,,85,,3256.35,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2605.08,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2145.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2298.6,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32555 - THORACENTESIS NEEDLE-CATH PLEURA W-IMAGING,32555,HCPCS,,,50,Outpatient,,,5600.54,1400.135,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3673.95,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3920.38,Percent of Total Billed Charges, ,,85,,4760.46,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3808.37,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3136.3,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3360.32,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32556 - PERQ DRAINAGE PLEURA INSERT CATH W-O IMAGING,32556,HCPCS,,,LT,Outpatient,,,3303,825.75,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2166.77,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2312.1,Percent of Total Billed Charges, ,,85,,2807.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2246.04,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1849.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1981.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32556 - PERQ DRAINAGE PLEURA INSERT CATH W-O IMAGING,32556,HCPCS,,,50,Outpatient,,,3303,825.75,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2166.77,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2312.1,Percent of Total Billed Charges, ,,85,,2807.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2246.04,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1849.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1981.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32557 - PERQ DRAINAGE PLEURA INSERT CATH W-IMAGING,32557,HCPCS,,,RT,Outpatient,,,2154,538.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1413.02,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1507.8,Percent of Total Billed Charges, ,,85,,1830.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1464.72,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1206.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1292.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32557 - PERQ DRAINAGE PLEURA INSERT CATH W-IMAGING,32557,HCPCS,,,LT,Outpatient,,,2154,538.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1413.02,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1507.8,Percent of Total Billed Charges, ,,85,,1830.9,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1464.72,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1206.24,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1292.4,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
32560 - INSTLJ VIA CHEST TUBE-CATH AGENT FOR PLEURODESIS,32560,HCPCS,,,XU,Outpatient,,,1800,450,587.8,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36410 - VNPNXR 3 YEARS-GREATER THAN PHYS-QHP SKILL DX-THER PURPOSES,36410,HCPCS,,,XU,Outpatient,,,595,148.75,0.01,742.5,,,46,,273.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,390.32,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,416.5,Percent of Total Billed Charges, ,,85,,505.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,404.6,Percent of Total Billed Charges,0,,50,,297.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,333.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,357,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36465 - NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN,36465,HCPCS,,,RT,Outpatient,,,9501,2375.25,882.09,8200,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2701.51,,,2701.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6232.66,Percent of Total Billed Charges, ,2799.64,,,2799.64,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6650.7,Percent of Total Billed Charges, ,,85,,8075.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6460.68,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5320.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5700.6,Percent of Total Billed Charges, ,2673.9,,,2673.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2711.88,,,2711.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1799.99,,,1799.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1817.38,,,1817.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1739.12,,,1739.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1756.51,,,1756.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1791.29,,,1791.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.73,,,1821.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36478 - ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,36478,HCPCS,,,RT,Outpatient,,,9601,2400.25,882.09,13976,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36478 - ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,36478,HCPCS,,,LT,Outpatient,,,9601,2400.25,882.09,13976,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,13976,,,13976,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36482 - ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN,36482,HCPCS,,,LT,Outpatient,,,9859,2464.75,0.01,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,7983.44,,,7983.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6467.5,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6901.3,Percent of Total Billed Charges, ,,85,,8380.15,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,6704.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5521.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5915.4,Percent of Total Billed Charges, ,7901.86,,,7901.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5319.3,,,5319.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5370.69,,,5370.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5139.42,,,5139.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5190.81,,,5190.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5293.6,,,5293.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5383.54,,,5383.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36556 - INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR-GREATER THAN,36556,HCPCS,,,RT,Outpatient,,,5043,1260.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36556 - INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR-GREATER THAN,36556,HCPCS,,,LT,Outpatient,,,5043,1260.75,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3308.21,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3530.1,Percent of Total Billed Charges, ,,85,,4286.55,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3429.24,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2824.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3025.8,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36558 - INSJ TUNNELED CVC W-O SUBQ PORT-PMP AGE 5 YR-GREATER THAN,36558,HCPCS,,,XU,Outpatient,,,5151,1287.75,742.5,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36558 - INSJ TUNNELED CVC W-O SUBQ PORT-PMP AGE 5 YR-GREATER THAN,36558,HCPCS,,,RT,Outpatient,,,5151,1287.75,742.5,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36558 - INSJ TUNNELED CVC W-O SUBQ PORT-PMP AGE 5 YR-GREATER THAN,36558,HCPCS,,,LT,Outpatient,,,5151,1287.75,742.5,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36561 - INSJ TUNNELED CTR VAD W-SUBQ PORT AGE 5 YR-GREATER THAN,36561,HCPCS,,,RT,Outpatient,,,5586,1396.5,882.09,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3664.42,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3910.2,Percent of Total Billed Charges, ,,85,,4748.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3798.48,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3128.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3351.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36561 - INSJ TUNNELED CTR VAD W-SUBQ PORT AGE 5 YR-GREATER THAN,36561,HCPCS,,,LT,Outpatient,,,5586,1396.5,882.09,5431,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3664.42,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3910.2,Percent of Total Billed Charges, ,,85,,4748.1,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3798.48,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3128.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3351.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36569 - INSERTION PICC W-O IMG GDN 5 YR-GREATER THAN,36569,HCPCS,,,RT,Outpatient,,,2933,733.25,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1924.05,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2053.1,Percent of Total Billed Charges, ,,85,,2493.05,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1994.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1642.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1759.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36573 - INSERTION PICC W-RSANDI 5 YR-GREATER THAN,36573,HCPCS,,,RT,Outpatient,,,6352,1588,882.09,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4166.91,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4446.4,Percent of Total Billed Charges, ,,85,,5399.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4319.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3557.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3811.2,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36573 - INSERTION PICC W-RSANDI 5 YR-GREATER THAN,36573,HCPCS,,,LT,Outpatient,,,6352,1588,882.09,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4166.91,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,4446.4,Percent of Total Billed Charges, ,,85,,5399.2,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4319.36,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,3557.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3811.2,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36580 - RPLCMT COMPL NON-TUN CVC W-O SUBQ PORT-PMP,36580,HCPCS,,,RT,Outpatient,,,2858,714.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1874.85,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2000.6,Percent of Total Billed Charges, ,,85,,2429.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1943.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1600.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1714.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36580 - RPLCMT COMPL NON-TUN CVC W-O SUBQ PORT-PMP,36580,HCPCS,,,LT,Outpatient,,,2858,714.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1874.85,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2000.6,Percent of Total Billed Charges, ,,85,,2429.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1943.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1600.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1714.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36581 - RPLCMT COMPL TUN CVC W-O SUBQ PORT-PMP,36581,HCPCS,,,XE,Outpatient,,,5151,1287.75,882.09,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36581 - RPLCMT COMPL TUN CVC W-O SUBQ PORT-PMP,36581,HCPCS,,,RT,Outpatient,,,5151,1287.75,882.09,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36581 - RPLCMT COMPL TUN CVC W-O SUBQ PORT-PMP,36581,HCPCS,,,LT,Outpatient,,,5151,1287.75,882.09,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3379.06,Percent of Total Billed Charges, ,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3605.7,Percent of Total Billed Charges, ,,85,,4378.35,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3502.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2884.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3090.6,Percent of Total Billed Charges, ,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36581 - RPLCMT COMPL TUN CVC W-O SUBQ PORT-PMP,36581,HCPCS,,,74,Outpatient,,,,,882.09,5431,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,4648.4,,,4648.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,4832.4,,,4832.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,,,,,,4600.89,,,4600.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4680.92,,,4680.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3097.19,,,3097.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3127.11,,,3127.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2992.45,,,2992.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3022.37,,,3022.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3082.22,,,3082.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3134.59,,,3134.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36584 - COMPLETE REPLACEMENT PICC RSANDI,36584,HCPCS,,,RT,Outpatient,,,2858,714.5,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1874.85,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2000.6,Percent of Total Billed Charges, ,,85,,2429.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1943.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1600.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1714.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36584 - COMPLETE REPLACEMENT PICC RSANDI,36584,HCPCS,,,LT,Outpatient,,,2858,714.5,950.4,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1874.85,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2000.6,Percent of Total Billed Charges, ,,85,,2429.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1943.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1600.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1714.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,950.4,,,950.4,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36589 - RMVL TUN CVC W-O SUBQ PORT-PMP,36589,HCPCS,,,RT,Outpatient,,,1800,450,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36589 - RMVL TUN CVC W-O SUBQ PORT-PMP,36589,HCPCS,,,LT,Outpatient,,,1800,450,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36589 - RMVL TUN CVC W-O SUBQ PORT-PMP,36589,HCPCS,,,53,Outpatient,,,1800,450,587.8,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,913.07,,,913.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,938.42,,,938.42,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,903.74,,,903.74,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,909,,,909,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,608.37,,,608.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,614.25,,,614.25,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,587.8,,,587.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,593.68,,,593.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,605.43,,,605.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,615.72,,,615.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36590 - RMVL TUN CTR VAD W-SUBQ PORT-PMP CTR-PRPH INSJ,36590,HCPCS,,,RT,Outpatient,,,2858,714.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1874.85,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2000.6,Percent of Total Billed Charges, ,,85,,2429.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1943.44,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1600.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1714.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36590 - RMVL TUN CTR VAD W-SUBQ PORT-PMP CTR-PRPH INSJ,36590,HCPCS,,,LT,Outpatient,,,2858,714.5,882.09,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1874.85,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2000.6,Percent of Total Billed Charges, ,,85,,2429.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1943.44,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1600.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1714.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36597 - RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE,36597,HCPCS,,,XS,Outpatient,,,2858,714.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1874.85,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2000.6,Percent of Total Billed Charges, ,,85,,2429.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1943.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1600.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1714.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
36597 - RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE,36597,HCPCS,,,RT,Outpatient,,,2858,714.5,742.5,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2294.21,,,2294.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1874.85,Percent of Total Billed Charges, ,2413.54,,,2413.54,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2000.6,Percent of Total Billed Charges, ,,85,,2429.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1943.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1600.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1714.8,Percent of Total Billed Charges, ,2270.76,,,2270.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2337.88,,,2337.88,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1528.61,,,1528.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1543.38,,,1543.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1476.92,,,1476.92,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1491.69,,,1491.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1521.23,,,1521.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1547.07,,,1547.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
37252 - INTRAVASCULAR US NONCORONARY RSANDI INTIAL VESSEL,37252,HCPCS,,,RT,Outpatient,,,4366,1091.5,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2864.1,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3056.2,Percent of Total Billed Charges, ,,85,,3711.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2968.88,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2444.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2619.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37252 - INTRAVASCULAR US NONCORONARY RSANDI INTIAL VESSEL,37252,HCPCS,,,LT,Outpatient,,,4366,1091.5,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2864.1,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3056.2,Percent of Total Billed Charges, ,,85,,3711.1,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2968.88,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2444.96,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2619.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37253 - INTRAVASCULAR US NONCORONARY RSANDI ADDL VESSEL,37253,HCPCS,,,XU,Outpatient,,,15876,3969,0.01,13494.6,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,10414.66,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,11113.2,Percent of Total Billed Charges, ,,85,,13494.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,10795.68,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,8890.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,9525.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37253 - INTRAVASCULAR US NONCORONARY RSANDI ADDL VESSEL,37253,HCPCS,,,RT,Outpatient,,,3969,992.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2603.66,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2778.3,Percent of Total Billed Charges, ,,85,,3373.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2698.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2222.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2381.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
37253 - INTRAVASCULAR US NONCORONARY RSANDI ADDL VESSEL,37253,HCPCS,,,LT,Outpatient,,,3969,992.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2603.66,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2778.3,Percent of Total Billed Charges, ,,85,,3373.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,2698.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2222.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2381.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
42400 - BIOPSY SALIVARY GLAND NEEDLE,42400,HCPCS,,,RT,Outpatient,,,1388,347,668.93,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,910.53,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,971.6,Percent of Total Billed Charges, ,,85,,1179.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,943.84,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,777.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,832.8,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
42400 - BIOPSY SALIVARY GLAND NEEDLE,42400,HCPCS,,,LT,Outpatient,,,1388,347,668.93,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1039.1,,,1039.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,910.53,Percent of Total Billed Charges, ,1052.75,,,1052.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,971.6,Percent of Total Billed Charges, ,,85,,1179.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,943.84,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,777.28,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,832.8,Percent of Total Billed Charges, ,1028.48,,,1028.48,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1019.75,,,1019.75,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,692.34,,,692.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,699.03,,,699.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,668.93,,,668.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,675.62,,,675.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689,,,689,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,700.7,,,700.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
43232 - ESOPHAGOSCOPY INTRA-TRANSMURAL NEEDLE ASPIRAT-BX,43232,HCPCS,,,52,Outpatient,,,3303,825.75,742.5,3804,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2801.58,,,2801.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2166.77,Percent of Total Billed Charges, ,2825.16,,,2825.16,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2312.1,Percent of Total Billed Charges, ,,85,,2807.55,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2246.04,Percent of Total Billed Charges,0,1895,,,1895,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1849.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1981.8,Percent of Total Billed Charges, ,2772.94,,,2772.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2736.6,,,2736.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1866.66,,,1866.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1884.7,,,1884.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1803.54,,,1803.54,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1821.58,,,1821.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1857.65,,,1857.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1889.21,,,1889.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
47531 - NJX CHOLANGIO PRQ W-IMG GID RSANDI EXISTING ACCESS,47531,HCPCS,,,XU,Outpatient,,,5227,1306.75,742.5,5745.6,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3428.91,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3658.9,Percent of Total Billed Charges, ,,85,,4442.95,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3554.36,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2927.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,3136.2,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
47534 - PRQ PLMT BILIARY DRG CATH W-IMG GID RSANDI INT-EXT,47534,HCPCS,,,XU,Outpatient,,,9601,2400.25,882.09,10028,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5211.91,,,5211.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5745.6,,,5745.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5158.65,,,5158.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5565.49,,,5565.49,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3472.65,,,3472.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3506.2,,,3506.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3355.22,,,3355.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3388.77,,,3388.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3455.88,,,3455.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3514.59,,,3514.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
47538 - PLMT BILE DUCT STENT PRQ EXISTING ACCESS,47538,HCPCS,,,XU,Outpatient,,,9859,2464.75,882.09,10452,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8616.51,,,8616.51,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6467.5,Percent of Total Billed Charges, ,8454.98,,,8454.98,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6901.3,Percent of Total Billed Charges, ,,85,,8380.15,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6704.12,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5521.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5915.4,Percent of Total Billed Charges, ,8528.45,,,8528.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,8189.94,,,8189.94,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5741.1,,,5741.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5796.57,,,5796.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5546.96,,,5546.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5602.43,,,5602.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5713.37,,,5713.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5810.44,,,5810.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
47544 - REMOVAL BILIARY DUCT AND-GLBLDR CALCULI PERQ RSANDI,47544,HCPCS,,,XU,Outpatient,,,4569,1142.25,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2997.26,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3198.3,Percent of Total Billed Charges, ,,85,,3883.65,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3106.92,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2558.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2741.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
50389 - RMVL NFROS TUBE REQ FLUORO GUIDANCE,50389,HCPCS,,,RT,Outpatient,,,1800,450,634.59,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50389 - RMVL NFROS TUBE REQ FLUORO GUIDANCE,50389,HCPCS,,,LT,Outpatient,,,1800,450,634.59,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50431 - NJX PX ANTEGRDE NFROSGRM AND-URTRGRM EXSTNG ACESS,50431,HCPCS,,,XU,Outpatient,,,4608,1152,634.59,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2580.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2764.8,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50431 - NJX PX ANTEGRDE NFROSGRM AND-URTRGRM EXSTNG ACESS,50431,HCPCS,,,RT,Outpatient,,,4608,1152,634.59,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2580.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2764.8,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50431 - NJX PX ANTEGRDE NFROSGRM AND-URTRGRM EXSTNG ACESS,50431,HCPCS,,,50,Outpatient,,,4608,1152,634.59,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,985.75,,,985.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,1014.4,,,1014.4,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2580.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2764.8,Percent of Total Billed Charges, ,975.68,,,975.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,982.6,,,982.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,656.8,,,656.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,663.15,,,663.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,634.59,,,634.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,640.94,,,640.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,653.63,,,653.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.73,,,664.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50432 - PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RSANDI,50432,HCPCS,,,XU,Outpatient,,,7218,1804.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4735.01,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5052.6,Percent of Total Billed Charges, ,,85,,6135.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4908.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4042.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4330.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50432 - PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RSANDI,50432,HCPCS,,,XP,Outpatient,,,7218,1804.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4735.01,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5052.6,Percent of Total Billed Charges, ,,85,,6135.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4908.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4042.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4330.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50432 - PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RSANDI,50432,HCPCS,,,RT,Outpatient,,,7218,1804.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4735.01,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5052.6,Percent of Total Billed Charges, ,,85,,6135.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4908.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4042.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4330.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50432 - PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RSANDI,50432,HCPCS,,,LT,Outpatient,,,7218,1804.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4735.01,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5052.6,Percent of Total Billed Charges, ,,85,,6135.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4908.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4042.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4330.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50432 - PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RSANDI,50432,HCPCS,,,50,Outpatient,,,7218,1804.5,742.5,9153,,3804,,,3804,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,4735.01,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,5052.6,Percent of Total Billed Charges, ,,85,,6135.3,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,4908.24,Percent of Total Billed Charges,0,3246,,,3246,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,4042.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,4330.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50434 - CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ,50434,HCPCS,,,RT,Outpatient,,,4417,1104.25,742.5,4145,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2897.55,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3091.9,Percent of Total Billed Charges, ,,85,,3754.45,Percent of Total Billed Charges, ,4145,,,4145,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3003.56,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2473.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2650.2,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W-IMG GID RSANDI,50435,HCPCS,,,RT,Outpatient,,,4608,1152,742.5,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2580.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2764.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W-IMG GID RSANDI,50435,HCPCS,,,LT,Outpatient,,,4608,1152,742.5,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2580.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2764.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50435 - EXCHANGE NEPHROSTOMY CATHETER PRQ W-IMG GID RSANDI,50435,HCPCS,,,50,Outpatient,,,4608,1152,742.5,3916.8,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3215,,,3215,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3025.36,,,3025.36,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,3022.85,Percent of Total Billed Charges, ,3008.92,,,3008.92,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,3225.6,Percent of Total Billed Charges, ,,85,,3916.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,3133.44,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2580.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2764.8,Percent of Total Billed Charges, ,2994.44,,,2994.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2914.6,,,2914.6,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2015.77,,,2015.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2035.24,,,2035.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1947.6,,,1947.6,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1967.08,,,1967.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2006.03,,,2006.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,2040.11,,,2040.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50693 - PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT,50693,HCPCS,,,RT,Outpatient,,,9601,2400.25,742.5,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50693 - PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT,50693,HCPCS,,,LT,Outpatient,,,9601,2400.25,742.5,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50693 - PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT,50693,HCPCS,,,50,Outpatient,,,9601,2400.25,742.5,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50694 - PLMT URTRL STNT PRQ NEW ACESS W-O SEP NFROS CATH,50694,HCPCS,,,RT,Outpatient,,,9601,2400.25,742.5,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50694 - PLMT URTRL STNT PRQ NEW ACESS W-O SEP NFROS CATH,50694,HCPCS,,,LT,Outpatient,,,9601,2400.25,742.5,8200,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6298.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6720.7,Percent of Total Billed Charges, ,,85,,8160.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6528.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5376.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5760.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50695 - PLMT URTRL STENT PRQ NEW ACCESS W-SEP NFROS CATH,50695,HCPCS,,,LT,Outpatient,,,9201,2300.25,742.5,10028,,4478,,,4478,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,6035.86,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,6440.7,Percent of Total Billed Charges, ,,85,,7820.85,Percent of Total Billed Charges, ,10028,,,10028,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,6256.68,Percent of Total Billed Charges,0,5431,,,5431,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,5152.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,5520.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50706 - BALLOON DILAT URETERAL STRICTURE W-IMG GID RSANDI,50706,HCPCS,,,RT,Outpatient,,,1812,453,0.01,6015,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1188.67,Percent of Total Billed Charges, ,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1268.4,Percent of Total Billed Charges, ,,85,,1540.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,1232.16,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1014.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1087.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
62322 - NJX DX-THER SBST INTRLMNR LMBR-SAC W-O IMG GDN,62322,HCPCS,,,XP,Outpatient,,,2328,582,846.43,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1527.17,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1629.6,Percent of Total Billed Charges, ,,85,,1978.8,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1583.04,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1303.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1396.8,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62323 - NJX DX-THER SBST INTRLMNR LMBR-SAC W-IMG GDN,62323,HCPCS,,,XU,Outpatient,,,2328,582,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1527.17,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1629.6,Percent of Total Billed Charges, ,,85,,1978.8,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1583.04,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1303.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1396.8,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
62323 - NJX DX-THER SBST INTRLMNR LMBR-SAC W-IMG GDN,62323,HCPCS,,,XS,Outpatient,,,2328,582,658.41,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1527.17,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1629.6,Percent of Total Billed Charges, ,,85,,1978.8,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1583.04,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1303.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1396.8,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64405 - INJECTION AAAND-STRD GREATER OCCIPITAL NERVE,64405,HCPCS,,,RT,Outpatient,,,1800,450,280.65,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,435.95,,,435.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,441.07,,,441.07,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,431.5,,,431.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,427.24,,,427.24,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,290.47,,,290.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.28,,,293.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,280.65,,,280.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,283.46,,,283.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,289.07,,,289.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,293.98,,,293.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
64454 - INJECTION AAAND-STRD GENICULAR NRV BRANCHES W-IMG,64454,HCPCS,,,XP,Outpatient,,,1400,350,658.41,3030,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1022.75,,,1022.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,918.4,Percent of Total Billed Charges, ,1045.22,,,1045.22,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,980,Percent of Total Billed Charges, ,,85,,1190,Percent of Total Billed Charges, ,3030,,,3030,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,952,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,784,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,840,Percent of Total Billed Charges, ,1012.31,,,1012.31,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1012.45,,,1012.45,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,681.45,,,681.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,688.04,,,688.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,658.41,,,658.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,664.99,,,664.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,678.16,,,678.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,689.68,,,689.68,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC,64510,HCPCS,,,50,Outpatient,,,1800,450,846.43,9153,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,2100,,,2100,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1314.83,,,1314.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1180.8,Percent of Total Billed Charges, ,1382.37,,,1382.37,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1260,Percent of Total Billed Charges, ,,85,,1530,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1224,Percent of Total Billed Charges,0,1460,,,1460,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,1008,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1080,Percent of Total Billed Charges, ,1301.39,,,1301.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1339.04,,,1339.04,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,876.06,,,876.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,884.52,,,884.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,846.43,,,846.43,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,854.89,,,854.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,871.82,,,871.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,886.64,,,886.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,882.09,,,882.09,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
96523 - IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST,96523,HCPCS,,,XU,Outpatient,,,85,21.25,29.24,87.72,,,34.4,,29.24,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,55.76,Percent of Total Billed Charges, ,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,59.5,Percent of Total Billed Charges, ,,85,,72.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,57.8,Percent of Total Billed Charges,0,,50,,42.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,47.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,51,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.15,,,77.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97597 - DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM-LESS THAN,97597,HCPCS,,,XU,Outpatient,,,725,181.25,71.46,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,253.93,,,253.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97597 - DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM-LESS THAN,97597,HCPCS,,,XS,Outpatient,,,725,181.25,71.46,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,253.93,,,253.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97597 - DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM-LESS THAN,97597,HCPCS,,,59,Outpatient,,,725,181.25,71.46,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,293.45,,,293.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,262.19,,,262.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,290.45,,,290.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,253.93,,,253.93,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,195.52,,,195.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.41,,,197.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,188.91,,,188.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,190.8,,,190.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,194.58,,,194.58,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197.88,,,197.88,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,71.46,,,71.46,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
97598 - DEBRIDEMENT OPN WND EA ADDL 20 SQ CM-PRT THEREOF,97598,HCPCS,,,XU,Outpatient,,,725,181.25,0.01,2812,,2812,,,2812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,475.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,507.5,Percent of Total Billed Charges, ,,85,,616.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,493,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,406,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,435,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,90.85,,,90.85,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
99202 - OFFICE-OUTPATIENT NEW SF MDM 15 MINUTES,99202,HCPCS,,,U1,Outpatient,,,223.33,55.8325,0.01,189.83,,,46,,102.73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,71.61,,,71.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,146.5,Percent of Total Billed Charges, ,71.61,,,71.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,156.33,Percent of Total Billed Charges, ,,85,,189.83,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,151.86,Percent of Total Billed Charges,0,,50,,111.67,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,125.06,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,134,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.36,,,69.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99202 - OFFICE-OUTPATIENT NEW SF MDM 15 MINUTES,99202,HCPCS,,,25,Outpatient,,,288.33,72.0825,0.01,245.08,,,46,,132.63,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,71.61,,,71.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,189.14,Percent of Total Billed Charges, ,71.61,,,71.61,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,201.83,Percent of Total Billed Charges, ,,85,,245.08,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,196.06,Percent of Total Billed Charges,0,,50,,144.17,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,161.46,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,173,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.36,,,69.36,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99203 - OFFICE-OUTPATIENT NEW LOW MDM 30 MINUTES,99203,HCPCS,,,U1,Outpatient,,,382,95.5,0.01,324.7,,,46,,175.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,107.43,,,107.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,250.59,Percent of Total Billed Charges, ,107.43,,,107.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,267.4,Percent of Total Billed Charges, ,,85,,324.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,259.76,Percent of Total Billed Charges,0,,50,,191,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,213.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,229.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.04,,,104.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99203 - OFFICE-OUTPATIENT NEW LOW MDM 30 MINUTES,99203,HCPCS,,,25,Outpatient,,,382,95.5,0.01,324.7,,,46,,175.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,107.43,,,107.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,250.59,Percent of Total Billed Charges, ,107.43,,,107.43,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,267.4,Percent of Total Billed Charges, ,,85,,324.7,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,259.76,Percent of Total Billed Charges,0,,50,,191,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,213.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,229.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.04,,,104.04,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99204 - OFFICE-OUTPATIENT NEW MODERATE MDM 45 MINUTES,99204,HCPCS,,,25,Outpatient,,,569,142.25,0.01,483.65,,,46,,261.74,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,183.78,,,183.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,373.26,Percent of Total Billed Charges, ,183.78,,,183.78,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,398.3,Percent of Total Billed Charges, ,,85,,483.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,386.92,Percent of Total Billed Charges,0,,50,,284.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,318.64,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,341.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,177.99,,,177.99,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99211 - OFFICE-OUTPATIENT EST PT MAY NOT REQ PHYS-QHP,99211,HCPCS,,,U1,Outpatient,,,174,43.5,0.01,147.9,,,46,,80.04,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.84,,,32.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,114.14,Percent of Total Billed Charges, ,32.84,,,32.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,121.8,Percent of Total Billed Charges, ,,85,,147.9,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,118.32,Percent of Total Billed Charges,0,,50,,87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,97.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,104.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.8,,,31.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99211 - OFFICE-OUTPATIENT EST PT MAY NOT REQ PHYS-QHP,99211,HCPCS,,,25,Outpatient,,,200.4,50.1,0.01,170.34,,,46,,92.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,32.84,,,32.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,131.46,Percent of Total Billed Charges, ,32.84,,,32.84,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,140.28,Percent of Total Billed Charges, ,,85,,170.34,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,136.27,Percent of Total Billed Charges,0,,50,,100.2,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,112.22,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,120.24,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.8,,,31.8,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99212 - OFFICE-OUTPATIENT ESTABLISHED SF MDM 10 MIN,99212,HCPCS,,,U1,Outpatient,,,192,48,0.01,163.2,,,46,,88.32,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.9,,,64.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,125.95,Percent of Total Billed Charges, ,64.9,,,64.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,134.4,Percent of Total Billed Charges, ,,85,,163.2,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,130.56,Percent of Total Billed Charges,0,,50,,96,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,107.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,115.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.85,,,62.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99212 - OFFICE-OUTPATIENT ESTABLISHED SF MDM 10 MIN,99212,HCPCS,,,25,Outpatient,,,280,70,0.01,238,,,46,,128.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,64.9,,,64.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,183.68,Percent of Total Billed Charges, ,64.9,,,64.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,196,Percent of Total Billed Charges, ,,85,,238,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,190.4,Percent of Total Billed Charges,0,,50,,140,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,156.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,168,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,62.85,,,62.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99213 - OFFICE-OUTPATIENT ESTABLISHED LOW MDM 20 MIN,99213,HCPCS,,,25,Outpatient,,,387.07,96.7675,0.01,329.01,,,46,,178.05,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,108.22,,,108.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,253.92,Percent of Total Billed Charges, ,108.22,,,108.22,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,270.95,Percent of Total Billed Charges, ,,85,,329.01,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,263.21,Percent of Total Billed Charges,0,,50,,193.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,216.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,232.24,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.81,,,104.81,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99214 - OFFICE-OUTPATIENT ESTABLISHED MOD MDM 30 MIN,99214,HCPCS,,,25,Outpatient,,,509,127.25,0.01,432.65,,,46,,234.14,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.68,,,157.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,333.9,Percent of Total Billed Charges, ,157.68,,,157.68,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,356.3,Percent of Total Billed Charges, ,,85,,432.65,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,346.12,Percent of Total Billed Charges,0,,50,,254.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,285.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,305.4,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,152.71,,,152.71,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
99215 - OFFICE-OUTPATIENT ESTABLISHED HIGH MDM 40 MIN,99215,HCPCS,,,25,Outpatient,,,536,134,0.01,455.6,,,46,,246.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,212.39,,,212.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,351.62,Percent of Total Billed Charges, ,212.39,,,212.39,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,375.2,Percent of Total Billed Charges, ,,85,,455.6,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,364.48,Percent of Total Billed Charges,0,,50,,268,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,300.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,321.6,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,205.69,,,205.69,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
C9772 - REVASC LITHOTRIP TIBI-PERONE,C9772,HCPCS,,,LT,Outpatient,,,23061,5765.25,5995.86,19601.85,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,10608.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,15128.02,Percent of Total Billed Charges, ,,46,,10608.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,16142.7,Percent of Total Billed Charges, ,,85,,19601.85,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,15681.48,Percent of Total Billed Charges,0,11151,,,11151,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,12914.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,13836.6,Percent of Total Billed Charges, ,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,5995.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0463 - HOSPITAL OUTPT CLINIC VISIT,G0463,HCPCS,,,U1,Outpatient,,,227.42,56.855,0.01,193.31,,,46,,104.61,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,190.32,,,190.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,149.19,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,159.19,Percent of Total Billed Charges, ,,85,,193.31,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,154.65,Percent of Total Billed Charges,0,,50,,113.71,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,127.36,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,136.45,Percent of Total Billed Charges, ,188.37,,,188.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.81,,,126.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.03,,,128.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.52,,,122.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.2,,,126.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.34,,,128.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0463 - HOSPITAL OUTPT CLINIC VISIT,G0463,HCPCS,,,PO,Outpatient,,,279.85,69.9625,0.01,237.87,,,46,,128.73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,190.32,,,190.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,183.58,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,195.9,Percent of Total Billed Charges, ,,85,,237.87,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,190.3,Percent of Total Billed Charges,0,,50,,139.93,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,156.72,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,167.91,Percent of Total Billed Charges, ,188.37,,,188.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.81,,,126.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.03,,,128.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.52,,,122.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.2,,,126.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.34,,,128.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0463 - HOSPITAL OUTPT CLINIC VISIT,G0463,HCPCS,,,27,Outpatient,,,303.45,75.8625,0.01,257.93,,,46,,139.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,190.32,,,190.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,199.06,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,212.42,Percent of Total Billed Charges, ,,85,,257.93,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,206.35,Percent of Total Billed Charges,0,,50,,151.73,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,169.93,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,182.07,Percent of Total Billed Charges, ,188.37,,,188.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.81,,,126.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.03,,,128.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.52,,,122.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.2,,,126.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.34,,,128.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0463 - HOSPITAL OUTPT CLINIC VISIT,G0463,HCPCS,,,25,Outpatient,,,266.35,66.5875,0.01,226.4,,,46,,122.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,190.32,,,190.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,174.73,Percent of Total Billed Charges, ,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,186.45,Percent of Total Billed Charges, ,,85,,226.4,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,181.12,Percent of Total Billed Charges,0,,50,,133.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,149.16,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,159.81,Percent of Total Billed Charges, ,188.37,,,188.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.81,,,126.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.03,,,128.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.52,,,122.52,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.75,,,123.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.2,,,126.2,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.34,,,128.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
T1015 - CLINIC SERVICE,T1015,HCPCS,,,U1,Outpatient,,,199.71,49.9275,35.64,169.75,,,46,,91.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,91.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,,,,65.6,,131.01,Percent of Total Billed Charges, ,,46,,91.87,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,139.8,Percent of Total Billed Charges, ,,85,,169.75,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,135.8,Percent of Total Billed Charges,0,,50,,99.86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,111.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,119.83,Percent of Total Billed Charges, ,,,,,,,,26,,51.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,35.64,,,35.64,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0761 - SPECIALTY SERVICES - TREATMENT ROOM,0761,RC,,,,Outpatient,,,1581.27,395.3175,948.76,6015,,,,,,,,,,,,,,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,1037.31,Percent of Total Billed Charges, ,,,,,,,,70,,1106.89,Percent of Total Billed Charges, ,,85,,1344.08,Percent of Total Billed Charges, ,3461,,,3461,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1075.26,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,948.76,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
37228 - REVSC OPN-PRQ TIB-PERO W-ANGIOPLASTY UNI,37228,HCPCS,,,RT,Outpatient,,,,,1078.11,17219.83,,9034,,,9034,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,16748.39,,,16748.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,17219.83,,,17219.83,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,Service Paid at Rev Code level,,,,,,,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,Service Paid at Rev Code level,,,,,,,16577.22,,,16577.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,16680.02,,,16680.02,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,11159.3,,,11159.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11267.12,,,11267.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10781.93,,,10781.93,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,10889.75,,,10889.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11105.39,,,11105.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,11294.07,,,11294.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,1078.11,,,1078.11,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
G0378 - HOSPITAL OBSERVATION PER HR,G0378,HCPCS,,,GZ,Outpatient,,,281.6,70.4,0.01,239.36,,,,,,,Service Paid at Rev Code level,,,,,,Service Paid at Rev Code level,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,184.73,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,197.12,Percent of Total Billed Charges, ,,85,,239.36,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,191.49,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,,,,,Service Paid at Rev Code level,,60,,168.96,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0378 - HOSPITAL OBSERVATION PER HR,G0378,HCPCS,,,FS,Outpatient,,,285,71.25,0.01,242.25,,,,,,,Service Paid at Rev Code level,,,,,,Service Paid at Rev Code level,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,186.96,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,70,,199.5,Percent of Total Billed Charges, ,,85,,242.25,Percent of Total Billed Charges, ,,,,,,Service Paid at Rev Code level,,68,,193.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,,,,,Service Paid at Rev Code level,,60,,171,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,Service Paid at Rev Code level,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0762 - SPECIALTY SERVICES - OBSERVATION HOURS,0762,RC,,,,Outpatient,,,281.29,70.3225,168.77,4548,,4548,,,4548,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3800,,,3800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3920,,,3920,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,184.53,Percent of Total Billed Charges, ,3800,,,3800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,196.9,Percent of Total Billed Charges, ,,85,,239.1,Percent of Total Billed Charges, ,3461,,,3461,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,191.28,Percent of Total Billed Charges,0,3815,,,3815,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,2747,,,2747,Case Rate,"Paid at the lesser of billed charges and contractual allowable.""",,60,,168.77,Percent of Total Billed Charges, ,,,,,,,3800,,,3800,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
99401 - PREV MED CNSLAND-RSK FCTR RDCTJ INDV APPROX 15 MIN,99401,HCPCS,,,GT,Outpatient,,,72,18,0.01,61.2,,,46,,33.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,33.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,33.48,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,47.23,Percent of Total Billed Charges, ,,46,,33.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,50.4,Percent of Total Billed Charges, ,,85,,61.2,Percent of Total Billed Charges, ,,50,,36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,48.96,Percent of Total Billed Charges,0,,50,,36,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,40.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,43.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,18.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,32.67,,,32.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.67,,,32.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.67,,,32.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,32.67,,,32.67,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
99402 - PREV MED CNSLAND-RSK FCTR RDCTJ INDV APPROX 30 MIN,99402,HCPCS,,,GT,Outpatient,,,150,37.5,0.01,127.5,,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,69.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,98.4,Percent of Total Billed Charges, ,,46,,69,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,105,Percent of Total Billed Charges, ,,85,,127.5,Percent of Total Billed Charges, ,,50,,75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,102,Percent of Total Billed Charges,0,,50,,75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,90,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,39,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,84.94,,,84.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.94,,,84.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.94,,,84.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,84.94,,,84.94,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
99403 - PREV MED CNSLAND-RSK FCTR RDCTJ INDV APPROX 45 MIN,99403,HCPCS,,,GT,Outpatient,,,222,55.5,0.01,188.7,,,46,,102.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46,,102.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,103.23,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,145.63,Percent of Total Billed Charges, ,,46,,102.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,155.4,Percent of Total Billed Charges, ,,85,,188.7,Percent of Total Billed Charges, ,,50,,111,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,150.96,Percent of Total Billed Charges,0,,50,,111,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,124.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,133.2,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,26,,57.72,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0770 - PREVENTIVE CARE SERVICES - GENERAL CLASSIFICATION,0770,RC,,,,Outpatient,,,129.48,32.37,77.69,110.06,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,84.94,Percent of Total Billed Charges, ,,,,,,,,70,,90.64,Percent of Total Billed Charges, ,,85,,110.06,Percent of Total Billed Charges, ,,,,,,,,68,,88.05,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,77.69,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
90471 - IM ADM PRQ ID SUBQ-IM NJXS 1 VACCINE,90471,HCPCS,,,JZ,Outpatient,,,95,23.75,39.03,105.11,,,46,,43.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,44.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,62.32,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,66.5,Percent of Total Billed Charges, ,,85,,80.75,Percent of Total Billed Charges, ,,50,,47.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,64.6,Percent of Total Billed Charges,0,,50,,47.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,53.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,57,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.03,,,39.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,39.03,,,39.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,39.03,,,39.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,39.03,,,39.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
90471 - IM ADM PRQ ID SUBQ-IM NJXS 1 VACCINE,90471,HCPCS,,,JG,Outpatient,,,95,23.75,39.03,105.11,,,46,,43.7,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,44.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,62.32,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,66.5,Percent of Total Billed Charges, ,,85,,80.75,Percent of Total Billed Charges, ,,50,,47.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,64.6,Percent of Total Billed Charges,0,,50,,47.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,53.2,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,57,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,39.03,,,39.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,39.03,,,39.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,39.03,,,39.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,39.03,,,39.03,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,0771,RC,,,,Outpatient,,,95,23.75,57,80.75,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,62.32,Percent of Total Billed Charges, ,,,,,,,,70,,66.5,Percent of Total Billed Charges, ,,85,,80.75,Percent of Total Billed Charges, ,,,,,,,,68,,64.6,Percent of Total Billed Charges,0,,,,,,,,,,,,,,,,,,,,60,,57,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
50590 - LITHOTRIPSY XTRCORP SHOCK WAVE,50590,HCPCS,,,RT,Outpatient,,,11101,2775.25,3279.07,12812,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7282.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7770.7,Percent of Total Billed Charges, ,,85,,9435.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7548.68,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6216.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6660.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
50590 - LITHOTRIPSY XTRCORP SHOCK WAVE,50590,HCPCS,,,LT,Outpatient,,,11101,2775.25,3279.07,12812,,12812,,,12812,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,8200,,,8200,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,5093.63,,,5093.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,7282.26,Percent of Total Billed Charges, ,5199.25,,,5199.25,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,7770.7,Percent of Total Billed Charges, ,,85,,9435.85,Percent of Total Billed Charges, ,4841,,,4841,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7548.68,Percent of Total Billed Charges,0,10452,,,10452,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,6216.56,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,6660.6,Percent of Total Billed Charges, ,5041.57,,,5041.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,5036.27,,,5036.27,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,3393.84,,,3393.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3426.63,,,3426.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3279.07,,,3279.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3311.86,,,3311.86,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3377.44,,,3377.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,3434.83,,,3434.83,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,4627.26,,,4627.26,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0790 - EXTRA-CORPOREAL SHOCK WAVE THERAPY (FORMERLY LITHOTRIPSY) - GENERAL CLASSIFICATION,0790,RC,,,,Outpatient,,,11101,2775.25,1442,9477,,9477,,,9477,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,6015,,,6015,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,65.6,,7282.26,Percent of Total Billed Charges, ,,,,,,,,70,,7770.7,Percent of Total Billed Charges, ,,85,,9435.85,Percent of Total Billed Charges, ,9153,,,9153,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,7548.68,Percent of Total Billed Charges,0,1442,,,1442,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,6660.6,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
59025 - FETAL NONSTRESS TEST,59025,HCPCS,,,XU,Outpatient,,,1155,288.75,191.26,981.75,,,46,,531.3,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,288.95,,,288.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,650,,,650,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,297.09,,,297.09,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,757.68,Percent of Total Billed Charges, ,288.95,,,288.95,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,808.5,Percent of Total Billed Charges, ,,85,,981.75,Percent of Total Billed Charges, ,,50,,577.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,785.4,Percent of Total Billed Charges,0,674,,,674,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,646.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,693,Percent of Total Billed Charges, ,294.06,,,294.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,279.89,,,279.89,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,197.95,,,197.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,199.87,,,199.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.17,,,193.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,191.26,,,191.26,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,193.17,,,193.17,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,197,,,197,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,200.34,,,200.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,742.5,,,742.5,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,93923,HCPCS,,,52,Outpatient,,,734,183.5,148.75,623.9,,,46,,337.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,225.16,,,225.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,481.5,Percent of Total Billed Charges, ,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,513.8,Percent of Total Billed Charges, ,,85,,623.9,Percent of Total Billed Charges, ,,50,,367,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,499.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,411.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,440.4,Percent of Total Billed Charges, ,228.7,,,228.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.19,,,195.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93925 - DUP-SCAN LXTR ART-ARTL BPGS COMPL BI STUDY,93925,HCPCS,,,PO,Outpatient,,,760,190,216.81,646,,,46,,349.6,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,498.56,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,532,Percent of Total Billed Charges, ,,85,,646,Percent of Total Billed Charges, ,,50,,380,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,516.8,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,425.6,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,456,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93926 - DUP-SCAN LXTR ART-ARTL BPGS UNI-LMTD STUDY,93926,HCPCS,,,RT,Outpatient,,,565,141.25,101.1,480.25,,,46,,259.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,370.64,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,395.5,Percent of Total Billed Charges, ,,85,,480.25,Percent of Total Billed Charges, ,,50,,282.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,384.2,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,316.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,339,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
95810 - POLYSOM 6-GREATER THAN YRS SLEEP 4-GREATER THAN ADDL PARAM ATTND,95810,HCPCS,,,GA,Outpatient,,,3599,899.75,362.34,3059.15,,,34.4,,1238.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1294.95,,,1294.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,1673.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1502.53,,,1502.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2360.94,Percent of Total Billed Charges, ,1294.95,,,1294.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2519.3,Percent of Total Billed Charges, ,,85,,3059.15,Percent of Total Billed Charges, ,,50,,1799.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2447.32,Percent of Total Billed Charges,0,1836,,,1836,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2015.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2159.4,Percent of Total Billed Charges, ,1487.18,,,1487.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1254.15,,,1254.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1001.12,,,1001.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1010.8,,,1010.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,976.94,,,976.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,967.27,,,967.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,976.94,,,976.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,996.29,,,996.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1013.22,,,1013.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,362.34,,,362.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,362.34,,,362.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,362.34,,,362.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,362.34,,,362.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
95810 - POLYSOM 6-GREATER THAN YRS SLEEP 4-GREATER THAN ADDL PARAM ATTND,95810,HCPCS,,,52,Outpatient,,,3599,899.75,362.34,3059.15,,,34.4,,1238.06,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1294.95,,,1294.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,1673.54,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1502.53,,,1502.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2360.94,Percent of Total Billed Charges, ,1294.95,,,1294.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2519.3,Percent of Total Billed Charges, ,,85,,3059.15,Percent of Total Billed Charges, ,,50,,1799.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2447.32,Percent of Total Billed Charges,0,1836,,,1836,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2015.44,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2159.4,Percent of Total Billed Charges, ,1487.18,,,1487.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1254.15,,,1254.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1001.12,,,1001.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1010.8,,,1010.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,976.94,,,976.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,967.27,,,967.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,976.94,,,976.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,996.29,,,996.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1013.22,,,1013.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,362.34,,,362.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,362.34,,,362.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,362.34,,,362.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,362.34,,,362.34,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
95811 - POLYSOM 6-GREATER THAN YRS SLEEP W-CPAP 4-GREATER THAN ADDL PARAM ATTND,95811,HCPCS,,,52,Outpatient,,,3993,998.25,609.95,3394.05,,,34.4,,1373.59,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1294.95,,,1294.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,1856.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1502.53,,,1502.53,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,2619.41,Percent of Total Billed Charges, ,1294.95,,,1294.95,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,2795.1,Percent of Total Billed Charges, ,,85,,3394.05,Percent of Total Billed Charges, ,,50,,1996.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,2715.24,Percent of Total Billed Charges,0,1836,,,1836,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,2236.08,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,2395.8,Percent of Total Billed Charges, ,1487.18,,,1487.18,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1254.15,,,1254.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,1001.12,,,1001.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1010.8,,,1010.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,976.94,,,976.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,967.27,,,967.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,976.94,,,976.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,996.29,,,996.29,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,1013.22,,,1013.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,609.95,,,609.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,609.95,,,609.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,609.95,,,609.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,609.95,,,609.95,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
95938 - SHORT-LATENCY SOMATOSENS EP STD UPR AND LOW LIMB,95938,HCPCS,,,XU,Outpatient,,,748,187,344.08,797.56,,,46,,344.08,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,669.96,,,669.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,347.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,783.62,,,783.62,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,490.69,Percent of Total Billed Charges, ,669.96,,,669.96,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,523.6,Percent of Total Billed Charges, ,,85,,635.8,Percent of Total Billed Charges, ,,50,,374,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,508.64,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,418.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,448.8,Percent of Total Billed Charges, ,775.61,,,775.61,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,648.86,,,648.86,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,522.12,,,522.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,527.16,,,527.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,509.5,,,509.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,504.46,,,504.46,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,509.5,,,509.5,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,519.59,,,519.59,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,528.42,,,528.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,797.56,,,797.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,797.56,,,797.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,797.56,,,797.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,797.56,,,797.56,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
G0399 - HOME SLEEP TEST-TYPE 3 PORTA,G0399,HCPCS,,,GA,Outpatient,,,1698,424.5,148.75,1836,,,34.4,,584.11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,789.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1113.89,Percent of Total Billed Charges, ,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1188.6,Percent of Total Billed Charges, ,,85,,1443.3,Percent of Total Billed Charges, ,,50,,849,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1154.64,Percent of Total Billed Charges,0,1836,,,1836,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,950.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1018.8,Percent of Total Billed Charges, ,228.7,,,228.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.19,,,195.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0399 - HOME SLEEP TEST-TYPE 3 PORTA,G0399,HCPCS,,,52,Outpatient,,,1698,424.5,148.75,1836,,,34.4,,584.11,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,789.57,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,1113.89,Percent of Total Billed Charges, ,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,1188.6,Percent of Total Billed Charges, ,,85,,1443.3,Percent of Total Billed Charges, ,,50,,849,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,1154.64,Percent of Total Billed Charges,0,1836,,,1836,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,56,,950.88,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,1018.8,Percent of Total Billed Charges, ,228.7,,,228.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.19,,,195.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION,0920,RC,,,,Outpatient,,,2031.4,507.85,746,1726.69,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,1332.6,Percent of Total Billed Charges, ,,,,,,,,70,,1421.98,Percent of Total Billed Charges, ,,85,,1726.69,Percent of Total Billed Charges, ,,,,,,,,68,,1381.35,Percent of Total Billed Charges,0,746,,,746,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,1218.84,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
93880 - DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,93880,HCPCS,,,XU,Outpatient,,,1114,278.5,207.9,946.9,,,46,,512.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,730.78,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,779.8,Percent of Total Billed Charges, ,,85,,946.9,Percent of Total Billed Charges, ,,50,,557,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,757.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,623.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,668.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93880 - DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,93880,HCPCS,,,PO,Outpatient,,,1114,278.5,207.9,946.9,,,46,,512.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,730.78,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,779.8,Percent of Total Billed Charges, ,,85,,946.9,Percent of Total Billed Charges, ,,50,,557,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,757.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,623.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,668.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93880 - DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,93880,HCPCS,,,GA,Outpatient,,,1114,278.5,207.9,946.9,,,46,,512.44,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,730.78,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,779.8,Percent of Total Billed Charges, ,,85,,946.9,Percent of Total Billed Charges, ,,50,,557,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,757.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,623.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,668.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93882 - DUPLEX SCAN EXTRACRANIAL ART UNI-LMTD STUDY,93882,HCPCS,,,GA,Outpatient,,,622,155.5,101.1,528.7,,,46,,286.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,408.03,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,435.4,Percent of Total Billed Charges, ,,85,,528.7,Percent of Total Billed Charges, ,,50,,311,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,422.96,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,348.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,373.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,207.9,,,207.9,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93923 - NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,93923,HCPCS,,,52,Outpatient,,,734,183.5,148.75,623.9,,,46,,337.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,225.16,,,225.16,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,231.07,,,231.07,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,481.5,Percent of Total Billed Charges, ,201.54,,,201.54,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,513.8,Percent of Total Billed Charges, ,,85,,623.9,Percent of Total Billed Charges, ,,50,,367,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,499.12,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,411.04,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,440.4,Percent of Total Billed Charges, ,228.7,,,228.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,195.19,,,195.19,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,153.96,,,153.96,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,148.75,,,148.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,150.24,,,150.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,153.21,,,153.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.82,,,155.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93926 - DUP-SCAN LXTR ART-ARTL BPGS UNI-LMTD STUDY,93926,HCPCS,,,RT,Outpatient,,,565,141.25,101.1,480.25,,,46,,259.9,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,370.64,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,395.5,Percent of Total Billed Charges, ,,85,,480.25,Percent of Total Billed Charges, ,,50,,282.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,384.2,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,316.4,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,339,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93930 - DUP-SCAN UXTR ART-ARTL BPGS COMPL BI STUDY,93930,HCPCS,,,PO,Outpatient,,,707,176.75,98.01,600.95,,,46,,325.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,463.79,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,494.9,Percent of Total Billed Charges, ,,85,,600.95,Percent of Total Billed Charges, ,,50,,353.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,480.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,395.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,424.2,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,98.01,,,98.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93931 - DUP-SCAN UXTR ART-ARTL BPGS UNI-LMTD STUDY,93931,HCPCS,,,LT,Outpatient,,,607,151.75,101.1,515.95,,,46,,279.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,398.19,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,424.9,Percent of Total Billed Charges, ,,85,,515.95,Percent of Total Billed Charges, ,,50,,303.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,412.76,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,339.92,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,364.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93970 - DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,93970,HCPCS,,,XS,Outpatient,,,430,107.5,124.74,371.08,,,46,,197.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,282.08,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,301,Percent of Total Billed Charges, ,,85,,365.5,Percent of Total Billed Charges, ,,50,,215,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,292.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,240.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,258,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93970 - DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,93970,HCPCS,,,PO,Outpatient,,,430,107.5,124.74,371.08,,,46,,197.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,282.08,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,301,Percent of Total Billed Charges, ,,85,,365.5,Percent of Total Billed Charges, ,,50,,215,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,292.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,240.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,258,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93970 - DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,93970,HCPCS,,,GZ,Outpatient,,,430,107.5,124.74,371.08,,,46,,197.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,282.08,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,301,Percent of Total Billed Charges, ,,85,,365.5,Percent of Total Billed Charges, ,,50,,215,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,292.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,240.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,258,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93970 - DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,93970,HCPCS,,,GA,Outpatient,,,430,107.5,124.74,371.08,,,46,,197.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,282.08,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,301,Percent of Total Billed Charges, ,,85,,365.5,Percent of Total Billed Charges, ,,50,,215,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,292.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,240.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,258,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93970 - DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,93970,HCPCS,,,76,Outpatient,,,430,107.5,124.74,371.08,,,46,,197.8,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,282.08,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,301,Percent of Total Billed Charges, ,,85,,365.5,Percent of Total Billed Charges, ,,50,,215,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,292.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,240.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,258,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,124.74,,,124.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93971 - DUP-SCAN XTR VEINS UNILATERAL-LIMITED STUDY,93971,HCPCS,,,XS,Outpatient,,,802,200.5,101.1,681.7,,,46,,368.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,526.11,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,561.4,Percent of Total Billed Charges, ,,85,,681.7,Percent of Total Billed Charges, ,,50,,401,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,545.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,449.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,481.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93971 - DUP-SCAN XTR VEINS UNILATERAL-LIMITED STUDY,93971,HCPCS,,,RT,Outpatient,,,802,200.5,101.1,681.7,,,46,,368.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,526.11,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,561.4,Percent of Total Billed Charges, ,,85,,681.7,Percent of Total Billed Charges, ,,50,,401,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,545.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,449.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,481.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93971 - DUP-SCAN XTR VEINS UNILATERAL-LIMITED STUDY,93971,HCPCS,,,LT,Outpatient,,,802,200.5,101.1,681.7,,,46,,368.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,526.11,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,561.4,Percent of Total Billed Charges, ,,85,,681.7,Percent of Total Billed Charges, ,,50,,401,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,545.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,449.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,481.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93971 - DUP-SCAN XTR VEINS UNILATERAL-LIMITED STUDY,93971,HCPCS,,,GA,Outpatient,,,802,200.5,101.1,681.7,,,46,,368.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,526.11,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,561.4,Percent of Total Billed Charges, ,,85,,681.7,Percent of Total Billed Charges, ,,50,,401,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,545.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,449.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,481.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93971 - DUP-SCAN XTR VEINS UNILATERAL-LIMITED STUDY,93971,HCPCS,,,76,Outpatient,,,802,200.5,101.1,681.7,,,46,,368.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,526.11,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,561.4,Percent of Total Billed Charges, ,,85,,681.7,Percent of Total Billed Charges, ,,50,,401,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,545.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,449.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,481.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93975 - DUP-SCAN ARTL FLO ABDL-PEL-SCROTAND-RPR ORGN COM,93975,HCPCS,,,PO,Outpatient,,,889,222.25,229.81,755.65,,,46,,408.94,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,371.08,,,371.08,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,356.99,,,356.99,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,583.18,Percent of Total Billed Charges, ,323.64,,,323.64,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,622.3,Percent of Total Billed Charges, ,,85,,755.65,Percent of Total Billed Charges, ,,50,,444.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,604.52,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,497.84,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,533.4,Percent of Total Billed Charges, ,353.33,,,353.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,313.44,,,313.44,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,237.85,,,237.85,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.15,,,240.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,229.81,,,229.81,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,232.11,,,232.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,236.7,,,236.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,240.73,,,240.73,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,270.27,,,270.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,270.27,,,270.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,270.27,,,270.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,270.27,,,270.27,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93976 - DUP-SCAN ARTL FLO ABDL-PEL-SCROTAND-RPR ORGN LMT,93976,HCPCS,,,XU,Outpatient,,,577,144.25,101.1,490.45,,,46,,265.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,378.51,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,403.9,Percent of Total Billed Charges, ,,85,,490.45,Percent of Total Billed Charges, ,,50,,288.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,392.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,323.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,346.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93976 - DUP-SCAN ARTL FLO ABDL-PEL-SCROTAND-RPR ORGN LMT,93976,HCPCS,,,PO,Outpatient,,,577,144.25,101.1,490.45,,,46,,265.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,378.51,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,403.9,Percent of Total Billed Charges, ,,85,,490.45,Percent of Total Billed Charges, ,,50,,288.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,392.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,323.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,346.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
93976 - DUP-SCAN ARTL FLO ABDL-PEL-SCROTAND-RPR ORGN LMT,93976,HCPCS,,,59,Outpatient,,,577,144.25,101.1,490.45,,,46,,265.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,175.57,,,175.57,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,157.04,,,157.04,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,378.51,Percent of Total Billed Charges, ,148.12,,,148.12,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,403.9,Percent of Total Billed Charges, ,,85,,490.45,Percent of Total Billed Charges, ,,50,,288.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,392.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,323.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,346.2,Percent of Total Billed Charges, ,155.44,,,155.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,143.45,,,143.45,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,104.64,,,104.64,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.65,,,105.65,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,101.1,,,101.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,102.11,,,102.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,104.13,,,104.13,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,105.9,,,105.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,216.81,,,216.81,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,0921,RC,,,,Outpatient,,,808.57,202.1425,485.14,687.28,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,530.42,Percent of Total Billed Charges, ,,,,,,,,70,,566,Percent of Total Billed Charges, ,,85,,687.28,Percent of Total Billed Charges, ,,,,,,,,68,,549.83,Percent of Total Billed Charges,0,587,,,587,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,485.14,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
95861 - NDL EMG 2 XTR W-WO RELATED PARASPINAL AREAS,95861,HCPCS,,,XU,Outpatient,,,427,106.75,19.01,362.95,,,46,,196.42,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,160.92,,,160.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,198.56,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,190.37,,,190.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,280.11,Percent of Total Billed Charges, ,160.92,,,160.92,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,298.9,Percent of Total Billed Charges, ,,85,,362.95,Percent of Total Billed Charges, ,,50,,213.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,290.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,239.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,256.2,Percent of Total Billed Charges, ,188.42,,,188.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,155.85,,,155.85,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,126.84,,,126.84,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.06,,,128.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,122.55,,,122.55,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.78,,,123.78,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,126.23,,,126.23,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,128.37,,,128.37,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,19.01,,,19.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.01,,,19.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.01,,,19.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,19.01,,,19.01,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
95886 - NEEDLE EMG EA EXTREMTY W-PARASPINL AREA COMPLETE,95886,HCPCS,,,GA,Outpatient,,,308,77,0.01,261.8,,,46,,141.68,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,67.79,,,67.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,143.22,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,202.05,Percent of Total Billed Charges, ,67.79,,,67.79,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,215.6,Percent of Total Billed Charges, ,,85,,261.8,Percent of Total Billed Charges, ,,50,,154,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,209.44,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,172.48,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,184.8,Percent of Total Billed Charges, ,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,65.65,,,65.65,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,127,,,127,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,127,,,127,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,127,,,127,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,127,,,127,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
95908 - NERVE CONDUCTION STUDIES 3-4 STUDIES,95908,HCPCS,,,GA,Outpatient,,,405,101.25,136.74,459.89,,,46,,186.3,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,188.33,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,265.68,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,283.5,Percent of Total Billed Charges, ,,85,,344.25,Percent of Total Billed Charges, ,,50,,202.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,275.4,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,226.8,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,243,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,136.74,,,136.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,136.74,,,136.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,136.74,,,136.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,136.74,,,136.74,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
95910 - NERVE CONDUCTION STUDIES 7-8 STUDIES,95910,HCPCS,,,GA,Outpatient,,,652,163,212.38,554.2,,,46,,299.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,303.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,459.89,,,459.89,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,427.71,Percent of Total Billed Charges, ,388.13,,,388.13,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,456.4,Percent of Total Billed Charges, ,,85,,554.2,Percent of Total Billed Charges, ,,50,,326,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,443.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,365.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,391.2,Percent of Total Billed Charges, ,455.19,,,455.19,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,375.9,,,375.9,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,306.42,,,306.42,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,309.38,,,309.38,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,296.06,,,296.06,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,299.02,,,299.02,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,304.94,,,304.94,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,310.12,,,310.12,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,212.38,,,212.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,212.38,,,212.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,212.38,,,212.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.,212.38,,,212.38,Fee Schedule,Paid under AR Medicaid Methodologies and coverage restrictions.
0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYOGRAM,0922,RC,,,,Outpatient,,,387.73,96.9325,232.64,587,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,254.35,Percent of Total Billed Charges, ,,,,,,,,70,,271.41,Percent of Total Billed Charges, ,,85,,329.57,Percent of Total Billed Charges, ,,,,,,,,68,,263.66,Percent of Total Billed Charges,0,587,,,587,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,232.64,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
94625 - PHYS-QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,HCPCS,,,KX,Outpatient,,,128,32,56.47,108.8,,,46,,58.88,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,59.52,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,87.72,,,87.72,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,83.97,Percent of Total Billed Charges, ,79.66,,,79.66,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,89.6,Percent of Total Billed Charges, ,,85,,108.8,Percent of Total Billed Charges, ,,50,,64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,87.04,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,71.68,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,76.8,Percent of Total Billed Charges, ,86.82,,,86.82,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,77.15,,,77.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,58.45,,,58.45,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.01,,,59.01,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,56.47,,,56.47,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,57.03,,,57.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,58.16,,,58.16,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,59.15,,,59.15,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96372 - THERAPEUTIC PROPHYLACTIC-DX INJECTION SUBQ-IM,96372,HCPCS,,,XU,Outpatient,,,172,43,67.66,146.2,,,46,,79.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,79.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96372 - THERAPEUTIC PROPHYLACTIC-DX INJECTION SUBQ-IM,96372,HCPCS,,,XS,Outpatient,,,172,43,67.66,146.2,,,46,,79.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,79.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96372 - THERAPEUTIC PROPHYLACTIC-DX INJECTION SUBQ-IM,96372,HCPCS,,,JZ,Outpatient,,,172,43,67.66,146.2,,,46,,79.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,79.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96372 - THERAPEUTIC PROPHYLACTIC-DX INJECTION SUBQ-IM,96372,HCPCS,,,JW,Outpatient,,,172,43,67.66,146.2,,,46,,79.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,79.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96372 - THERAPEUTIC PROPHYLACTIC-DX INJECTION SUBQ-IM,96372,HCPCS,,,JB,Outpatient,,,172,43,67.66,146.2,,,46,,79.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,79.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
96372 - THERAPEUTIC PROPHYLACTIC-DX INJECTION SUBQ-IM,96372,HCPCS,,,52,Outpatient,,,172,43,67.66,146.2,,,46,,79.12,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,79.98,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,105.11,,,105.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,112.83,Percent of Total Billed Charges, ,93.5,,,93.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,120.4,Percent of Total Billed Charges, ,,85,,146.2,Percent of Total Billed Charges, ,,50,,86,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,116.96,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,96.32,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,103.2,Percent of Total Billed Charges, ,104.03,,,104.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,90.55,,,90.55,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,70.03,,,70.03,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.7,,,70.7,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,67.66,,,67.66,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,68.34,,,68.34,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,69.69,,,69.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,70.87,,,70.87,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0940 - OTHER THERAPEUTIC SERVICES (ALSO SEE 095X  AN EXTENSION OF 094X) - GENERAL CLASSIFICATION,0940,RC,,,,Outpatient,,,170.1,42.525,102.06,574,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,111.59,Percent of Total Billed Charges, ,,,,,,,,70,,119.07,Percent of Total Billed Charges, ,,85,,144.59,Percent of Total Billed Charges, ,,,,,,,,68,,115.67,Percent of Total Billed Charges,0,574,,,574,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,102.06,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
97802 - MEDICAL NUTRITION ASSMTANDIVNTJ INDIV EACH 15 MI,97802,HCPCS,,,PO,Outpatient,,,67,16.75,30.82,56.95,,,46,,30.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,31.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.27,,,55.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.95,Percent of Total Billed Charges, ,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.9,Percent of Total Billed Charges, ,,85,,56.95,Percent of Total Billed Charges, ,,50,,33.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,45.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,37.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,40.2,Percent of Total Billed Charges, ,53.44,,,53.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.94,,,44.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.76,,,34.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.41,,,36.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97802 - MEDICAL NUTRITION ASSMTANDIVNTJ INDIV EACH 15 MI,97802,HCPCS,,,GT,Outpatient,,,67,16.75,30.82,56.95,,,46,,30.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,31.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.27,,,55.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.95,Percent of Total Billed Charges, ,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.9,Percent of Total Billed Charges, ,,85,,56.95,Percent of Total Billed Charges, ,,50,,33.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,45.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,37.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,40.2,Percent of Total Billed Charges, ,53.44,,,53.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.94,,,44.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.76,,,34.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.41,,,36.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97802 - MEDICAL NUTRITION ASSMTANDIVNTJ INDIV EACH 15 MI,97802,HCPCS,,,GA,Outpatient,,,67,16.75,30.82,56.95,,,46,,30.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,31.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.27,,,55.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.95,Percent of Total Billed Charges, ,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.9,Percent of Total Billed Charges, ,,85,,56.95,Percent of Total Billed Charges, ,,50,,33.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,45.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,37.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,40.2,Percent of Total Billed Charges, ,53.44,,,53.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.94,,,44.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.76,,,34.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.41,,,36.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97802 - MEDICAL NUTRITION ASSMTANDIVNTJ INDIV EACH 15 MI,97802,HCPCS,,,95,Outpatient,,,67,16.75,30.82,56.95,,,46,,30.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,31.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.27,,,55.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.95,Percent of Total Billed Charges, ,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.9,Percent of Total Billed Charges, ,,85,,56.95,Percent of Total Billed Charges, ,,50,,33.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,45.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,37.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,40.2,Percent of Total Billed Charges, ,53.44,,,53.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.94,,,44.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.76,,,34.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.41,,,36.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97802 - MEDICAL NUTRITION ASSMTANDIVNTJ INDIV EACH 15 MI,97802,HCPCS,,,33,Outpatient,,,67,16.75,30.82,56.95,,,46,,30.82,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,31.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,55.27,,,55.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,43.95,Percent of Total Billed Charges, ,46.4,,,46.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,46.9,Percent of Total Billed Charges, ,,85,,56.95,Percent of Total Billed Charges, ,,50,,33.5,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,45.56,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,37.52,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,40.2,Percent of Total Billed Charges, ,53.44,,,53.44,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,44.94,,,44.94,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,35.98,,,35.98,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.32,,,36.32,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,34.76,,,34.76,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.11,,,35.11,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,35.8,,,35.8,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,36.41,,,36.41,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97803 - MEDICAL NUTRITION RE-ASSMTANDIVNTJ INDIV EA 15 M,97803,HCPCS,,,PO,Outpatient,,,52,13,23.92,48.22,,,46,,23.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,24.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.22,,,48.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.11,Percent of Total Billed Charges, ,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,36.4,Percent of Total Billed Charges, ,,85,,44.2,Percent of Total Billed Charges, ,,50,,26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,35.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,29.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.2,Percent of Total Billed Charges, ,46.63,,,46.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.91,,,37.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.39,,,31.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.69,,,31.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.33,,,30.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.24,,,31.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.77,,,31.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97803 - MEDICAL NUTRITION RE-ASSMTANDIVNTJ INDIV EA 15 M,97803,HCPCS,,,GT,Outpatient,,,52,13,23.92,48.22,,,46,,23.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,24.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.22,,,48.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.11,Percent of Total Billed Charges, ,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,36.4,Percent of Total Billed Charges, ,,85,,44.2,Percent of Total Billed Charges, ,,50,,26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,35.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,29.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.2,Percent of Total Billed Charges, ,46.63,,,46.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.91,,,37.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.39,,,31.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.69,,,31.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.33,,,30.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.24,,,31.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.77,,,31.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97803 - MEDICAL NUTRITION RE-ASSMTANDIVNTJ INDIV EA 15 M,97803,HCPCS,,,GA,Outpatient,,,52,13,23.92,48.22,,,46,,23.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,24.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.22,,,48.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.11,Percent of Total Billed Charges, ,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,36.4,Percent of Total Billed Charges, ,,85,,44.2,Percent of Total Billed Charges, ,,50,,26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,35.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,29.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.2,Percent of Total Billed Charges, ,46.63,,,46.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.91,,,37.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.39,,,31.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.69,,,31.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.33,,,30.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.24,,,31.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.77,,,31.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97803 - MEDICAL NUTRITION RE-ASSMTANDIVNTJ INDIV EA 15 M,97803,HCPCS,,,95,Outpatient,,,52,13,23.92,48.22,,,46,,23.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,24.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.22,,,48.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.11,Percent of Total Billed Charges, ,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,36.4,Percent of Total Billed Charges, ,,85,,44.2,Percent of Total Billed Charges, ,,50,,26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,35.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,29.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.2,Percent of Total Billed Charges, ,46.63,,,46.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.91,,,37.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.39,,,31.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.69,,,31.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.33,,,30.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.24,,,31.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.77,,,31.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
97803 - MEDICAL NUTRITION RE-ASSMTANDIVNTJ INDIV EA 15 M,97803,HCPCS,,,33,Outpatient,,,52,13,23.92,48.22,,,46,,23.92,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,24.18,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,48.22,,,48.22,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,34.11,Percent of Total Billed Charges, ,39.14,,,39.14,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,36.4,Percent of Total Billed Charges, ,,85,,44.2,Percent of Total Billed Charges, ,,50,,26,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,35.36,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,29.12,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,31.2,Percent of Total Billed Charges, ,46.63,,,46.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,37.91,,,37.91,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,31.39,,,31.39,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.69,,,31.69,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.33,,,30.33,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,30.63,,,30.63,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.24,,,31.24,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,31.77,,,31.77,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
G0108 - DIAB MANAGE TRN PER INDIV,G0108,HCPCS,,,PO,Outpatient,,,350,87.5,51.75,365,,,46,,161,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,365,,,365,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,162.75,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,82.28,,,82.28,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,229.6,Percent of Total Billed Charges, ,365,,,365,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,245,Percent of Total Billed Charges, ,,85,,297.5,Percent of Total Billed Charges, ,,50,,175,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,238,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,196,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,210,Percent of Total Billed Charges, ,79.57,,,79.57,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,353.5,,,353.5,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,53.56,,,53.56,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.08,,,54.08,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.27,,,52.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,51.75,,,51.75,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,52.27,,,52.27,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,53.3,,,53.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,54.21,,,54.21,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0942 - OTHER THERAPEUTIC SERVICES (ALSO SEE 095X  AN EXTENSION OF 094X) - EDUCATION-TRAINING,0942,RC,,,,Outpatient,,,100.12,25.03,60.07,224,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,65.68,Percent of Total Billed Charges, ,,,,,,,,70,,70.08,Percent of Total Billed Charges, ,,85,,85.1,Percent of Total Billed Charges, ,,,,,,,,68,,68.08,Percent of Total Billed Charges,0,224,,,224,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,60.07,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
93798 - PHYS-QHP O-P CARDIAC RHAB W-CONT ECG MONITORING,93798,HCPCS,,,XU,Outpatient,,,896,224,119.71,761.6,,,46,,412.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,166.4,,,166.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,416.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,185.95,,,185.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,587.78,Percent of Total Billed Charges, ,166.4,,,166.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,627.2,Percent of Total Billed Charges, ,,85,,761.6,Percent of Total Billed Charges, ,,50,,448,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,609.28,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,501.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,537.6,Percent of Total Billed Charges, ,184.05,,,184.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,161.15,,,161.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,123.9,,,123.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,125.1,,,125.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.91,,,120.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.71,,,119.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.91,,,120.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.3,,,123.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,125.4,,,125.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
93798 - PHYS-QHP O-P CARDIAC RHAB W-CONT ECG MONITORING,93798,HCPCS,,,KX,Outpatient,,,896,224,119.71,761.6,,,46,,412.16,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,166.4,,,166.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,46.5,,416.64,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,185.95,,,185.95,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,65.6,,587.78,Percent of Total Billed Charges, ,166.4,,,166.4,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,70,,627.2,Percent of Total Billed Charges, ,,85,,761.6,Percent of Total Billed Charges, ,,50,,448,Percent of Total Billed Charges,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,,68,,609.28,Percent of Total Billed Charges,0,,,,,,Service Paid at Rev Code level,,,,,,,,56,,501.76,Percent of Total Billed Charges,"Paid at the lesser of billed charges and contractual allowable.""",,60,,537.6,Percent of Total Billed Charges, ,184.05,,,184.05,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,161.15,,,161.15,Fee Schedule,Certain packaging reductions may apply when multiple procedures are billed together. Paid at the lesser of billed charges and contractual allowable.,123.9,,,123.9,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,125.1,,,125.1,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.91,,,120.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,119.71,,,119.71,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,120.91,,,120.91,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,123.3,,,123.3,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,125.4,,,125.4,Fee Schedule,Paid under Medicare methodologies. Paid at the lesser of billed charges and contractual allowable.,,,,,,,,,,,,,,,,,,,,,,,,
0943 - OTHER THERAPEUTIC SERVICES (ALSO SEE 095X  AN EXTENSION OF 094X) - CARDIAC REHABILITATION,0943,RC,,,,Outpatient,,,896,224,537.6,1388,,,,,,,,,,,,,,,,,,,,,,,,,,,65.6,,587.78,Percent of Total Billed Charges, ,,,,,,,,70,,627.2,Percent of Total Billed Charges, ,,85,,761.6,Percent of Total Billed Charges, ,,,,,,,,68,,609.28,Percent of Total Billed Charges,0,1388,,,1388,Case Rate,Certain packaging reductions may apply when multiple procedures are billed together,,,,,,,,,,,,,,60,,537.6,Percent of Total Billed Charges, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - PRIVATE - GEN,11000001,CDM,,,,Both,,,3621,905,,3621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B- TELEMETRY-PRIVATE,11000002,CDM,,,,Both,,,3226,807,,3226,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B PRIVATE LTACH,11000003,CDM,,,,Both,,,3621,905,,3621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - PRIVATE ONE ON ONE,11000004,CDM,,,,Both,,,3621,905,,3621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - PRIVATE - MED/SURG/GYN,11100001,CDM,,,,Both,,,3621,905,,3621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B-PRIVATE-OB,11200001,CDM,,,,Both,,,3621,905,,3621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B PRIVATE OB ONE ON ONE CARE,11200002,CDM,,,,Both,,,6822,1706,,6822,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B-PRIVATE-OB ONE TO FOUR CARE,11200003,CDM,,,,Both,,,4759,1190,,4759,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B PRIVATE OB HIGH RISK ONE TO ONE CARE,11200004,CDM,,,,Both,,,6822,1706,,6822,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - PRIVATE - PEDI,11300001,CDM,,,,Both,,,3621,905,,3621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B PRIVATE PSYCH,11400001,CDM,,,,Both,,,5239,1310,,5239,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B PRIVATE GERI PSYCH,11400002,CDM,,,,Both,,,5239,1310,,5239,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B HOSPICE,11500001,CDM,,,,Both,,,3595,899,,3595,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B-PRIVATE-DETOX-W/ OR W/O TELEMETRY,11600001,CDM,,,,Both,,,5239,1310,,5239,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - PRIVATE ONCOLOGY,11700001,CDM,,,,Both,,,3226,807,,3226,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - PRIVATE - REHAB,11800001,CDM,,,,Both,,,3687,922,,3687,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - SEMIPRIVATE - GEN,12000001,CDM,,,,Both,,,3415,854,,3415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - TELEMETRY- SEMIPRIVATE,12000002,CDM,,,,Both,,,2953,738,,2953,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B SEMIPRIVATE EXT CARE,12000003,CDM,,,,Both,,,3415,854,,3415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - SEMIPRIVATE - MED/SURG/GYN,12100001,CDM,,,,Both,,,3057,764,,3057,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B-SEMIPRIVATE-OB,12200001,CDM,,,,Both,,,3415,854,,3415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - SEMIPRIVATE - PEDI,12300001,CDM,,,,Both,,,3415,854,,3415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - SEMIPRIVATE - PSYCH,12400001,CDM,,,,Both,,,5099,1275,,5099,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - SEMIPRIVATE - GERI PSYCH,12400002,CDM,,,,Both,,,5099,1275,,5099,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B-SEMIPRIVATE-DETOX-W/ OR W/O TELEMETRY,12600001,CDM,,,,Both,,,5099,1275,,5099,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - SEMIPRIVATE - REHAB,12800001,CDM,,,,Both,,,3306,827,,3306,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - WARD MED/SURG/GYN,15100000,CDM,,,,Both,,,3415,854,,3415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - ISOLATION,16400001,CDM,,,,Both,,,3057,764,,3057,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEWBORN-LEVEL I,17100001,CDM,,,,Both,,,3895,974,,3895,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEWBORN-LEVEL II,17200001,CDM,,,,Both,,,8456,2114,,8456,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEWBORN- NICU STEPDOWN,17300001,CDM,,,,Both,,,9208,2302,,9208,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEWBORN NICU STEPDOWN ONE ON ONE CARE,17300002,CDM,,,,Both,,,11466,2867,,11466,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEWBORN-NICU,17400001,CDM,,,,Both,,,9648,2412,,9648,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEWBORN NICU ONE ON ONE CARE,17400002,CDM,,,,Both,,,17380,4345,,17380,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUBACUTE-LEVEL I RECOUP CARE SEMI-PRIVATE,19100001,CDM,,,,Both,,,2784,696,,2784,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUBACUTE-LEVEL I RECOUP CARE PRIVATE,19100002,CDM,,,,Both,,,2899,725,,2899,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUBACUTE-LEVEL II RECOUP CARE SEMI-PRIVATE,19200001,CDM,,,,Both,,,1869,467,,1869,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUBACUTE-LEVEL II RECOUP CARE PRIVATE,19200002,CDM,,,,Both,,,1984,496,,1984,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUBACUTE-LEVEL III RECOUP CARE SEMI-PRIVATE,19300001,CDM,,,,Both,,,1898,475,,1898,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUBACUTE-LEVEL III RECOUP CARE PRIVATE,19300002,CDM,,,,Both,,,2013,503,,2013,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUBACUTE-LEVEL IV RECOUP CARE SEMI-PRIVATE,19400001,CDM,,,,Both,,,1926,482,,1926,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUBACUTE-LEVEL IV RECOUP CARE PRIVATE,19400002,CDM,,,,Both,,,2041,510,,2041,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ICU - GENERAL,20000001,CDM,,,,Both,,,10000,2500,,10000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B-TELEMETRY ICU,20000002,CDM,,,,Both,,,3884,971,,3884,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ICU - GENERAL EXT CARE,20000003,CDM,,,,Both,,,10000,2500,,10000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ICU GENERAL CRRT,20000005,CDM,,,,Both,,,20089,5022,,20089,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&B - ICU SURGICAL,20100001,CDM,,,,Both,,,3136,784,,3136,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ICU/ PSYCH,20400001,CDM,,,,Both,,,10000,2500,,10000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ICU/ INTERMEDIATE,20600001,CDM,,,,Both,,,5853,1463,,5853,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CCU - GENERAL,21000001,CDM,,,,Both,,,8735,2184,,8735,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CCU GENERAL CRRT,21000002,CDM,,,,Both,,,20089,5022,,20089,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CCU/ INTERMEDIATE,21400001,CDM,,,,Both,,,5853,1463,,5853,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CCU/ OTHER-CVICU,21900001,CDM,,,,Both,,,9690,2423,,9690,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CVICU - ECMO,21900002,CDM,,,,Both,,,26433,6608,,26433,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CCU/OTHER CVICU CRRT,21900003,CDM,,,,Both,,,20089,5022,,20089,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH RISK NURSERY CARE PER DAY,23100001,CDM,,,,Both,,,11049,2762,,11049,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH RISK OB CARE PER DAY,23200001,CDM,,,,Both,,,6822,1706,,6822,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH RISK ICU CARE PER DAY  ,23300001,CDM,,,,Both,,,10965,2741,,10965,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH RISK CCU CARE PER DAY,23400001,CDM,,,,Both,,,10965,2741,,10965,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH RISK NICU CARE PER DAY,23900001,CDM,,,,Both,,,11049,2762,,11049,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 250 WO HCPCS,25001250,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARM REV 250 W/O HCPCS FOR ED,25001251,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRIMASOL,25001252,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRISMASATE,25001253,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SODIUM CITRATE,25001254,CDM,,,,Both,,,26,7,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 251,25100251,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 252,25200252,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 253,25300253,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 254,25400254,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLN,25500001,CDM,,,,Both,,,3,1,,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE,25500002,CDM,,,,Both,,,137,34,,137,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ OCTAFLUOROPROPANE MIC 1ML,25500003,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ SULF HEXA LIPID MICROSPH,25500004,CDM,,,,Both,,,34,9,,34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 255,25500255,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 256,25600256,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 257,25700257,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INFUSION SOLUTION W/O HCPCS,25800039,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 258,25800258,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 259,25900259,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,26000001,CDM,,,,Both,,,439,110,,439,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION HYDRATION EACH ADDITIONAL HOUR,26000002,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION THERAPY/PROPH /DX 1ST TO 1 HR,26000003,CDM,,,,Both,,,493,123,,493,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION THERAPY PROPH/DX EA HOUR,26000004,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION THER PROPH ADDL SEQ TO 1 HR,26000005,CDM,,,,Both,,,259,65,,259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV NFS THERAPY PROPHY/DX CONCURRENT NFS,26000006,CDM,,,,Both,,,212,53,,212,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERAPEUTIC PROPHY/DX INJECTION SUBQ/IM,26000007,CDM,,,,Both,,,172,43,,172,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,26000008,CDM,,,,Both,,,388,97,,388,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,26000009,CDM,,,,Both,,,153,38,,153,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC,26000010,CDM,,,,Both,,,126,32,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED THER./PROPHYLACTIC/DIAG. INJ.,26000011,CDM,,,,Both,,,189,47,,189,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INITIATION PROLONGED INFUSION MORE THAN 8 HOURS VIA PORTABLE OR IMPLANTABLE PUMP,26000012,CDM,,,,Both,,,489,122,,489,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SC THER INFUSION UP TO 1 HR,26000013,CDM,,,,Both,,,809,202,,809,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SC THER INFUSION ADDL HR,26000014,CDM,,,,Both,,,144,36,,144,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SC THER INFUSION RESET PUMP,26000015,CDM,,,,Both,,,256,64,,256,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLICATON ON-BODY INJECTOR,26000016,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THER/PROPH/DIAG INJ IA,26000018,CDM,,,,Both,,,468,117,,468,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SURGI BRA MEDIUM,27000048,CDM,,,,Both,,,83,21,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SURGI BRA 2X,27000051,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BOOT WAFFLE AIR BOOT 304FW,27000053,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BREAST PUMP KIT,27000060,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLEURX DRAINAGE BTL 1000ML 50 7210,27000070,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SKIN BOND CEMENT,27000095,CDM,,,,Both,,,143,36,,143,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SYSTEM FECAL MANAGEMENT 411100,27000104,CDM,,,,Both,,,393,98,,393,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPLINT LYNX WHFO RIGHT MEDC7906 03 01,27000113,CDM,,,,Both,,,115,29,,115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPLINT LYNX WHFO LEFT LARGE C7906 04 02,27000114,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEST TUBE CLAMP,27000117,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TUBE TRACH SHILEY CUFF/FEN 4 10,27000129,CDM,,,,Both,,,143,36,,143,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TUBING BLADDER IRRIGATION 51582492,27000161,CDM,,,,Both,,,62,16,,62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI KIT VAC CANNISTER M6275071,27000178,CDM,,,,Both,,,78,20,,78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AQUACEL AG RIBBON BOX 403712,27000191,CDM,,,,Both,,,153,38,,153,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI VAC AG LARGE M6275099/10,27000193,CDM,,,,Both,,,126,32,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPECIAL PURCHASE ITEM ORTHOTIC,27000196,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLEUR EVAC SINGLE A 700008LF,27000228,CDM,,,,Both,,,1208,302,,1208,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CAPD MINI EXT LIFE TRANS. SET CAP 5C4482,27000235,CDM,,,,Both,,,115,29,,115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCD EXPRESS SLEEVE MED KNEE 9529,27000246,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCD EXPRESS SLEEVE LARGE KNEE 9789,27000247,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABDUCTION PILLOW (FOAM) MED,27000260,CDM,,,,Both,,,19,5,,19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POLAR CARE UNIT,27000271,CDM,,,,Both,,,404,101,,404,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEEL BOOT,27000274,CDM,,,,Both,,,126,32,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY CHEST TUBE INSERTION DISPOSABLE,27000290,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY CTAGLIA BLUE RHINO PERC TRACH INTRO,27000306,CDM,,,,Both,,,693,173,,693,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SYVEK NT PATCH #NT6 400 09 05,27000315,CDM,,,,Both,,,171,43,,171,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI DRESSING VAC SMALL M6275051/10,27000317,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI DRESSING VAC MED M6275052/10,27000318,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI DRESSING VAC LARGE M6275053/10,27000319,CDM,,,,Both,,,122,31,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI VAC AG MEDIUM M6275096/10,27000327,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACER CABLES,27000336,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYTOLOGY BRUSH,27000342,CDM,,,,Both,,,294,74,,294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADIAL JAW BIOPSY FORCEPS,27000343,CDM,,,,Both,,,233,58,,233,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GASTROGRAFIN, PER BOTTLE",27000346,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VIPER SLIDE LUBRICANT,27000347,CDM,,,,Both,,,157,39,,157,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BARD BIOPSY GUN 18G #MC1825,27000495,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMFORT  CIRCUIT,27000542,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLUTTER VALVE,27000631,CDM,,,,Both,,,100,25,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH EMB FOGARTY,27000633,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FORCEPS BRONCH,27000636,CDM,,,,Both,,,132,33,,132,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRAUTERINE DISP PRESS KIT,27000673,CDM,,,,Both,,,56,14,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OSCILLATOR CIRCUIT,27000716,CDM,,,,Both,,,366,92,,366,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERCUSSIVE NEB,27000727,CDM,,,,Both,,,181,45,,181,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEMPERATURE SENSOR SET (OLYMPIC 60040),27000844,CDM,,,,Both,,,584,146,,584,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSBRONCHIAL BIOPSY NEEDLE,27000855,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMOBILIZER SHOULDER ABD SUPPORT MED,27000948,CDM,,,,Both,,,316,79,,316,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTRODE 25 MR DC DEEP CUPS 3 ARRAYS,27001083,CDM,,,,Both,,,207,52,,207,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PATCHES FETAL MONITOR,27001085,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTRODE NEONATE,27001087,CDM,,,,Both,,,107,27,,107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEVICE DETACH NEURO WEB  WDC-1,27001088,CDM,,,,Both,,,426,107,,426,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HYBRID KNIFE,27001091,CDM,,,,Both,,,1286,322,,1286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAMILTON VENT CIRCUIT W/EXPIRATORY VALVE 300CM 260167,27001093,CDM,,,,Both,,,160,40,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PATCH FETAL MONITORING BLUE WATERPROOF,27001094,CDM,,,,Both,,,95,24,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PATCH FETAL MONITORING WHITE BLUE WATERPROOF,27001095,CDM,,,,Both,,,302,76,,302,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOAM SCLERO INJ 18ML FP00019 ,27001096,CDM,,,,Both,,,8039,2010,,8039,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAMITLON VENT CIRCUIT W/ E-VALVE 480CM 260168,27001097,CDM,,,,Both,,,168,42,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAMITLON VENT CIRCUIT 300CM 260145,27001098,CDM,,,,Both,,,90,23,,90,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAMILTON SET VALVE EXPIRATORY 161186,27001099,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OR SUPPLIES,27010000,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NITRIC OXYIDE GAS,27100003,CDM,,,,Both,,,793,198,,793,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OXYGEN USE DAILY,27100004,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATHETER SIMPLASTIC HEMATURIA 24/30CC,27200017,CDM,,,,Both,,,118,30,,118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH TENCKHOFF STRAIGHT QUINTON,27200060,CDM,,,,Both,,,211,53,,211,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY BONE MARROW DISP,27200070,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIT PNEUMOTHORAX DISP AK01500,27200075,CDM,,,,Both,,,204,51,,204,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY INTRO./SHEATH PICC 1.9FR NICU,27200077,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY INTRO/SHEATH PICC 2.8FR   NICU,27200078,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY THORA/PARACENTESIS 6FR PIG1260T,27200081,CDM,,,,Both,,,133,33,,133,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TUBE TRACH 4 10 UNCUFF FEN DISP,27200082,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TUBE TRACH 4 10 CUFF LOW PRESS DISP,27200084,CDM,,,,Both,,,89,22,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TUBE TRACH 4 10 UNCUFF DISP,27200085,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH PERQCATH 5FR. PICC 4135100,27200098,CDM,,,,Both,,,220,55,,220,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SET MULTILUMEN CVC ARROW AK45703,27200099,CDM,,,,Both,,,166,42,,166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY PICC DUAL LUMEN,27200108,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY PICC TRIPLE LUMAN,27200109,CDM,,,,Both,,,490,123,,490,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AQUACEL AG WOUND DRESSING 4X4.7BX 403765,27200127,CDM,,,,Both,,,253,63,,253,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI VAC PULL APART DRESSING M67275081/5,27200130,CDM,,,,Both,,,252,63,,252,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI DRESSING VAC X LARGE M6275065/5,27200132,CDM,,,,Both,,,190,48,,190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRODUCER SHEATH GUIDING IA EP FXD CURV,27200140,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRODUCER RADSTICK 5FR 10CM 0669050,27200143,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY PICC LINE SINGLE LUMEN,27200147,CDM,,,,Both,,,430,108,,430,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCREW IN TEMP PACER,27200157,CDM,,,,Both,,,732,183,,732,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARROW AK01600 PERCUTANEOUS DRAINAGE KIT,27200159,CDM,,,,Both,,,132,33,,132,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEL BIPOLAR PACING CATHETER,27200180,CDM,,,,Both,,,224,56,,224,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH TENCKHOFF CURVED QUINTON,27200187,CDM,,,,Both,,,110,28,,110,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POLAR CARE PAD,27200197,CDM,,,,Both,,,141,35,,141,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIDURAL TRAY,27200203,CDM,,,,Both,,,82,21,,82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAXXIM ARTLINE KIT,27200225,CDM,,,,Both,,,692,173,,692,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH GUARD (ARROW),27200229,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUAL LUMEN CENTRAL ACCESS,27200230,CDM,,,,Both,,,529,132,,529,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SURGICEL 2 X 3,27200240,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SURGICEL 4 X 8,27200241,CDM,,,,Both,,,145,36,,145,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AQUACEL AG SURG 14 INCH DRESSING 412012,27200246,CDM,,,,Both,,,117,29,,117,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC JAMSHIDI BIOPSY NEEDLE,27200256,CDM,,,,Both,,,59,15,,59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 20G X 9 CM LOCALIZATION WIRES,27200260,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BS EASY CORE BIOPSY SYSTEM,27200282,CDM,,,,Both,,,464,116,,464,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SAFE SHEATH WORLEY OR LVI,27200287,CDM,,,,Both,,,769,192,,769,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSEPATAL NEEDLE,27200290,CDM,,,,Both,,,561,140,,561,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OUTBACK LTD CATHETER,27200297,CDM,,,,Both,,,4952,1238,,4952,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHUTTLE SHEATH,27200300,CDM,,,,Both,,,427,107,,427,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENCORE INDEFLATOR,27200301,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GLIDESHEATH INTRODUCER W/WIRE, W/NEEDLE",27200312,CDM,,,,Both,,,103,26,,103,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TR BAND WITH INFLATOR,27200313,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPIDER PROTECTION DEVICE,27200326,CDM,,,,Both,,,3172,793,,3172,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MINI ENSNARE,27200338,CDM,,,,Both,,,1548,387,,1548,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ELECTRODE, NEEDLE, ABLATION LEVEEN",27200343,CDM,,,,Both,,,4490,1123,,4490,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASCULAR SIZING CATHETER,27200348,CDM,,,,Both,,,732,183,,732,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSEPTAL SHEATH NMT,27200349,CDM,,,,Both,,,282,71,,282,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BALLOON/POLAR CATH BALLOON SET,27200350,CDM,,,,Both,,,1586,397,,1586,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPECIALTY WIRES,27200355,CDM,,,,Both,,,415,104,,415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY LIVER ACCESS SET,27200358,CDM,,,,Both,,,756,189,,756,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC JAMSHIDI BM BIOPSY & ASPIRATION TRAY,27200359,CDM,,,,Both,,,169,42,,169,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY GUN,27200361,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RAULERSON CATHETER SHORT TERM,27200364,CDM,,,,Both,,,157,39,,157,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STERLING BALLOON,27200367,CDM,,,,Both,,,549,137,,549,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROPUNCTURE KIT  5 FR,27200377,CDM,,,,Both,,,152,38,,152,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTROSTOMY TUBE,27200382,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTROJEJUNAL TUBE,27200383,CDM,,,,Both,,,511,128,,511,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GORE EVG 24FR SHEATH,27200384,CDM,,,,Both,,,732,183,,732,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STEREO CORE BIOPSY PROBE 11G,27200392,CDM,,,,Both,,,500,125,,500,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VIPERWIRE ADVANCE,27200406,CDM,,,,Both,,,366,92,,366,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STABILIT FIRST FRACTURE KIT # 1435,27200412,CDM,,,,Both,,,8772,2193,,8772,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ULTRASOUND 11G PROBE,27200414,CDM,,,,Both,,,451,113,,451,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY PROBE 8G STEREO,27200416,CDM,,,,Both,,,545,136,,545,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY PROBE 8G ULTRASOUND,27200418,CDM,,,,Both,,,514,129,,514,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABSCESS DRAINAGE CATHETER,27200424,CDM,,,,Both,,,373,93,,373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SNARE SETS,27200436,CDM,,,,Both,,,671,168,,671,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CCL  DIAGNOSTIC GUIDEWIRE,27200442,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERICARDIALCENTESIS TRAY,27200456,CDM,,,,Both,,,343,86,,343,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CATHETER, PICC LINE, DOUBLE LUMEN",27200460,CDM,,,,Both,,,234,59,,234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CATHETER, PICC LINE, SINGLE LUMEN",27200461,CDM,,,,Both,,,204,51,,204,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROCATHETER/EXCELSIOR,27200464,CDM,,,,Both,,,1213,303,,1213,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CATHETER, DRAINAGE, THALQUICK",27200473,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PNEUMOTHORAX SET,27200476,CDM,,,,Both,,,225,56,,225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CATHETER, SIZING PIGTAIL",27200480,CDM,,,,Both,,,359,90,,359,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PICC LINE, DOUBLE LUMEN",27200485,CDM,,,,Both,,,209,52,,209,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EP INTRACARD FIX-CURVE GUIDING INTROD/SHEATH,27200487,CDM,,,,Both,,,197,49,,197,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUINTON CATHETER,27200490,CDM,,,,Both,,,247,62,,247,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRIPLE LUMEN CATHETER  16CM,27200491,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CUTTING BALLOON, PERIPHERAL",27200492,CDM,,,,Both,,,1952,488,,1952,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY FORCEP,27200496,CDM,,,,Both,,,915,229,,915,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SILVERHAWK PERIPHERAL CATH KIT ALL SIZES,27200500,CDM,,,,Both,,,6088,1522,,6088,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMOSTASE HPH PRODUCT,27200502,CDM,,,,Both,,,291,73,,291,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PROBE/NEEDLE, CRYO",27200505,CDM,,,,Both,,,10979,2745,,10979,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CATHETER, SUPRAPUBIC / CYSTOSCOPIC",27200522,CDM,,,,Both,,,310,78,,310,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEAD PACER TRANSVENOUS VDD SINGLE PASS,27200523,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUAL LUMEN PICC LINE  NAVILYST,27200525,CDM,,,,Both,,,240,60,,240,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BALLOONS(MICROVASIVE),27200586,CDM,,,,Both,,,1129,282,,1129,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLEURX DRAINAGE CATHETER KIT,27200615,CDM,,,,Both,,,1008,252,,1008,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDEWIRE HP .035 JAGWIR,27200622,CDM,,,,Both,,,338,85,,338,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACCESS SHEATH/RING TRANSJUG IHEP,27200647,CDM,,,,Both,,,1037,259,,1037,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BARD MAX CORE DIPS. BIOPSY INSTR.,27200689,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EEG ELECTRODE NEEDLE (LOW IMPEDANCE),27200773,CDM,,,,Both,,,72,18,,72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTROSTOMY KIT 18 FR,27200840,CDM,,,,Both,,,299,75,,299,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAXCORE BIOPSY 14GA 10/16,27200892,CDM,,,,Both,,,135,34,,135,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEPILEX AG 6X6,27200905,CDM,,,,Both,,,54,14,,54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEPITEL 20CM X 30,27200911,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PEG TRAY,27200935,CDM,,,,Both,,,587,147,,587,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROMOGRAN MATRIX DRESSING 4.34X4.34,27200942,CDM,,,,Both,,,20,5,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REDDICK CHOLANGIOGRAM CATHETER 12624050N,27200946,CDM,,,,Both,,,375,94,,375,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE GASTROSTOMY 22FR,27200949,CDM,,,,Both,,,90,23,,90,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY CRITICORE FOLEY 900216,27201248,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABC PROBE,27201272,CDM,,,,Both,,,462,116,,462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COAG WIRE,27201280,CDM,,,,Both,,,122,31,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENCORE INFLATION DEVICE,27201287,CDM,,,,Both,,,183,46,,183,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLEXIBLE ERBE PROBE  STRAIGHT,27201289,CDM,,,,Both,,,486,122,,486,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTOR NEEDLE,27201293,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OLYMPUS SHEALTH,27201296,CDM,,,,Both,,,633,158,,633,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SNARES(MICROVASIVE) #626720,27201308,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMOSTATIC POWDER 3GM - ARISTA,27201320,CDM,,,,Both,,,518,130,,518,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHARGER BALLOON CATHETER 20-120MM,27201324,CDM,,,,Both,,,267,67,,267,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MUSTANG BALLOON CATHETER 120-200MM,27201328,CDM,,,,Both,,,500,125,,500,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MUSTANG BALLOON CATHETER 20-100MM,27201329,CDM,,,,Both,,,404,101,,404,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TREK BALLOON,27201333,CDM,,,,Both,,,366,92,,366,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VACUUM DELIVERY SYSTEM KIWI PRO CUP,27201334,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPYSCOPE WITH BIOPSY CHANNEL,27201392,CDM,,,,Both,,,1853,463,,1853,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STIMUPLEX NEEDLE ALL SIZES,27201393,CDM,,,,Both,,,143,36,,143,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AQUACEL AG SURG 10 INCH DRESSING 412011,27201398,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SAFE-T-CENTESIS CATH TRAY,27201401,CDM,,,,Both,,,152,38,,152,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLEURX DRAINAGE KIT,27201402,CDM,,,,Both,,,139,35,,139,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BSS PLUS 500ML,27201434,CDM,,,,Both,,,122,31,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FORCEP 23 GAU,27201435,CDM,,,,Both,,,317,79,,317,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROBE LASER 25 GAUGE,27201438,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VITRECTOMY PACK 23 GAU,27201442,CDM,,,,Both,,,1316,329,,1316,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERFLUORON 5CC,27201486,CDM,,,,Both,,,938,235,,938,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI DRESSING VAC MED M6275052/10,27201491,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PAK ACCURUS VISCUS FLUID INJ 8065-740254,27201544,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH BALLOON TAMPONADE POSTPARTUM,27201619,CDM,,,,Both,,,573,143,,573,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TUBE GASTROSTOMY FEEDING 18F,27201631,CDM,,,,Both,,,117,29,,117,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CASSETTE VAC VERALINK,27201640,CDM,,,,Both,,,123,31,,123,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VAPOTHERM CIRCUIT,27201657,CDM,,,,Both,,,214,54,,214,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MOUTHPIECE AEROBIKA OPEP DEVICE,27201658,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE BIOPSY SYSTEM ON CONTROL,27201692,CDM,,,,Both,,,863,216,,863,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATION INSTRUMENT SPINESTAR,27201784,CDM,,,,Both,,,6613,1653,,6613,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SYSTEM INZONE DETACHMENT 2.0,27201791,CDM,,,,Both,,,443,111,,443,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROCATHETER EXCELSIOR SL-10,27201792,CDM,,,,Both,,,2043,511,,2043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OXYGENATOR PERFUSN QUADROX ID,27201802,CDM,,,,Both,,,2565,641,,2565,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEPILEX AG 4X12,27201808,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MASK FULL FACE MED,27201811,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IVENT MASK MEDIUM,27201814,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TUBING MAX ASPIRATION,27201822,CDM,,,,Both,,,851,213,,851,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DETACHER COVIDIEN INSTANT,27201859,CDM,,,,Both,,,112,28,,112,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRILL DFINE VERTECOR BONE,27201860,CDM,,,,Both,,,483,121,,483,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVICEL FIBRIN 2ML,27201870,CDM,,,,Both,,,491,123,,491,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE ASPIRATION 22G,27201877,CDM,,,,Both,,,224,56,,224,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INFLA DEV B/G60 ENDO-AN6012,27201878,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPIN ACCESS CATH INS-5900,27201879,CDM,,,,Both,,,2760,690,,2760,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ALWAYS ON TIP TRACKED FORCEP OVAL/SERRATED INS-0362 & INS-0372,27201881,CDM,,,,Both,,,1380,345,,1380,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ALWAYS ON TIP TRACKED 19 & 21 GA NEEDLE INS-0382 & INS-0392,27201883,CDM,,,,Both,,,1380,345,,1380,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ALWAYS ON TIP TRACKED 22 GA NITINOL NEEDLE INS-5410,27201885,CDM,,,,Both,,,2070,518,,2070,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROBE KIT OSTEOCOOL RF ABLATION SINGLE,27201886,CDM,,,,Both,,,7360,1840,,7360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROBE KIT OSTEOCOOL RF ABLATION DUAL,27201887,CDM,,,,Both,,,10120,2530,,10120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE ACCESS KIT OSTEOCOOL RF ABLATION,27201888,CDM,,,,Both,,,920,230,,920,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MIXER AUTOPLEX W/VHV STRYKER,27201899,CDM,,,,Both,,,1702,426,,1702,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CANNULA VERTEPORT CEMENT STRYKER,27201901,CDM,,,,Both,,,139,35,,139,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CANNULA ACCESS STRYKER,27201902,CDM,,,,Both,,,140,35,,140,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIT IVAS BIOPSY STRYKER,27201903,CDM,,,,Both,,,1085,271,,1085,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CURETTE STRYKER,27201904,CDM,,,,Both,,,1254,314,,1254,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE CURVED STRYKER,27201905,CDM,,,,Both,,,978,245,,978,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI DRSG WND VAC GRANUFOAM PAD LG 3.2X15X26CM,27201911,CDM,,,,Both,,,126,32,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4351,27201915,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6025,27201918,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6457,27201919,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENA INCISION MANAGEMENT SYSTEM 90CM,27201922,CDM,,,,Both,,,1196,299,,1196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENA INCISION MANAGEMENT SYSTEM 13CM,27201923,CDM,,,,Both,,,911,228,,911,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VALVE IN CARTRIDGE 9MM,27201926,CDM,,,,Both,,,6900,1725,,6900,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VALVE IN CARTRIDGE 7MM 6MM 5MM,27201927,CDM,,,,Both,,,5300,1325,,5300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH DEPLOYMENT AND LOADER,27201928,CDM,,,,Both,,,2000,500,,2000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AIRWAY SIZING KIT,27201929,CDM,,,,Both,,,690,173,,690,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPIN PERC KIT INS-5600 & INS-5620,27201931,CDM,,,,Both,,,920,230,,920,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4338,27201935,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4346,27201936,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENSITE PROTECTION ELECTRODE KIT,27201937,CDM,,,,Both,,,2185,546,,2185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KCI VAC VERAFLO DRESSING MED,27201946,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LOADING SYSTEM LS ENVEOR,27201948,CDM,,,,Both,,,897,224,,897,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DELIVERY SYSTEM ENVEOR,27201950,CDM,,,,Both,,,4853,1213,,4853,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6021,27201956,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMPLANT WITHOUT HCPC,27201963,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRSG WND CARE V.A.C. VERAFLO CLEANSE LF ST DISP MD,27201966,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRSG WND V.A.C. GRANUFOAM AG LF ST MD 5.0CA 3.2X12.5X18CM,27201973,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRSG WND V.A.C. GRANUFOAM POLYURET DRP PAD MD 3.3X12.5X18CM,27201974,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HYDROFIBER IONIC GELLATEX FREE AQUACEL SURG DSG 3.5X12IN 420670,27201986,CDM,,,,Both,,,76,19,,76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATHETER POWERPICC MAX 5FR SLFULL W/ TCS 1175108D,27201987,CDM,,,,Both,,,490,123,,490,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRESSING WOUND PREVENA PLUSLATEX FREE HYDROLLOID PRE4001US.S,27201988,CDM,,,,Both,,,1196,299,,1196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIT THORACENT PLEURA-SEAL 8FR SHARPS SFTY DISP AK-01000,27201991,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VPAD 2 PATIENT TRACKER,27201994,CDM,,,,Both,,,920,230,,920,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4340,27201996,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4556,27201997,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4557,27201998,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4615,27201999,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4618,27202000,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A5200,27202001,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6196,27202002,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6197,27202003,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6198,27202004,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6206,27202005,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6207,27202006,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6208,27202007,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6209,27202008,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6210,27202009,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6211,27202010,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6212,27202011,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6213,27202012,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6214,27202013,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6215,27202014,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6216,27202015,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6217,27202016,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6231,27202017,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6243,27202018,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6248,27202019,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6251,27202020,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6252,27202021,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6253,27202022,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6445,27202023,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6450,27202024,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6550,27202025,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7521,27202026,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PORT SMART CT,27202027,CDM,,,,Both,,,924,231,,924,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PIGTAIL MARKER BAND,27202028,CDM,,,,Both,,,537,134,,537,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GATEWAY Y ADAPTER,27202030,CDM,,,,Both,,,95,24,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ROTAGLIDE,27202031,CDM,,,,Both,,,221,55,,221,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POWER PULSE KIT,27202033,CDM,,,,Both,,,884,221,,884,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMBOZENE SPHERE,27202034,CDM,,,,Both,,,520,130,,520,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ONCOZENE SPHERE,27202035,CDM,,,,Both,,,4420,1105,,4420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FASCIAL DILATOR,27202039,CDM,,,,Both,,,244,61,,244,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH ANGIO HNBR P-NS,27202044,CDM,,,,Both,,,65,16,,65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE ACCESS BX RMT RTPS,27202045,CDM,,,,Both,,,1095,274,,1095,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MIC-KEY / MIC TRANSGASTRIC J TUBE KIT,27202046,CDM,,,,Both,,,2420,605,,2420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CV LINE KIT DYDNA2260,27202048,CDM,,,,Both,,,290,73,,290,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SYRINGE KIT MERIT,27202049,CDM,,,,Both,,,125,31,,125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DOUBLE Y HEMO VALVE,27202055,CDM,,,,Both,,,94,24,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US PROBE COVER,27202057,CDM,,,,Both,,,358,90,,358,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE DIAMOND,27202058,CDM,,,,Both,,,180,45,,180,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE AVAFLEX CURVED,27202059,CDM,,,,Both,,,1403,351,,1403,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRILLBIT STRYKER,27202060,CDM,,,,Both,,,201,50,,201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH NAVICROSS ANG TIP / STR,27202063,CDM,,,,Both,,,480,120,,480,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COIL AZUR CX / FRAMING,27202064,CDM,,,,Both,,,2985,746,,2985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DETACHMENT CONTROLLER,27202065,CDM,,,,Both,,,906,227,,906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN BAG 600ML,27202067,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SOLERO ABLATION WAND,27202071,CDM,,,,Both,,,7360,1840,,7360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACCORDIAN DRAIN BAG,27202074,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIT WRENCH PACEMAKER BOSTON,27202080,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIT WRENCH PACEMAKER MEDLINE,27202081,CDM,,,,Both,,,231,58,,231,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CABLE BIO SENSE WEBSTER,27202087,CDM,,,,Both,,,918,230,,918,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEAD PACER BARD,27202090,CDM,,,,Both,,,366,92,,366,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONNECTOR LEAD TOOL ACUITY X4 LEAD,27202091,CDM,,,,Both,,,345,86,,345,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CASSET ENDOANCHOR HELI-FX SYSSING DISP 16FR 62CMCM SA-85,27202093,CDM,,,,Both,,,11362,2841,,11362,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDE ENDOANCHOR HELI-FX 16FR 22MMX62CM DISP SG-64,27202094,CDM,,,,Both,,,4212,1053,,4212,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4344,27202097,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANGI ASSIST KIT AA0608,27202099,CDM,,,,Both,,,219,55,,219,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARTRIDGE REFILL CO2/31813,27202100,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4400,27202102,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4222,27202103,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4223,27202104,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4270,27202105,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4310,27202106,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4315,27202108,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4330,27202109,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4331,27202110,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4355,27202111,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4357,27202112,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4364,27202113,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4369,27202114,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4389,27202115,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4390,27202116,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4393,27202117,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4394,27202118,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4398,27202119,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4421,27202120,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4435,27202121,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4465,27202122,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4500,27202123,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4558,27202124,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4559,27202125,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4605,27202126,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4606,27202127,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4614,27202128,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4620,27202129,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4623,27202130,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4624,27202131,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4628,27202132,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4653,27202133,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4690,27202134,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4719,27202135,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4721,27202136,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4722,27202137,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4723,27202138,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4724,27202139,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4725,27202140,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4726,27202141,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4750,27202142,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4911,27202143,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4913,27202144,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A5210,27202145,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6010,27202146,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6011,27202147,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6022,27202148,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6023,27202149,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6024,27202150,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6154,27202151,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6199,27202152,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6203,27202153,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6204,27202154,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6222,27202156,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6223,27202157,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6234,27202159,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6240,27202160,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6242,27202161,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6250,27202162,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6258,27202163,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6260,27202164,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6261,27202165,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6262,27202166,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6266,27202167,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6402,27202168,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6404,27202169,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6407,27202170,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6441,27202171,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6442,27202172,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6443,27202173,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6446,27202174,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6448,27202175,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6449,27202176,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6453,27202177,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A6454,27202178,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7025,27202181,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7040,27202182,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7041,27202183,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7048,27202184,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7504,27202185,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7520,27202186,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1819,27202187,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4314,27202188,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7524,27202190,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7526,27202191,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A7527,27202192,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4212,27202193,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4215,27202194,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4322,27202195,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4616,27202196,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4649,27202197,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4657,27202198,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4663,27202199,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4706,27202200,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4707,27202201,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4709,27202202,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WAVELINQ 4 FR CATHETER,27202203,CDM,,,,Both,,,16284,4071,,16284,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMBU ASCOPE 4 LG 478001000,27202204,CDM,,,,Both,,,690,173,,690,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACCUCATH ACE BASIC KIT 18GA X 2.25CM,27202211,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIT STRT IV IVS3825,27202214,CDM,,,,Both,,,59,15,,59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIT CATH ACCUCATH 20GA 2.25IN BASIC INTVSLR AC0202250,27202215,CDM,,,,Both,,,94,24,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SITZ MARKER,27202216,CDM,,,,Both,,,153,38,,153,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH IVUS PERIPH 8FR,27202218,CDM,,,,Both,,,2070,518,,2070,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIALYZER OPTIFLUX,27202220,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BALLOON TAMPONADE VACUUM HEMORRHAGE JADA,27202222,CDM,,,,Both,,,2790,698,,2790,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OR STERILE SUPPLIES,27210000,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC EO WITH JOINT, PREFABRICATED",27400002,CDM,,,,Both,,,1291,323,,1291,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FO TIP/DIP WITH JOINT/SPRING,27400003,CDM,,,,Both,,,98,25,,98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLLAR CERVICAL SEMI RIGIDTHERMO FOAM 2 PCS,27400004,CDM,,,,Both,,,388,97,,388,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WALKER BOOT  W/WO JOINTS,27400008,CDM,,,,Both,,,469,117,,469,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II SYST CONT BATTERY MODULE#1264,27400017,CDM,,,,Both,,,901,225,,901,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM STABILIZATION BELT LXL 100760 REPLACE ONLY,27400025,CDM,,,,Both,,,600,150,,600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II BATTERY CLIPS FOR MBL REPLACE ONLY,27400047,CDM,,,,Both,,,3734,934,,3734,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II POWER MODULE TO DC INPUT CABLE,27400050,CDM,,,,Both,,,764,191,,764,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II PWR MODULE PM INPUT CABLE 1340,27400053,CDM,,,,Both,,,26477,6619,,26477,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II UNIVERSAL BATTERY CHARGER,27400054,CDM,,,,Both,,,24441,6110,,24441,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II POWER MODULE/UBC AC CORD,27400055,CDM,,,,Both,,,73,18,,73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II POWER MODULE CABLE 14V 103426,27400061,CDM,,,,Both,,,2016,504,,2016,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PASSE MUIR TRACH VALVE,27400064,CDM,,,,Both,,,231,58,,231,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHO WRIST EXTENSION COCKUP,27400065,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT HO PREFAB METACARPAL FX ORTHOSIS,27400066,CDM,,,,Both,,,189,47,,189,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEEL LIFTS,27400067,CDM,,,,Both,,,89,22,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE/FOOT ORTHOTIC FRACTURE ORTHOTIC,27400073,CDM,,,,Both,,,2161,540,,2161,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMOBILIZER A/C PREFAB CANVAS,27400074,CDM,,,,Both,,,316,79,,316,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHFO NONTORSION JOINT PREFAB,27400075,CDM,,,,Both,,,219,55,,219,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC WHFO, NO JOINT, PREFABRICATED",27400076,CDM,,,,Both,,,444,111,,444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II SYSTEM CONTROLLER REPLACE ONLY,27400078,CDM,,,,Both,,,22473,5618,,22473,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE/FOOT ORTHOTIC STATIC PREFAB,27400079,CDM,,,,Both,,,868,217,,868,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RIGID EO WITHOUT JOINTS,27400086,CDM,,,,Both,,,190,48,,190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHFO RIGID WITHOUT JOINTS,27400087,CDM,,,,Both,,,357,89,,357,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHO W/O JOINTS CF,27400088,CDM,,,,Both,,,702,176,,702,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLEX GLOVE W/ELASTIC FINGER,27400089,CDM,,,,Both,,,345,86,,345,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HFO W/O JOINTS PF,27400090,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HFO NONTORSION JOINT PREFAB,27400091,CDM,,,,Both,,,248,62,,248,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIO FLEX PELVIC/SACR PRE OTS,27400096,CDM,,,,Both,,,116,29,,116,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOOT INSERT REMOVABLE,27400098,CDM,,,,Both,,,91,23,,91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II HOLSTER VEST PC S/M/L REPLACEMENT  ONLY,27400103,CDM,,,,Both,,,655,164,,655,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II PC SYSTEM CONTROLLER,27400106,CDM,,,,Both,,,20625,5156,,20625,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM PC 11V LI-ION BACKUP BATTERY,27400107,CDM,,,,Both,,,1312,328,,1312,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM PC WEARABLE ACCESSORIES KIT,27400108,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM PC CONSOLIDATED BAG LEFT,27400109,CDM,,,,Both,,,853,213,,853,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM PC CONSOLIDATED BAG RIGHT,27400110,CDM,,,,Both,,,853,213,,853,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM PC HOLSTER VEST SMALL,27400111,CDM,,,,Both,,,1037,259,,1037,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM PC HOLSTER VEST MEDIUM,27400112,CDM,,,,Both,,,1037,259,,1037,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM PC HOLSTER VEST LARGE,27400113,CDM,,,,Both,,,1037,259,,1037,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM PC BATTERY HOLSTER,27400114,CDM,,,,Both,,,655,164,,655,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM PC SHOWER BAG,27400115,CDM,,,,Both,,,591,148,,591,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM II 14V LI-ION BATTERY,27400121,CDM,,,,Both,,,1641,410,,1641,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0120,27400122,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0172,27400123,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0456,27400124,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0621,27400125,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0625,27400126,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0628,27400127,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0810,27400128,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0859,27400129,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L1620,27400130,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L1686,27400131,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L1830,27400132,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L1832,27400133,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L1906,27400134,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L1930,27400135,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L2116,27400136,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L2128,27400137,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L2132,27400138,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3030,27400139,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3332,27400140,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3650,27400141,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3670,27400142,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3730,27400143,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3760,27400144,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3762,27400145,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3807,27400146,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3808,27400147,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3900,27400148,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3906,27400149,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3908,27400150,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3912,27400151,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3917,27400152,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3923,27400153,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3925,27400154,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3929,27400155,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3931,27400156,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3960,27400157,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3980,27400158,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3982,27400159,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3984,27400160,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L4350,27400161,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L4360,27400162,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L4386,27400163,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L4398,27400164,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8501,27400165,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8606,27400166,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8610,27400167,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8613,27400168,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8614,27400169,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8693,27400170,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0478,27400171,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0479,27400172,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0480,27400173,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0481,27400174,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0484,27400175,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0486,27400176,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0487,27400177,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0489,27400178,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0491,27400179,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0492,27400180,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0494,27400181,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0495,27400182,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0496,27400183,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0497,27400184,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0498,27400185,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0499,27400186,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0500,27400187,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0501,27400188,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0502,27400189,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0503,27400190,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0504,27400191,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0506,27400193,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0508,27400194,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3924,27400195,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0507,27400197,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L1902,27400198,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3060,27400199,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3916,27400200,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3999,27400201,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8619,27400202,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0483,27400203,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SO AIRPLANE W/WO JOINT CF,27400205,CDM,,,,Both,,,2099,525,,2099,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EO ELAS W/METAL JNTS PRE OTS,27400206,CDM,,,,Both,,,264,66,,264,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHFO W/JOINT(S) CUSTOM FAB,27400207,CDM,,,,Both,,,807,202,,807,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHFO W/O JOINTS PRE OTS,27400208,CDM,,,,Both,,,444,111,,444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHO NONTORSION JNTS PRE CST,27400209,CDM,,,,Both,,,944,236,,944,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HFO NONTORSION JNTS PRE OTS,27400210,CDM,,,,Both,,,163,41,,163,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HFO W/O JOINTS OTS,27400211,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EWHO RIGID W/O JOINT CUSTOM,27400212,CDM,,,,Both,,,1243,311,,1243,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FO W/O JOINTS CUSTOM,27400213,CDM,,,,Both,,,379,95,,379,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHO WRIST HAND ORTHOSIS CUSTOM,27400214,CDM,,,,Both,,,1761,440,,1761,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0509,27400215,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM III MODULAR CABLE BTT,27400218,CDM,,,,Both,,,19306,4827,,19306,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM III SYSTEM CONTROLLER BTT,27400219,CDM,,,,Both,,,21450,5363,,21450,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM III MOBILE POWER UNIT W/AC POWER CABLE BTT,27400220,CDM,,,,Both,,,31200,7800,,31200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L1810,27400221,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8509,27400222,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L1833,27400223,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L4396,27400224,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0140,27400225,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0150,27400226,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0174,27400227,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3040,27400228,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3806,27400229,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0220,27400230,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L2999,27400231,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L4370,27400232,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L0450,27400233,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3031,27400234,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3050,27400235,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3080,27400236,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3170,27400237,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3334,27400238,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3350,27400239,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3678,27400240,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3913,27400241,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L3927,27400242,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8000,27400243,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8047,27400244,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8627,27400245,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8689,27400246,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS V2629,27400247,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS V2715,27400248,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HFO W/O JOINTS CF,27400249,CDM,,,,Both,,,710,178,,710,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EO W/O JOINTS CF,27400250,CDM,,,,Both,,,758,190,,758,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HFO W/JOINT(S) CF,27400251,CDM,,,,Both,,,843,211,,843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEMAKER DUAL CHAMBER RATE RESPONSIVE IMP,27500002,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEMAKER SINGLE CHAMBER RATE RESPNSV IMP,27500003,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEMAKER DUAL CHMB NON RATE RESPNSV IMP,27500004,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEMAKER SNGL CHAM NON RATE RESPNSV IMP,27500005,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEMAKER OTHR THAN SNGL OR DUAL CHAM IP,27500006,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARDIOVERTER DEFIB DUAL CHAMBER IMP,27500007,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARDIOVERTER DEFIBRILLATOR SGL CHAM IMP,27500008,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIVENTRICULAR ICD,27500009,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEAD LFT VENTRICULAR CORONARY VENOUS,27500010,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEAD PACER OTR/THN TRANSVENOUS VDD SCL P,27500011,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEAD CARDIOVERTER DEFIB EC SGL COIL IMP,27500013,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEAD CARDIOVERTER DEFIB EC DUAL COIL IMP,27500014,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEAD CARDI DEFIB OTR/THN EC SGL OR DUAL,27500015,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ADAPTOR EXTENSION PACING LEAD IMP5867,27500016,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ST JUDE LEAD 1488TC, 1688TC",27500017,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANT LEAD 4456,27500018,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEDTRONIC PACER 560/565,27500019,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ST JUDE SCREW IN LEAD 511212,27500020,CDM,,,,Both,,,1300,325,,1300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANT LEAD 4469/70/71/72/73/74,27500021,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANT LEAD 4456/57/58/59/79/80,27500022,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANT ICD LEAD 155,27500023,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANT PACER,27500024,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANT IMPLANTABLE LEAD 4510/11/12/13,27500025,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANT ICD GEN VENTAK PRIZM 2VR 1860,27500027,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEDTRONIC ICD LEAD 6947/6944,27500028,CDM,,,,Both,,,8262,2066,,8262,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANT LEAD 4086/4087/4088,27500029,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANT ICD GEN  CONTAK RENEWAL H175,27500030,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ST JUDE PACERMAKER V343,27500031,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARIDOVERTER DIFIB OTR THAN SGL OR DUAL,27500032,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1721,27500033,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1722,27500034,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1777,27500035,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1779,27500036,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1785,27500037,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1786,27500038,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1882,27500039,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1883,27500040,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1895,27500041,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1896,27500042,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1898,27500043,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1900,27500044,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2619,27500045,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2620,27500046,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2621,27500047,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AICD DYNAGEN DL VR,27500048,CDM,,,,Both,,,20800,5200,,20800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AICD DYNAGEN MINI DF4 DR,27500049,CDM,,,,Both,,,22204,5551,,22204,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AICD EVERA XT,27500050,CDM,,,,Both,,,28100,7025,,28100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AICD INOGEN,27500051,CDM,,,,Both,,,20696,5174,,20696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AICD DYNAGEN EL VR,27500053,CDM,,,,Both,,,20592,5148,,20592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AICD VISIA VR DF4,27500054,CDM,,,,Both,,,20373,5093,,20373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AICD VISIA VR DF4 MRI,27500055,CDM,,,,Both,,,29657,7414,,29657,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEMAKER ACCOLADE DUAL,27500056,CDM,,,,Both,,,9838,2460,,9838,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEMAKER ACCOLADE SINGLE,27500057,CDM,,,,Both,,,6864,1716,,6864,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEMAKER ADAPTA SINGLE,27500058,CDM,,,,Both,,,5666,1417,,5666,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PACEMAKER MICRA SINGLE,27500059,CDM,,,,Both,,,19668,4917,,19668,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT GRAFTMASTER,27500060,CDM,,,,Both,,,4982,1246,,4982,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT DES SIERRA,27500061,CDM,,,,Both,,,1862,466,,1862,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT ICAST,27500062,CDM,,,,Both,,,5280,1320,,5280,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRT-D AMPLIA,27500063,CDM,,,,Both,,,35378,8845,,35378,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRT-D CLARIA,27500064,CDM,,,,Both,,,43851,10963,,43851,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRT-D DYNAGEN,27500065,CDM,,,,Both,,,51994,12999,,51994,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRT-D VIVA XT,27500066,CDM,,,,Both,,,35229,8807,,35229,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRT-P VALUTIDE X4,27500067,CDM,,,,Both,,,12896,3224,,12896,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRT-P SOLAR BIPOLAR,27500068,CDM,,,,Both,,,12695,3174,,12695,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1780,27600004,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS V2630,27600005,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS V2632,27600006,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS V2787,27600007,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS V2788,27600008,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCIMED WALLSTENT LONG,27800008,CDM,,,,Both,,,3558,890,,3558,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ADAPTOR/EXT PACING LEAD OR NEURO LEAD IMPLANT,27800014,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RITA CHEMOEMBOLIZATION BEADS,27800044,CDM,,,,Both,,,2694,674,,2694,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VIABAHN STENT,27800059,CDM,,,,Both,,,13103,3276,,13103,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EKOSONIC US INFUSION CATH,27800091,CDM,,,,Both,,,5190,1298,,5190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEMPORARY BALLOON PACING ELECTRODE,27800093,CDM,,,,Both,,,266,67,,266,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMPLATZER  VASCULAR PLUG,27800113,CDM,,,,Both,,,1664,416,,1664,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TISSUE MARKER IMPLANTABLE,27800114,CDM,,,,Both,,,182,46,,182,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VAS-STENT, MEDTRONIC ANEURX, CUFF",27800133,CDM,,,,Both,,,5564,1391,,5564,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC STENT, VIATORR, VIAHAHN",27800150,CDM,,,,Both,,,5222,1306,,5222,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CATHETER, PICC LINE, TRIPLE LUMEN",27800156,CDM,,,,Both,,,559,140,,559,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLLEGEN BULKING AGENT IMPLANT,27800451,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEAD CARDIODEFIB OTR/THN EC SGL OR DUAL,27800565,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GRAFT VASCULAR ACUSEAL,27800658,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONCERTO HELIX COIL NYLON,27800698,CDM,,,,Both,,,1430,358,,1430,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BALLOON HYPERFORM,27800703,CDM,,,,Both,,,7467,1867,,7467,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROCATHETER ECHELON,27800706,CDM,,,,Both,,,1696,424,,1696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATHETER SOLITAIRE,27800713,CDM,,,,Both,,,41574,10394,,41574,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATHETER POLY OD KIT 1.4FR PICC,27800731,CDM,,,,Both,,,182,46,,182,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMBOLIC DEVICE PIPELINE,27800740,CDM,,,,Both,,,26000,6500,,26000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLUG MICROVASCULAR,27800785,CDM,,,,Both,,,3590,898,,3590,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BALLOON CATHETER GATEWAY PTA,27800800,CDM,,,,Both,,,2750,688,,2750,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT SYSTEM WINGSPAN,27800804,CDM,,,,Both,,,16871,4218,,16871,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHEATH NEURON MAX LONG,27800853,CDM,,,,Both,,,990,248,,990,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRACHYTX NON STR YTTRIUM 90,27800873,CDM,,,,Both,,,31165,7791,,31165,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4264,27800917,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4648,27800918,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1713,27800919,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1714,27800920,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1724,27800921,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1725,27800922,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1726,27800923,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1727,27800924,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1729,27800925,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1730,27800926,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1731,27800927,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1732,27800928,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1733,27800929,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1750,27800930,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1751,27800931,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1752,27800932,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1753,27800933,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1755,27800934,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1757,27800935,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1758,27800936,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1759,27800937,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1760,27800938,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1762,27800939,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1763,27800940,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1764,27800941,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1765,27800942,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1766,27800943,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1767,27800944,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1768,27800945,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1769,27800946,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1771,27800947,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1772,27800948,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1773,27800949,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1776,27800950,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1778,27800951,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1781,27800952,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1782,27800953,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1783,27800954,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1784,27800955,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1787,27800956,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1788,27800957,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1789,27800958,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1813,27800959,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1814,27800960,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1815,27800961,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1817,27800962,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1820,27800963,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1821,27800964,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1874,27800965,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1876,27800966,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1877,27800967,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1880,27800969,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1884,27800970,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1885,27800971,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1887,27800972,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1892,27800973,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1893,27800974,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1894,27800975,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1897,27800976,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2616,27800977,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2617,27800978,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2618,27800979,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2623,27800980,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2624,27800981,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2625,27800982,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2627,27800983,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2628,27800984,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2629,27800985,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2630,27800986,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2638,27800987,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2640,27800988,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9352,27800989,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9356,27800990,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9359,27800991,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9362,27800992,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9364,27800993,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8687,27800994,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8690,27800995,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8699,27800996,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4100,27800997,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4101,27800998,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4102,27800999,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4104,27801000,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4105,27801001,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4106,27801002,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4107,27801003,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4108,27801004,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4110,27801005,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4116,27801006,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4118,27801007,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4124,27801009,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4128,27801010,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4130,27801011,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4148,27801013,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT SYNERGY DES,27801014,CDM,,,,Both,,,2400,600,,2400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRODUCER ACC SET MICROPUNCTURE PEDAL,27801016,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2615,27801020,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1878,27801021,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8612,27801058,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4262,27801059,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1822,27801060,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1886,27801061,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9353,27801062,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9361,27801063,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9363,27801064,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8600,27801065,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4565,27801066,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q0485,27801067,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4142,27801069,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8629,27801070,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8641,27801071,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS V2790,27801072,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2622,27801073,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4156,27801074,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VALVES AORTIC MITRAL,27801075,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A4263,27801078,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1875,27801079,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENVELOPE CORMATRIX CANGAROO,27801090,CDM,,,,Both,,,1900,475,,1900,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2631,27801091,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4147,27801092,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4155,27801093,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1889,27801095,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHIAL TRACHEAL STENT,27801096,CDM,,,,Both,,,900,225,,900,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC Y STENT,27801097,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATHETER COYOTE,27801106,CDM,,,,Both,,,1170,293,,1170,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDURANT BIFURCATED STENT GRAFT,27801108,CDM,,,,Both,,,20748,5187,,20748,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDURANT STENT GRAFT LIMB,27801109,CDM,,,,Both,,,11520,2880,,11520,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RELIANT BALLOON,27801110,CDM,,,,Both,,,957,239,,957,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SENTRANT SHEATH 12FR,27801111,CDM,,,,Both,,,312,78,,312,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUPPORT CATHETER RUBICON,27801116,CDM,,,,Both,,,1248,312,,1248,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATHETER EXPEL APD DRAINAGE,27801127,CDM,,,,Both,,,115,29,,115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIT CATH MAHURKAR DIALYSIS,27801131,CDM,,,,Both,,,171,43,,171,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIT CATH PALINDROME PRECISION DIALYSIS,27801134,CDM,,,,Both,,,525,131,,525,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT EPIC ILIAC SELF EXPANDING,27801136,CDM,,,,Both,,,5174,1294,,5174,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POWERGLIDE PRO 18,27801138,CDM,,,,Both,,,235,59,,235,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POWERGLIDE PRO 20,27801139,CDM,,,,Both,,,211,53,,211,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLEXOR CHECK FLO INTRO SET,27801143,CDM,,,,Both,,,998,250,,998,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4114,27801148,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRO SHEATH PERFORMER CHECK FLO,27801153,CDM,,,,Both,,,998,250,,998,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4132,27801154,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4133,27801155,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VALIANT CAPTIVIA STENT GRAFT,27801157,CDM,,,,Both,,,31490,7873,,31490,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH JETSTREAM ATHERECTOMY,27801160,CDM,,,,Both,,,14820,3705,,14820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GLIDEWIRE ADVANTAGE GUIDEWIRE,27801162,CDM,,,,Both,,,360,90,,360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRO VASC MICROPUNC 5.0FR 10CM,27801165,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4121,27801169,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4122,27801171,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERASKIN 2.5CM X 2.5CM 100TSXS (PER SQ CM),27801172,CDM,,,,Both,,,309,77,,309,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERASKIN 2.5CM X 5.1CM 101TSS (PER SQ CM),27801173,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1881,27801175,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4139,27801176,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9355,27801178,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIFIX 2CM X 2CM ALLOGRAFT PER SQ CM,27801179,CDM,,,,Both,,,493,123,,493,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIFIX 2CM X 3CM ALLOGRAFT PER SQ CM,27801180,CDM,,,,Both,,,381,95,,381,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIFIX 18MM DISK ALLOGRAFT PER SQ CM,27801182,CDM,,,,Both,,,457,114,,457,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4186,27801183,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4187,27801184,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4195,27801185,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4196,27801186,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4197,27801187,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POWERMIDLINE CATH MAX BARRIER TRAY 5F P4255108D,27801190,CDM,,,,Both,,,320,80,,320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1888,27801194,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8630,27801195,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8658,27801196,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS L8659,27801197,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9354,27801198,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4126,27801199,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BALLOON VIATRAC,27801206,CDM,,,,Both,,,1248,312,,1248,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NAV6 EMBOSHIELD,27801207,CDM,,,,Both,,,7670,1918,,7670,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERCLOSE PROGLIDE,27801208,CDM,,,,Both,,,1280,320,,1280,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT ACCULINK/ XACT,27801209,CDM,,,,Both,,,12974,3244,,12974,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WIRE SUPRACORE,27801210,CDM,,,,Both,,,254,64,,254,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMMAND WIRE ES,27801213,CDM,,,,Both,,,436,109,,436,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT COVERA STR/FLAIR,27801217,CDM,,,,Both,,,5096,1274,,5096,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT LIFESTREAM,27801218,CDM,,,,Both,,,4888,1222,,4888,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PICC NITINOL WIRE,27801220,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TUNNELLED PICC,27801221,CDM,,,,Both,,,1400,350,,1400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PORTACATH,27801222,CDM,,,,Both,,,2035,509,,2035,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACCUSTICK SET STRAIGHT WIRE,27801223,CDM,,,,Both,,,998,250,,998,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH EXPEL MPD,27801225,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WIRE PLATINUM PLUS,27801228,CDM,,,,Both,,,254,64,,254,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WIRE MAILMAN,27801229,CDM,,,,Both,,,254,64,,254,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WIRE THRUWAY,27801230,CDM,,,,Both,,,436,109,,436,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WIRE V-18 CONTROL,27801231,CDM,,,,Both,,,169,42,,169,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT EXPRESS LD / SD,27801234,CDM,,,,Both,,,1370,343,,1370,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT ELUVIA 40,27801235,CDM,,,,Both,,,4150,1038,,4150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT ELUVIA 60,27801236,CDM,,,,Both,,,4774,1194,,4774,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT ELUVIA 100,27801238,CDM,,,,Both,,,5398,1350,,5398,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT ELUVIA 120,27801239,CDM,,,,Both,,,6022,1506,,6022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH SOLENT OMNI / PROXI,27801245,CDM,,,,Both,,,41574,10394,,41574,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BALLOON STANDARD OCCLUSION,27801247,CDM,,,,Both,,,384,96,,384,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH STEALTH CROWN,27801249,CDM,,,,Both,,,13439,3360,,13439,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WIRE ROSEN / ROADRUNNER / COPE MANDRIL / COONS,27801250,CDM,,,,Both,,,259,65,,259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COIL NESTER,27801252,CDM,,,,Both,,,428,107,,428,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH OTW EMBOLECTOMY LEMAITRE,27801257,CDM,,,,Both,,,884,221,,884,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SNARE KIT INTVASC,27801260,CDM,,,,Both,,,1430,358,,1430,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROCATH PHENOM,27801262,CDM,,,,Both,,,2111,528,,2111,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH PHENOM PLUS,27801263,CDM,,,,Both,,,3605,901,,3605,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COIL AXIUM PRIME 3D ES,27801266,CDM,,,,Both,,,59155,14789,,59155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COIL AXIUM PRIME 3D SS,27801267,CDM,,,,Both,,,59155,14789,,59155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COIL AXIUM PRIME FRAME,27801270,CDM,,,,Both,,,59155,14789,,59155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH REACT ASPIRATION,27801271,CDM,,,,Both,,,4574,1144,,4574,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH TOURGUIDE,27801273,CDM,,,,Both,,,934,234,,934,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAXCESS GUIDEWIRE,27801278,CDM,,,,Both,,,2028,507,,2028,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAXCESS DOCKING WIRE,27801279,CDM,,,,Both,,,436,109,,436,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHAPERON GUIDE VERT,27801280,CDM,,,,Both,,,537,134,,537,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH NEURON SELECT 125 BER / SIM,27801283,CDM,,,,Both,,,537,134,,537,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WIRE ANGLED GLIDE STIFF,27801288,CDM,,,,Both,,,259,65,,259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANGIOSEAL,27801289,CDM,,,,Both,,,1280,320,,1280,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROCATH PROGREAT,27801290,CDM,,,,Both,,,1696,424,,1696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH DRAIN EXODUS,27801292,CDM,,,,Both,,,156,39,,156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH ARTERIAL LINE THERMODIL,27801313,CDM,,,,Both,,,505,126,,505,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GW V-18 CONTROLWIRE,27801324,CDM,,,,Both,,,188,47,,188,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HS STENT OMNILINK ELITE,27801330,CDM,,,,Both,,,1820,455,,1820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEV CLSR VASC MYNXGRIP,27801354,CDM,,,,Both,,,208,52,,208,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVEAL LINQ PRODUCT SYSTEM,27801358,CDM,,,,Both,,,9662,2416,,9662,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH GUIDE ASIPRATING FLOWTRIEVER,27801365,CDM,,,,Both,,,22880,5720,,22880,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1734,27801368,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C2596,27801369,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4117,27801378,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPTION ELITE FILTER 70CM,27801382,CDM,,,,Both,,,1700,425,,1700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIFIX 4CM X 4 CM,27801385,CDM,,,,Both,,,362,91,,362,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIFIX 14MM DISK ALLOGRAFT PER SQ CM,27801386,CDM,,,,Both,,,299,75,,299,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RANGER DCB 40-120,27801388,CDM,,,,Both,,,2400,600,,2400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RANGER DCB 150,27801389,CDM,,,,Both,,,2700,675,,2700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POWERPICC  CATHETER 4F SL 3CG CK000950,27801391,CDM,,,,Both,,,464,116,,464,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POWERPICC  PROVENA CATHETER 4FDL 3CG CK000951,27801392,CDM,,,,Both,,,490,123,,490,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POWERPICC  PROVENA CATHETER 5FTL 3CG CK000952,27801393,CDM,,,,Both,,,566,142,,566,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH IV POWERGLIDE 18GA 10CMPRO MDLN RT BASIC TRAY F118100T,27801394,CDM,,,,Both,,,130,33,,130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH IV POWERGLIDE 18GA 8CMPRO MDLN RT BASIC TRAY F118080T,27801395,CDM,,,,Both,,,130,33,,130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROVENA MEDLINE CATHETER 3F CK000978,27801396,CDM,,,,Both,,,300,75,,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4168,27801397,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4150,27801398,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OASIS 3X7 FENESTRATED,27801399,CDM,,,,Both,,,552,138,,552,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH CTR VEN POWERPICC SS 2LUMGWIRE TRAY PURPL 5.0FR 135CM,27801407,CDM,,,,Both,,,175,44,,175,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 11.5F 15CM DBL LUMEN CATH SETDUO-FLOW,27801408,CDM,,,,Both,,,118,30,,118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOCKWAVE M5 IVL 5.5MM X 60MM- 110CM REF M5IVL5560LOT P201105D,27801410,CDM,,,,Both,,,6900,1725,,6900,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERASKIN 1.75X1.75 SQ CM,27801412,CDM,,,,Both,,,679,170,,679,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERASKIN 4.0 X 6.5 26 SQ CM,27801413,CDM,,,,Both,,,118,30,,118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WEB SL 17 SINGLE LAYER W5-4.5-2,27801415,CDM,,,,Both,,,32990,8248,,32990,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH MICRO,27801416,CDM,,,,Both,,,2700,675,,2700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH DIST ACCESS 6FR 125CM,27801417,CDM,,,,Both,,,3743,936,,3743,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4125,27801418,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4154,27801419,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1761,27801420,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4171,27801421,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1982,27801422,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1052,27801423,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4158,27801426,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS A2007,27801428,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1747,27801429,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAY CATH POWERPICC 4FRPROVENA LF MAX BARR DBL LUM S1274108D,27801430,CDM,,,,Both,,,465,116,,465,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARROWG+ARD BLUE TWO-LUMEN HEMODIALYSIS CATH FOR HIGH VOL INFUSIONS CDC-22142-XC1A,27801431,CDM,,,,Both,,,468,117,,468,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMPLANT FOR CLINICAL TRIAL OR FREE SAMPLE,27801432,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C1830,27801433,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROBE CRYO FLEX,27801434,CDM,,,,Both,,,630,158,,630,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROBE CRYO FLEX W/SHEATH,27801435,CDM,,,,Both,,,872,218,,872,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMBU ASCOPE 5,27801437,CDM,,,,Both,,,740,185,,740,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POWERPICC PROVENA 3 FR SINGLE LUMEN CATHETER,27801438,CDM,,,,Both,,,464,116,,464,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MED COMP HEMODIALYSIS CATHETER TRIO-CT AS01135151,27801439,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4166,27801440,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGEAL BALLOON CATHETER,27801441,CDM,,,,Both,,,1000,250,,1000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OR IMPLANTS,27810000,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BREAST PUMP MANUAL,29000001,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BREAST PUMP HOSPITAL GRADE RENT/MONTH,29100002,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BREAST PUMP ELECTRIC,29200003,CDM,,,,Both,,,445,111,,445,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KETONE BODIES SERUM QUALITATIVE,30000001,CDM,,,,Both,,,73,18,,73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACTH QUANT,30000002,CDM,,,,Both,,,302,76,,302,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ALKALINE PHOSPHATASE FRACTIONATED,30000006,CDM,,,,Both,,,120,30,,120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ALBUMIN SERUM, PLASMA, WH BLD",30000010,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ALDOLASEQUANT,30000012,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ALKALINE PHOSPHATASE,30000014,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATITIS A ANTIBODY,30000021,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASSAY OF AMMONIA,30000022,CDM,,,,Both,,,209,52,,209,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASSAY OF AMYLASE,30000023,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ADENOVIRUS ANTIBODY,30000026,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTINUCLEAR ANTIBODIES ANA,30000027,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTISTREPTOLYSIN O TITER,30000028,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANGIOTENSIN CONVERTING ENZSER,30000029,CDM,,,,Both,,,147,37,,147,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTERIAL BLOOD GAS  ABG,30000034,CDM,,,,Both,,,261,65,,261,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC HEPATITUS B SURFACE AG, EIA",30000036,CDM,,,,Both,,,35,9,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIINTRINSIC FACTOR ANTIBODY,30000040,CDM,,,,Both,,,97,24,,97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL,30000043,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL URINE ALDOSTERONEQUANT,30000045,CDM,,,,Both,,,214,54,,214,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC URINE DIPNON AUTO, W/O MICRO",30000048,CDM,,,,Both,,,37,9,,37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BILIRUBIN TOTAL,30000049,CDM,,,,Both,,,151,38,,151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BILIRUBIN DIRECT,30000050,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATIC FUNCTION PANEL,30000053,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VA AMIKACINQUANT,30000056,CDM,,,,Both,,,266,67,,266,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIPID PROFILE,30000058,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BLEEDING TIME TEMPLATE,30000059,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MYELIN BASIC PROTEIN CSF,30000063,CDM,,,,Both,,,118,30,,118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CPEPTIDE INSULIN LEVEL,30000066,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE MARROW SMEAR INTERPRET,30000068,CDM,,,,Both,,,1334,334,,1334,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URINE CHLORIDE24 HR,30000070,CDM,,,,Both,,,34,9,,34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL C1 ESTERASE INHIBITOR (FUNCTIONAL),30000071,CDM,,,,Both,,,173,43,,173,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SEDIMENTATION RATE, AUTOMATED",30000073,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CALCIUM TOTAL,30000077,CDM,,,,Both,,,47,12,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CALCIUM QUANTITATIVE URINE,30000079,CDM,,,,Both,,,79,20,,79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CO2 CONTENT,30000081,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARCINOEMBRYONIC ANTIGEN (CEA),30000083,CDM,,,,Both,,,97,24,,97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT,30000085,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9,30000088,CDM,,,,Both,,,107,27,,107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125,30000089,CDM,,,,Both,,,112,28,,112,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC COLD AGGLUTININ, SCREEN",30000090,CDM,,,,Both,,,126,32,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHLORIDE SERUM,30000091,CDM,,,,Both,,,28,7,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CERULOPLASMIN,30000092,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHOLINESTERASESERUM,30000093,CDM,,,,Both,,,48,12,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CITRATE,30000094,CDM,,,,Both,,,166,42,,166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEMENT ANTIGEN EACH COMPONENT,30000098,CDM,,,,Both,,,42,11,,42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CBC WITH AUTO DIFF(INC PLAT),30000100,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL COMPLEMENTTOTAL HEMOLYTIC,30000101,CDM,,,,Both,,,307,77,,307,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL URINE FREE CORTISOL,30000102,CDM,,,,Both,,,100,25,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL 125 DIHYDROXY VITAMIN D,30000103,CDM,,,,Both,,,215,54,,215,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HEAVY METALS, URINE COPPER",30000106,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CORTISOL TOTAL,30000107,CDM,,,,Both,,,227,57,,227,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CREACTIVE PROTEIN  CRP,30000108,CDM,,,,Both,,,48,12,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CK, CPK; TOTAL",30000110,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CREATININE BLOOD,30000111,CDM,,,,Both,,,21,5,,21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL CRYOGLOBULIN,QUAL OR SEMIQUANT",30000113,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CULTURE (MISC SOURCE),30000114,CDM,,,,Both,,,79,20,,79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL THYROID ANTIBODIES,30000116,CDM,,,,Both,,,91,23,,91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CMV IGG,30000117,CDM,,,,Both,,,120,30,,120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CREATININE OTHER SOURCE,30000118,CDM,,,,Both,,,48,12,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CRYSTALS, BODY FLUIDS",30000119,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL CYSTINE, URINE (AMINO ACID QUANT)",30000121,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG ASSAY CYCLOSPORINE,30000126,CDM,,,,Both,,,624,156,,624,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DELTA AMINOLEVULINIC ACID,30000129,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL,30000130,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MANUAL DIFFERENTIAL,30000131,CDM,,,,Both,,,32,8,,32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL,30000132,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL,30000133,CDM,,,,Both,,,93,23,,93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DHEA SULFATE,30000136,CDM,,,,Both,,,115,29,,115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROLYTES PANEL,30000137,CDM,,,,Both,,,65,16,,65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ERYTHROPOIETIN,30000138,CDM,,,,Both,,,112,28,,112,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROPHORESIS SERUM PROTEIN,30000139,CDM,,,,Both,,,103,26,,103,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROPHORESIS URINE PROTEIN,30000140,CDM,,,,Both,,,103,26,,103,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CREATININE CLEARANCE,30000142,CDM,,,,Both,,,180,45,,180,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESTRADIOL,30000144,CDM,,,,Both,,,257,64,,257,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL EUGLOBULIN CLOT LYSIS,30000146,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLOOD CLOT FACTOR VIII TEST,30000147,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOTTING; FACTOR IX,30000148,CDM,,,,Both,,,65,16,,65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOTTING; FACTOR V,30000149,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL  FACTOR 10 ASSAY,30000150,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL  FACTOR 11 ASSAY,30000151,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL  FACTOR 2 ASSAY,30000154,CDM,,,,Both,,,41,10,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG ASSAY CAFFEINE,30000157,CDM,,,,Both,,,368,92,,368,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QUALITATIVE FECAL FAT,30000160,CDM,,,,Both,,,31,8,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRUG SCREEN QUANTITATIVE PHENYTOIN FREE,30000161,CDM,,,,Both,,,103,26,,103,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FREE THYROXINE,30000163,CDM,,,,Both,,,83,21,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETALDEX,30000164,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FERRITIN,30000165,CDM,,,,Both,,,100,25,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FIBRINOGEN; ACTIVITY,30000167,CDM,,,,Both,,,42,11,,42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FIB DEGRE. PROD;AGGL;SEMIQUAN,30000168,CDM,,,,Both,,,110,28,,110,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOLIC ACID FOLATESSERUM,30000171,CDM,,,,Both,,,135,34,,135,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOLLICULAR STIMULATING HORMONE,30000172,CDM,,,,Both,,,111,28,,111,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTITHROMBIN III ACTIVITY ASSAY,30000173,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FREE T3,30000174,CDM,,,,Both,,,156,39,,156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOBRAMYCIN PEAKQUANT,30000179,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOBRAMYCIN TROUGHQUANT,30000180,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUNGUS SMEARS AND CULTURES,30000183,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANA CULTURE,30000184,CDM,,,,Both,,,87,22,,87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GLUCOSE; QUAN, BLOOD",30000186,CDM,,,,Both,,,36,9,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TOPIRAMATE LEVEL(TOPOMAX),30000187,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASSAY OF GLUTAMYLTRASE GAMMA,30000188,CDM,,,,Both,,,66,17,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATITIS B CORE AB (IGM),30000190,CDM,,,,Both,,,40,10,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HEPATITIS BE ANTIBODY,30000192,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GASTRIN,30000196,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL EHRLICHIA ANTIBODY IGG,30000198,CDM,,,,Both,,,83,21,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL INFLUENZA A ANTIBODY,30000200,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GLUCOSE2 HOUR POSTGLUCOLA,30000210,CDM,,,,Both,,,29,7,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREGNANCY TEST SERUM HCGQUANT,30000211,CDM,,,,Both,,,138,35,,138,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GROWTH HORMONE,30000214,CDM,,,,Both,,,100,25,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAPTOGLOBINQUANT,30000216,CDM,,,,Both,,,79,20,,79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATITIS C AB,30000219,CDM,,,,Both,,,202,51,,202,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMATOCRIT,30000220,CDM,,,,Both,,,22,6,,22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMOGLOBIN,30000222,CDM,,,,Both,,,15,4,,15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HEMOGLOBIN PLASMA,30000223,CDM,,,,Both,,,114,29,,114,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATITUS B ANTIBODY,30000226,CDM,,,,Both,,,37,9,,37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATITUS B CORE ANTIBODYTOT,30000228,CDM,,,,Both,,,41,10,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY IDENTIFICATION PLATELET ANTIBODIES,30000229,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HETEROPHILE AB SCREEN,30000230,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HLA B27 ANTIGEN,30000235,CDM,,,,Both,,,183,46,,183,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL 5HIAA 24HOUR QUANTITATIVE URINE,30000236,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH DENSITY LIPOPROTEIN,30000237,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOGLOBULIN E,30000240,CDM,,,,Both,,,109,27,,109,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AMEBIASIS(E.HISTOLYTICA)ANTIBODY,30000241,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMR PRIM SRC WET MOUNT NFCT AGT,30000243,CDM,,,,Both,,,56,14,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL INSULINTOTAL,30000245,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL UREAPLASMA/MYCOPLASMA CULTURE,30000246,CDM,,,,Both,,,130,33,,130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IRON SERUM,30000248,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IRON BINDING CAPACITY,30000249,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IONIZED CALCIUM,30000250,CDM,,,,Both,,,126,32,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IGG SUBCLASS 2,30000252,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL KIDNEY STONE ANALYSIS,30000256,CDM,,,,Both,,,123,31,,123,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RUSSELL VIPER VENOM TIME DILUTED,30000258,CDM,,,,Both,,,31,8,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LACTIC ACID,30000260,CDM,,,,Both,,,98,25,,98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LACTIC DEHYDROGENASE  LDH,30000261,CDM,,,,Both,,,55,14,,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LDH ISOENZYMES,30000263,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIPASE,30000266,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG SCREEN QUANTITATIVE LITHIUM,30000267,CDM,,,,Both,,,82,21,,82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LUTEINIZING HORMONE,30000268,CDM,,,,Both,,,111,28,,111,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URINE ALBUMIN QUANTITATIVE,30000272,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MALARIA SMEAR,30000276,CDM,,,,Both,,,73,18,,73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MYOGLOBIN,30000281,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CMVIGM,30000284,CDM,,,,Both,,,93,23,,93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TOXPLASMOSIS AB IGM,30000285,CDM,,,,Both,,,212,53,,212,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY RUBELLA,30000287,CDM,,,,Both,,,90,23,,90,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OSMOLARITY PLASMA OR SERUM,30000290,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OSMOLARITY URINE,30000291,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PTT; PLASMA OR WHOLE BLOOD,30000296,CDM,,,,Both,,,27,7,,27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROLACTIN,30000297,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PH BODY FLUID EXCEPT BLOOD,30000299,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PROSTATE SPECIFIC ANTIGEN,TOTAL",30000300,CDM,,,,Both,,,122,31,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHOSPHATES URINE 24HR.,30000304,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHOSPHORUS,30000305,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PINWORM SCOTCH TAPE EXAM,30000307,CDM,,,,Both,,,26,7,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PORPHOBILINOGEN URINEQUANT,30000311,CDM,,,,Both,,,116,29,,116,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC POTASSIUM K SERUM, PLAS, WH BLD",30000312,CDM,,,,Both,,,42,11,,42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POTASSIUM  K URINE RANDOM,30000313,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREALBUMIN,30000315,CDM,,,,Both,,,196,49,,196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QUANT/FRACT PORPHYRIN URINE,30000316,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SERUM PREGNANCY TEST QUALITATIVE,30000317,CDM,,,,Both,,,69,17,,69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROTHROMBIN TIME,30000318,CDM,,,,Both,,,16,4,,16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROGESTERONE,30000319,CDM,,,,Both,,,127,32,,127,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PROTEIN TOT SERUM, PLAS, WH BLD",30000321,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOTAL PROTEIN FLUID,30000322,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROTEIN TOTAL 24HOUR URINE,30000323,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOTTING INHIBITOR PROTEIN S FREE,30000327,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROTEIN C;ACTIVITY,30000328,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARATHYROID HORMONE (INTACT),30000329,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RED BLOOD CELL COUNT  RBC,30000334,CDM,,,,Both,,,30,8,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RENIN (RANDOM),30000337,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RHEUMATOID ARTHRITIS QL,30000338,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG SCREEN QUANTITATIVE LIDOCAINE,30000339,CDM,,,,Both,,,221,55,,221,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HEAVY METALS, URINE ZINC",30000342,CDM,,,,Both,,,62,16,,62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SICKLE CELL PREPARATION,30000346,CDM,,,,Both,,,40,10,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SODIUM NA SERUM, PLASMA, WH BLD",30000350,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SODIUMNA URINE RANDOM,30000351,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL INSULINLIKE GROWTH FACTOR 1,30000354,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU NEURONAL NUCLEAR TITER,30000355,CDM,,,,Both,,,73,18,,73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLOW AB CD 45,30000359,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FLOW AB CD4, CD8",30000360,CDM,,,,Both,,,137,34,,137,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC T3 OR T4 (UPTAKE/BIND RATIO),30000367,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC T4,30000368,CDM,,,,Both,,,63,16,,63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG ASSAY CARBAMAZEPINE TOTAL,30000370,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG SCREEN QUANTITATIVE THEOPHYLLINE,30000371,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THYROID STIMULATING HORMONE,30000374,CDM,,,,Both,,,154,39,,154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TRAZADONE,30000375,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU THYROGLOBULIN,30000376,CDM,,,,Both,,,83,21,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSAMINASE SGOT,30000382,CDM,,,,Both,,,48,12,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSFERRIN,30000383,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRIGLYCERIDES,30000384,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL TOXOPLASMA ANTIBODY, IGG",30000386,CDM,,,,Both,,,93,23,,93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSAMINASE  SGPT,30000387,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URINE PROTEIN QUANTITATIVE,30000388,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VITAMIN B6,30000391,CDM,,,,Both,,,167,42,,167,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VASOACTIVE INTESTINAL POLYPEPTIDE,30000392,CDM,,,,Both,,,211,53,,211,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SEROTONIN, BLOOD",30000393,CDM,,,,Both,,,185,46,,185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UREA URINE,30000398,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLOOD UREA NITROGENBUN QUANT,30000399,CDM,,,,Both,,,36,9,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URIC ACID,30000400,CDM,,,,Both,,,42,11,,42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URIC ACID 24HOUR URINE,30000401,CDM,,,,Both,,,34,9,,34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC URINE DIPAUTO, W/MICRO",30000402,CDM,,,,Both,,,40,10,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,30000403,CDM,,,,Both,,,58,15,,58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VANCOMYCIN TROUGHQUANT,30000406,CDM,,,,Both,,,125,31,,125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU QUANTIFERON TB GOLD PLUS,30000407,CDM,,,,Both,,,213,53,,213,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VISCOSITY SERUM,30000408,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VDRL ROUTINEQUAL,30000409,CDM,,,,Both,,,69,17,,69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VORICONAZOLE,30000413,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VITAMIN B12,30000414,CDM,,,,Both,,,139,35,,139,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC WHITE BLOOD CELL COUNTWBC,AUTO",30000416,CDM,,,,Both,,,29,7,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,30000420,CDM,,,,Both,,,237,59,,237,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PRIMIDONEQUANT,30000426,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASSAY OF TACROLIMUS,30000428,CDM,,,,Both,,,47,12,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ZINC PROTOPORPHYRIN,30000430,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHROMIUM,30000431,CDM,,,,Both,,,90,23,,90,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC NK CELLS, TOTAL COUNT",30000433,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLOW ABCD3,30000434,CDM,,,,Both,,,211,53,,211,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THROMBIN TIME,30000436,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ROUTINE VENIPUNCTURE,30000437,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GLUCOSE REAGENT STRIP/BLOOD,30000449,CDM,,,,Both,,,21,5,,21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL STREP PNEUMONIAE ANTIGEN, URINE",30000450,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ADAMTS13 ACTIVITY,30000462,CDM,,,,Both,,,160,40,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC AFB, M. TUBERCULOSIS DNA, BY PCR",30000490,CDM,,,,Both,,,213,53,,213,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROCALCITONIN,30000498,CDM,,,,Both,,,246,62,,246,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU C-TELOPEPTIDE, SERUM",30000530,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MURAMIDASE,30000551,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED,30000559,CDM,,,,Both,,,31,8,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTRONIC CROSSMATCH,30000569,CDM,,,,Both,,,263,66,,263,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL NEURONAL NUCLEAR AB, WESTERN BLOT",30000570,CDM,,,,Both,,,113,28,,113,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIV-1 AG W/HIV-1&2 AB AG IA,30000576,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY,30000577,CDM,,,,Both,,,54,14,,54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEASURED LDL,30000582,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HEPATITIS C RNA, QUANT",30000583,CDM,,,,Both,,,282,71,,282,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CA 27.29,30000586,CDM,,,,Both,,,125,31,,125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TROPONINQUANT,30000592,CDM,,,,Both,,,100,25,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHLAMYDIA PSITTACIIGG,30000598,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHLAMYDIA PSITTACIIGM,30000599,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACTIVATED PROTEIN C RESISTANCE,30000600,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BETA2MICROGLOBULIN,30000607,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HEPATITIS C GENOTYPE BY NUCL,30000608,CDM,,,,Both,,,992,248,,992,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL PSA, PERCENT FREE",30000609,CDM,,,,Both,,,115,29,,115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL METHYLMALONIC ACID, SERUMQUNT",30000610,CDM,,,,Both,,,114,29,,114,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU MERCURY, BLOOD, QUANT",30000611,CDM,,,,Both,,,114,29,,114,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ECHINOCOCCUS ANTIBODY,30000626,CDM,,,,Both,,,78,20,,78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL Q FEVER ANTIBODY,30000628,CDM,,,,Both,,,66,17,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RSV ANTIBODY,30000629,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL COXSACKIE A VIRUS ANTIBODY,30000635,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BASIC METABOLIC PANEL(CALCIUM TOTAL),30000637,CDM,,,,Both,,,307,77,,307,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPREHENSIVE METABOLIC PANEL,30000638,CDM,,,,Both,,,1194,299,,1194,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ARSENIC, URINE",30000641,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HEAVY METALS, LEAD WHOLE BLOOD",30000647,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VITAMIN A LEVEL,30000653,CDM,,,,Both,,,72,18,,72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VITAMIN E LEVEL,30000655,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HEPATITIS BE ANTIGEN,30000658,CDM,,,,Both,,,69,17,,69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL INSULIN ANTIBODY,30000660,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HISTOPLASMA ANTIBODIES(CF),30000663,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HTLV I&II CONFIRMATION,30000665,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL LYME ANTIBODY, IGG(WESTERN BLOT)",30000667,CDM,,,,Both,,,93,23,,93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LAMOTRIGINE,30000668,CDM,,,,Both,,,72,18,,72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL THYROID STIMULATING IMMUNOGLOB,30000670,CDM,,,,Both,,,264,66,,264,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VITAMIN C LEVELSERUM,30000674,CDM,,,,Both,,,59,15,,59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL 5 NULCEOTIDASE,30000683,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL METHANEPHERINE, PLASMA",30000691,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL COCCIDIODES ANTIBODYCF,30000692,CDM,,,,Both,,,69,17,,69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PARVOVIRUS ANTIBODY IGG,30000700,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PSA,SCREENING",30000704,CDM,,,,Both,,,246,62,,246,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIDIURETIC HORMONE,30000705,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INFLUENZA A/B,AG,EIA",30000707,CDM,,,,Both,,,58,15,,58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC T4 WITH T7,30000711,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CRP HIGH SENSITIVITY,30000713,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL DHEA, SERUM",30000716,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HERPES I GLYCOPROTEIN SPEC,IGG",30000718,CDM,,,,Both,,,66,17,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HERPES II GLYCOPROTEIN SPEC,IGG",30000719,CDM,,,,Both,,,109,27,,109,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUANTITATIVE DDIMER,30000721,CDM,,,,Both,,,149,37,,149,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL FIBRONECTIN,30000722,CDM,,,,Both,,,416,104,,416,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HEPATITIS B, DNA, QUANT",30000723,CDM,,,,Both,,,250,63,,250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ORGANISM IDENTIFICATIONANAEROBIC,30000730,CDM,,,,Both,,,127,32,,127,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CONCENTRATION FOR INFECTIOUS AGENTS,30000731,CDM,,,,Both,,,32,8,,32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MTB AMPLIFIED PROBE,30000732,CDM,,,,Both,,,213,53,,213,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL STRONGYLOIDES ANTIBODY,30000736,CDM,,,,Both,,,78,20,,78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BENCE JONES PROTIMMUNOFIXATION ELECT,30000740,CDM,,,,Both,,,147,37,,147,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASSAY OF SIROLIMUS,30000742,CDM,,,,Both,,,47,12,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FIBRIN DEGRADATION PRODUCTS,30000743,CDM,,,,Both,,,201,50,,201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PTT; SUBSTITUTION PLASMA FRACTIONS EA,30000745,CDM,,,,Both,,,28,7,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MIXING STUDIES FOR PT INHIBITORS,30000746,CDM,,,,Both,,,26,7,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BNATRIURETIC PEPTIDE(BNP),30000747,CDM,,,,Both,,,232,58,,232,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CRYPTOSPORIDIUM AG, EIA",30000749,CDM,,,,Both,,,59,15,,59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRUG SCRN QUANT OXCARBAZEPIN,30000750,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL G6PD QUANTITATIVE,30000754,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLATELET FUNCTION STUDYEACH AGENT,30000755,CDM,,,,Both,,,73,18,,73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AR HCV QUANT NAAT,30000756,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ZONISAMIDE,30000760,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL KEPPRA (LEVETIRACETAM),30000761,CDM,,,,Both,,,139,35,,139,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SEMEN COUNTPOST VASECTOMY,30000762,CDM,,,,Both,,,111,28,,111,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL MANGANESE, SERUM",30000764,CDM,,,,Both,,,142,36,,142,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES,30000766,CDM,,,,Both,,,37,9,,37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PROCAINAMIDE(PRONESTYL)QUANT,30000767,CDM,,,,Both,,,127,32,,127,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL REVERSE T3,30000770,CDM,,,,Both,,,82,21,,82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU ORGANIC ACIDS, URINE",30000771,CDM,,,,Both,,,280,70,,280,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL,30000773,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FUNGAL SEROLOGYASPERGILLUS,30000774,CDM,,,,Both,,,95,24,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FUNGAL SEROLOGYHISTO M,30000777,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUNGAL SEROLOGYHISTO Y,30000778,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MYCOPLASMA AB IGM,30000786,CDM,,,,Both,,,73,18,,73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PSA TOTAL (PERCENT FREE),30000788,CDM,,,,Both,,,58,15,,58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PROINSULIN,30000791,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CHROMOGRANIN A,30000793,CDM,,,,Both,,,115,29,,115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU VW MULTIMERIC,30000801,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RETINOL BINDING PROTEIN,30000807,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BENCE JONES PROTEINTOTAL PROTEIN,30000813,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CBC WITHOUT DIFF(INC PLAT),30000825,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ORGANISM IDENTIFICATIONAEROB,30000837,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC  MIC (AEROBIC),30000838,CDM,,,,Both,,,79,20,,79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SENSITIVITY - AGAR DILUTION/AGENT,30000839,CDM,,,,Both,,,46,12,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CULTURE,BACT W/ISOL URINE",30000840,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLOOD CULTURE AERO,30000841,CDM,,,,Both,,,100,25,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FECES CULTURE SALM SHIGAEROB,30000842,CDM,,,,Both,,,144,36,,144,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUNGUS CULTURE (BLOOD ONLY),30000844,CDM,,,,Both,,,172,43,,172,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUNGUS CULTURE (SKIN/NAILS ONLY),30000845,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUNGUS (WET PREP) SMEAR,30000848,CDM,,,,Both,,,56,14,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC YEAST IDENTIFICATION,30000849,CDM,,,,Both,,,111,28,,111,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AFB IDENTIFICATION (CONVENTIONAL),30000850,CDM,,,,Both,,,111,28,,111,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC M. GORDONAENAP,30000851,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AFB SUSCEPTIBILITY,30000852,CDM,,,,Both,,,34,9,,34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VI VZV PCR,30000853,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LEGIONELLA ANTIGEN(URINE)EIA,30000854,CDM,,,,Both,,,170,43,,170,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CAT SCRATCH FEVER ANTIBODY (IGM),30000857,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DNA/RNA DIRECT PROBE,30000859,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FECES CULTURE CAMPY YER VIBRIO,30000862,CDM,,,,Both,,,43,11,,43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS,30000863,CDM,,,,Both,,,62,16,,62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MACRO BROTH DILUTION (EACH AGENT),30000865,CDM,,,,Both,,,32,8,,32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROBE SUSCEPTIBLE MIC,30000866,CDM,,,,Both,,,310,78,,310,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DISK DIFF FOR RAP GROW MYCOBACTERIUM,30000867,CDM,,,,Both,,,42,11,,42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACETONE SERUMQUANT,30000871,CDM,,,,Both,,,112,28,,112,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA NOS QUANTIFICATION EACH ORGANISM,30000878,CDM,,,,Both,,,337,84,,337,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VITAMIN B1 WB,30000882,CDM,,,,Both,,,133,33,,133,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL OLIGOCLONAL BAND PFIMMUNE,30000883,CDM,,,,Both,,,220,55,,220,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ASSAY OF GAMMAGLOBULIN, EA",30000885,CDM,,,,Both,,,107,27,,107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL OLIGOCLONAL BAND PFIGG, CSF",30000886,CDM,,,,Both,,,107,27,,107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL OLIGOCLONAL BAND PFALB, SERUM",30000887,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IMMUNOGLOBULIN G, CSF INDEXALB, CSF",30000895,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL WEST NILE VIRUS, IGG",30000897,CDM,,,,Both,,,112,28,,112,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL WEST NILE VIRUS, IGM",30000898,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTHROPOD EXAM,30000915,CDM,,,,Both,,,26,7,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARASITES MICROSCOPIC EXAM,30000916,CDM,,,,Both,,,26,7,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASPERGILLUS GALACTOMANNAN AG BY EIA,30000919,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HSV1 BY PCR,30000920,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GLUCOSE BODY FLUID OTHER THAN BLOOD,30000922,CDM,,,,Both,,,73,18,,73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ALKALINE HGB ELECTROPHORESIS,30000924,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CULTURE TYPING IMMUNOFLUORESCENCE,30000927,CDM,,,,Both,,,24,6,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU STRIATED MUSCLE ANTIBODY TITER,30000931,CDM,,,,Both,,,41,10,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URINALYSIS MICROSCOPIC ONLY,30000934,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL PLT CROSSMATCH, OBI",30000942,CDM,,,,Both,,,171,43,,171,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CMV ANTIBODY,30000943,CDM,,,,Both,,,114,29,,114,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY ELUTION (RBC),30000944,CDM,,,,Both,,,229,57,,229,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM,30000945,CDM,,,,Both,,,142,36,,142,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC AB ID(RBC), SEL CELLSQUAL;EA",30000948,CDM,,,,Both,,,263,66,,263,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY TITER (RBC AB)INDIR,30000949,CDM,,,,Both,,,232,58,,232,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BLOOD TYPING, ABO",30000950,CDM,,,,Both,,,199,50,,199,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BLOOD TYPING, RH",30000951,CDM,,,,Both,,,89,22,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AG SCREEN W/REAGENTPER UNIT,30000952,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANTIGEN TYPE, PATIENT",30000953,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC COMPATIBILITY TEST, IS; EA UNIT",30000954,CDM,,,,Both,,,229,57,,229,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL FREEZING RED CELLS, ARC;EA",30000955,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IRRADIATION, ARC; EACH",30000956,CDM,,,,Both,,,122,31,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IRRAD; ADD FOR NIGHT, ARC",30000957,CDM,,,,Both,,,122,31,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POOLING OFBLD PRODUCTS,30000958,CDM,,,,Both,,,366,92,,366,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY ABSORPTION,30000959,CDM,,,,Both,,,170,43,,170,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HEMOGLOBIN S, REDUCTION TEST",30000961,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IRRAD;ADD FOR NIGHT, ACH",30000962,CDM,,,,Both,,,122,31,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HIGH INCIDENCE AG TYPE, ARC",30000963,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AUTOLOGOUS/DIRECTED NOT TRANSFUSED,30000964,CDM,,,,Both,,,243,61,,243,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL DEGLYCEROLIZING, ARC",30000965,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RETICULOCYTE SEPARATION,30000966,CDM,,,,Both,,,229,57,,229,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FECES CULTURE FOR E. COLI 0157,30000967,CDM,,,,Both,,,43,11,,43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REFERRED MOLD IDENTIFICATION,30000968,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BASIC METABOLIC PANELIONIZED CA,30000969,CDM,,,,Both,,,404,101,,404,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VITAMIN D2/D3,30000970,CDM,,,,Both,,,237,59,,237,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ALLERGENS, RESP. DISEASE, REGION 6",30000978,CDM,,,,Both,,,28,7,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUANTITATIVE BACTERIAL CULTURE,30000982,CDM,,,,Both,,,172,43,,172,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NS BIOTIDINASE,30000983,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NS 17ALPHA HYDROXYPROGESTERONE(CAH),30000984,CDM,,,,Both,,,205,51,,205,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NS GAL1PHOS URIDYL TRANS QUANT(GALT,30000985,CDM,,,,Both,,,194,49,,194,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NS THYROID STIMULATING HORMONE(TSH),30000986,CDM,,,,Both,,,154,39,,154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NS TOTAL THYROXINE(T4)REQUIRG ELUTION,30000987,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL NS ACYLCARNITINES;QUANT.,EA SPECIMEN",30000988,CDM,,,,Both,,,160,40,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL NS CARNITINE(TOTAL&FREE),QUANT,EA SPE",30000989,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL NS AMINO ACIDS,6 OR MORE,QUANT,EA SPE",30000990,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOASSAY QUANT NOS NONAB,30000991,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL NS HGB FRACTIONATION & QUANT, CHROM",30000992,CDM,,,,Both,,,160,40,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYCOBACTERIAL IDENTIFICATION,30000998,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOASSAY ANALYTE QUANTITATIVE NOS,30001002,CDM,,,,Both,,,55,14,,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FACTOR 8 ACTIVITY BETHESDA QUANT,30001009,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL RETICULIN ANTIBODY, IGA, TITER",30001010,CDM,,,,Both,,,73,18,,73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL BORDETELLA PERTUSSIS PARAPERTUS,PCR",30001011,CDM,,,,Both,,,311,78,,311,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GM-CSF SERUM,30001013,CDM,,,,Both,,,115,29,,115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RHINOVIRUS RNA BY PCR,30001029,CDM,,,,Both,,,289,72,,289,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC S. AUREUS PCR (NAAT), MRSA",30001039,CDM,,,,Both,,,156,39,,156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC S. AUREUS PCR (NAAT), S. AUREUS",30001040,CDM,,,,Both,,,156,39,,156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL PARVOVIRUS B19 BY PCR, QUANTITATIVE",30001042,CDM,,,,Both,,,321,80,,321,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL BETA 2 TRANSFERRIN, FLUID",30001053,CDM,,,,Both,,,240,60,,240,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONCENTRATION INFECTIOUS AGENTS,30001084,CDM,,,,Both,,,35,9,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FUNGAL SENSITIVITY, MLC",30001085,CDM,,,,Both,,,110,28,,110,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FUNGAL SENSITIVITY, MDM",30001086,CDM,,,,Both,,,32,8,,32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP POTASSUM,30001092,CDM,,,,Both,,,132,33,,132,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP CARBOXYHEMOGLOBIN-QUANT,30001094,CDM,,,,Both,,,113,28,,113,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY,30001109,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MTHFR GENE ANALYSIS COMMON VARIANTS,30001114,CDM,,,,Both,,,199,50,,199,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PROTHROMBIN GENE ASSAY (FII),30001123,CDM,,,,Both,,,160,40,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT,30001124,CDM,,,,Both,,,403,101,,403,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HLA-DR GENOTYPING, HLAT2",30001125,CDM,,,,Both,,,537,134,,537,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HLA-DR GENOTYPING DQA1,30001126,CDM,,,,Both,,,298,75,,298,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ALPHA-1 ANTITRYPSIN,30001128,CDM,,,,Both,,,55,14,,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL MAGNESIUM, RED BLOOD CELL",30001134,CDM,,,,Both,,,234,59,,234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL RENIN, IVC, ABOVE RENAL VEIN",30001135,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT,30001136,CDM,,,,Both,,,184,46,,184,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ (DESCRIP CHANGE),30001139,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ (DESCRIP CHANGE),30001140,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU TBCPCR,30001142,CDM,,,,Both,,,246,62,,246,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HER2/NEU,30001155,CDM,,,,Both,,,874,219,,874,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PARAINFLUENZA ANTIBODY,30001156,CDM,,,,Both,,,520,130,,520,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NP TISSUE EXAM BY PATHOLOGY,30010544,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NP SPECIAL STAINS,30010545,CDM,,,,Both,,,177,44,,177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NP IMMUNOHISTOCHEMISTRY 1ST ANTIBODY,30010546,CDM,,,,Both,,,337,84,,337,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NP IMMUNO FLOURESCENT STUDY,30010547,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NP ELECTRON MICROSCOPY,30010548,CDM,,,,Both,,,2057,514,,2057,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BUFFY SMEAR DIFFERENTIAL,30010551,CDM,,,,Both,,,27,7,,27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ESTRIOL, SERUM",30010552,CDM,,,,Both,,,140,35,,140,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OCCULT BLOOD STOOL-CONSEC SPEC,30010554,CDM,,,,Both,,,35,9,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STREP A ASSAY W/OPTIC,30010555,CDM,,,,Both,,,79,20,,79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH FOR SPECIMEN COLLECT SGL PT,30010582,CDM,,,,Both,,,89,22,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUEST MICROALBUMIN W/CREAT,30010602,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUEST MICROALBUMIN TIMED,30010603,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AG SCREEN W/PATIENT SERUM,30010604,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUEST BODY FLUID COUNT,30010607,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BILIRUBIN TOTAL TRANSCUTANEOUS,30010610,CDM,,,,Both,,,21,5,,21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEGAL BLOOD ALCOHOL PATIENT REQUESTED,30010611,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL UAMS ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL,30010614,CDM,,,,Both,,,809,202,,809,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL UAMS ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL,30010615,CDM,,,,Both,,,815,204,,815,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL UAMS HLA CLASS I/II LOW RESOLUTION TYPING,30010619,CDM,,,,Both,,,1055,264,,1055,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL UAMS HLA CROSSMATCH NONCYTOTOXIC 1ST SERUM/DILUTION,30010620,CDM,,,,Both,,,274,69,,274,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL UAMS HLA CROSSMATCH NONCYTOTOXIC ADDL SERUM/DILUTION,30010621,CDM,,,,Both,,,91,23,,91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SARS-COV-2 COVID-19 AMP PRB,30010622,CDM,,,,Both,,,250,63,,250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2,30010627,CDM,,,,Both,,,1251,313,,1251,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NFCT DS VIR RESP RNA 4 TRGT,30010629,CDM,,,,Both,,,428,107,,428,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RBC DNA HEA 35 AB 11 BLD GRP,30010631,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MISCELLANEOUS,30010633,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CELL COUNT MISCELLANEOUS BODY FLUIDS,30010634,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IAAD IA CHLAMYDIA TRACHOMATIS,30010638,CDM,,,,Both,,,38,10,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL COMPATIBILITY EACH UNIT INCUBATION,30010639,CDM,,,,Both,,,373,93,,373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE,30010640,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG SCREEN QUANTITATIVE LEVETIRACETAM,30010641,CDM,,,,Both,,,34,9,,34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL,30100013,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GLUCOSE POST GLUCOSE DOSE - GTT 1 HOUR,30100020,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASSAY OF MAGNESIUM,30100023,CDM,,,,Both,,,62,16,,62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG ASSAY METHOTREXATE,30100024,CDM,,,,Both,,,103,26,,103,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GLYCOHEMOGLOBIN (HGB A1C),30100028,CDM,,,,Both,,,89,22,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOTAL T3,30100031,CDM,,,,Both,,,130,33,,130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HELIOBACTER PYLORI BREATH TEST,30100033,CDM,,,,Both,,,320,80,,320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL VANILLYLMANDELIC ACID, URINE (VMA)",30100035,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HEAVY METAL QUANTIATIVE EACH NES,30100036,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LACOSAMIDE(VIMPAT)SERUM OR PLASMA,30100038,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL CALPROTECTIN, FECAL",30100072,CDM,,,,Both,,,98,25,,98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PARATHYROID HORMONERELATED PEPTIDE,30100191,CDM,,,,Both,,,333,83,,333,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SELENIUM, SERUM",30100192,CDM,,,,Both,,,133,33,,133,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GONORRHEA BY PCR,30100193,CDM,,,,Both,,,238,60,,238,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL CARNITINE, TOTAL",30100194,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ALPHA-1 ANTITRYPSIN PHENOTYPE,30100195,CDM,,,,Both,,,79,20,,79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VITAMIN B2,30100206,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL PHENOLPTHALEINE, FECAL",30100209,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TESTOSTERONE TOTAL,30100221,CDM,,,,Both,,,148,37,,148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL TESTOSTERONE, SHBGFEMALE OR CHILD",30100224,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ESTROGENS, SERUM FRACTIONATED",30100225,CDM,,,,Both,,,156,39,,156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL FECAL FAT, QUANT",30100238,CDM,,,,Both,,,76,19,,76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN,30100241,CDM,,,,Both,,,270,68,,270,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ETHYLENE GLYCOL,30100249,CDM,,,,Both,,,76,19,,76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HLA MATCHED APHERESIS SURCHARGE,30100254,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ALPHA2 ANTIPLASMIN ASSAY,30100264,CDM,,,,Both,,,110,28,,110,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP GASES BLOOD PH ONLY,30100280,CDM,,,,Both,,,78,20,,78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP PH-BODY FLUID EXCEPT BLOOD,30100283,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RENAL FUNCTION PANEL,30100284,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF VOLATILES,30100291,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CHLORIDE FECES,30100304,CDM,,,,Both,,,37,9,,37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GENERAL HEALTH PANEL,30100306,CDM,,,,Both,,,130,33,,130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HLA B SEQUENCE,30100309,CDM,,,,Both,,,431,108,,431,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MEASUREMENT OF ALCOHOL, NON-BREATH AND NON-URINE",30100330,CDM,,,,Both,,,142,36,,142,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ALKALOIDS NOS,30100333,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VALPROIC ACID FREE,30100367,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GASTRIC PARIETAL ANTIBODY,30100371,CDM,,,,Both,,,91,23,,91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ALPHA 2 MACRO,30100377,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF CADMIUM,30100382,CDM,,,,Both,,,138,35,,138,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BRAF GENE ANALYSIS V600E VARIANT,30100385,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG ASSAY SALICYLATE,30100386,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG ASSAY ACETAMINOPHEN,30100387,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN,30100392,CDM,,,,Both,,,76,19,,76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL K-RAS GENE MUTATION,30100402,CDM,,,,Both,,,390,98,,390,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NMDA RECEPTOR AUTO ANTIBODY,30100404,CDM,,,,Both,,,561,140,,561,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHEMICAL RECEPTOR ANALYSIS,30100410,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REDUCING SUBSTANCES FECES,30100413,CDM,,,,Both,,,29,7,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TESTOSTERONE FREE,30100414,CDM,,,,Both,,,87,22,,87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MY GALACTOSE 1 PHOSPHATE ERYTHROCYTES,30100439,CDM,,,,Both,,,386,97,,386,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CLOZAPINE,30100440,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3,30100447,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL METHYLENEDIOXYAMPHETAMINES,30100458,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO CEPBA,30100459,CDM,,,,Both,,,784,196,,784,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QUANTITATIVE ASSAY DRUG THIOPURINE METABOLITES,30100461,CDM,,,,Both,,,123,31,,123,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ANTI MULLERIAN HORMONE,30100463,CDM,,,,Both,,,116,29,,116,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CARCINOEMBRYONIC ANTIGEN CEA,30100466,CDM,,,,Both,,,135,34,,135,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG SCREEN QUANTITATIVE GENTAMICIN,30100480,CDM,,,,Both,,,204,51,,204,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROALBUMIN URINE SEMIQUAN,30100481,CDM,,,,Both,,,15,4,,15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACUTE HEPATITIS PANEL,30100482,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ONKOSIGHT NGS AML PANEL SEQUENCING,30100486,CDM,,,,Both,,,2026,507,,2026,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CLL PROGNOSIS IGVH MUTATION ANALYSIS BY PCR,30100488,CDM,,,,Both,,,727,182,,727,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ONKOSIGHT NGS NPM1 SEQUENCING,30100491,CDM,,,,Both,,,475,119,,475,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AML CEBPA MUTATIONAL ANALYSIS,30100492,CDM,,,,Both,,,784,196,,784,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ONKOSIGHT NGS FLT3 GENE SEQUENCING,30100502,CDM,,,,Both,,,414,104,,414,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MOPATH PROCEDURE LEVEL 4,30100506,CDM,,,,Both,,,456,114,,456,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CALR BY NGS,30100507,CDM,,,,Both,,,364,91,,364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL JAK2 GENE MPN: JAK2/MPL/CALR BY NGS,30100512,CDM,,,,Both,,,364,91,,364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AMG BY NEPHELOMETRY,30100525,CDM,,,,Both,,,107,27,,107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHROMOSOMAL MICROARRAY POSTNAL,30100538,CDM,,,,Both,,,3118,780,,3118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MSI BY PCR IF MSI-H REFLEX,30100543,CDM,,,,Both,,,715,179,,715,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MLH-1 PROMOTER METHYLATION,30100544,CDM,,,,Both,,,385,96,,385,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RIA NONANTIBODY,30100555,CDM,,,,Both,,,242,61,,242,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH,30100566,CDM,,,,Both,,,76,19,,76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB,30100575,CDM,,,,Both,,,172,43,,172,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU SODIUM FECES,30100579,CDM,,,,Both,,,37,9,,37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ELECTROLYTES FECES (ANALYTE),30100580,CDM,,,,Both,,,37,9,,37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU URIC ACID, RANDOM URINE",30100584,CDM,,,,Both,,,26,7,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU URINE MAGNESIUM RANDOM,30100586,CDM,,,,Both,,,26,7,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HEREDITARY HEMOCHROMATOSIS DNA MUT ANALYSIS,30100589,CDM,,,,Both,,,184,46,,184,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE,30100592,CDM,,,,Both,,,208,52,,208,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRUG SCREEN QUANTITATIVE PHENOBARBITAL,30100602,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU METHYL ALCOHOL, BLOOD, SERUM",30100606,CDM,,,,Both,,,153,38,,153,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HYPOGLYCEMIC PANEL S/P,30100608,CDM,,,,Both,,,297,74,,297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HLA I TYPING 1 ANTIGEN LOW RES,30100610,CDM,,,,Both,,,186,47,,186,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CATECHOLAMINES FRACT 24HR U (W/O CREAT),30100611,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL  QU CORTISOL LC/MS/MS SALIVA,30100613,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU DEXAMETHASONE SUPPRESSION,30100614,CDM,,,,Both,,,54,14,,54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU BILE ACIDS FRACTIONATED & TOTAL PREGNANCY,30100616,CDM,,,,Both,,,132,33,,132,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ESTROGENS TOTAL SERUM,30100617,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU METHEMOGLOBIN,30100618,CDM,,,,Both,,,135,34,,135,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU TSH AUTOANTIBODY (QUEST 53843P),30100620,CDM,,,,Both,,,133,33,,133,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU INSULIN FREE (BIOACTIVE),30100624,CDM,,,,Both,,,87,22,,87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ALKALINE PHOSPHATASE BONE SPECIFIC,30100626,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ADENOSINE DEAMINASE PLEURAL FLUID,30100629,CDM,,,,Both,,,160,40,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU VITAMIN B3,30100630,CDM,,,,Both,,,165,41,,165,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU VITAMIN K,30100631,CDM,,,,Both,,,224,56,,224,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ESTRADIOL FREE LC/MS/MS,30100632,CDM,,,,Both,,,95,24,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PROLACTIN DILUTION STUDY,30100637,CDM,,,,Both,,,66,17,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PROLACTIN TOTAL & MONOMERIC,30100638,CDM,,,,Both,,,66,17,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU TSH W/HAMA TREATMENT,30100639,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ALDOSTERONE PLASMA RENINE ACTIVITY,30100640,CDM,,,,Both,,,139,35,,139,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU 24 HR URINE CALCIUM,30100642,CDM,,,,Both,,,28,7,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU 24 HR URINE CORTISONE,30100644,CDM,,,,Both,,,218,55,,218,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ALKALINE PHOSPHATASE ISOENZYMES,30100645,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL UNLISTED MOLECULAR PATHOLOGY PROCEDURE,30100650,CDM,,,,Both,,,347,87,,347,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL JAK2 GENE,30100651,CDM,,,,Both,,,854,214,,854,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AMMONIUM URINE,30100652,CDM,,,,Both,,,46,12,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CALCIUM URINE,30100653,CDM,,,,Both,,,26,7,,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CITRATE URINE,30100654,CDM,,,,Both,,,95,24,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU MAGNESIUM URINE,30100656,CDM,,,,Both,,,29,7,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL OXALATE,30100657,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PH URINE,30100658,CDM,,,,Both,,,20,5,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PHOSPHORUS URINE,30100659,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU POTASSIUM URINE,30100660,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU SODIUM URINE,30100661,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU SULFATE URINE,30100662,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOASSAY ANALYTE QUANT NOS,30100666,CDM,,,,Both,,,225,56,,225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU COPPER LIVER,30100673,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU EVEROLIMUS LC/MS BLOOD,30100674,CDM,,,,Both,,,122,31,,122,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU MUCIN CLOT TEST,30100675,CDM,,,,Both,,,23,6,,23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PROMETHEUS ANSER ADA,30100677,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PROMETHEUS ANSER IFX,30100678,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PROMETHEUS ANSER VDZ,30100679,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IO BCL/ABL, T(9;22) MAJOR",30100682,CDM,,,,Both,,,823,206,,823,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IO BCL/ABL, T(9;22) MINOR",30100683,CDM,,,,Both,,,771,193,,771,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO BRAF GENE ANALYSIS,30100684,CDM,,,,Both,,,701,175,,701,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO CALR GENE ANALYSIS,30100685,CDM,,,,Both,,,731,183,,731,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO EGFR GENE ANALYSIS,30100686,CDM,,,,Both,,,1304,326,,1304,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO FLT3 MUTATION,30100687,CDM,,,,Both,,,648,162,,648,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO IGH GENE REARRANGEMENT,30100688,CDM,,,,Both,,,1001,250,,1001,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO IGVH MUTATION,30100689,CDM,,,,Both,,,1557,389,,1557,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO JAK2 GENE MUTATIONS,30100690,CDM,,,,Both,,,464,116,,464,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO KRAS GENE ANALYSIS,30100691,CDM,,,,Both,,,770,193,,770,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO MSI MICROSATELLITE INSTABILITY PCR,30100692,CDM,,,,Both,,,1531,383,,1531,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO NPM1 GENE MUTATION,30100693,CDM,,,,Both,,,962,241,,962,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO PML/RARA ANALYSIS,30100694,CDM,,,,Both,,,932,233,,932,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO TRG GENE REARRANGEMENT,30100695,CDM,,,,Both,,,1068,267,,1068,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO MOLECULAR PATHOLOGY PROCEDURE LEVEL 3 ANALYSIS,30100698,CDM,,,,Both,,,392,98,,392,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO MOLECULAR PATHOLOGY PROCEDURE LEVEL 4 ANALYSIS,30100699,CDM,,,,Both,,,463,116,,463,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO UNLISTED MOLECULAR PATHOLOGY PROCEDURE,30100702,CDM,,,,Both,,,354,89,,354,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO HERMARK BREAST CANCER ASSAY,30100703,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AMPHIPHYSIN AB,30100713,CDM,,,,Both,,,181,45,,181,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AMIKACIN,30100714,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL  QU PARANEOPLASTIC AB, CSF",30100715,CDM,,,,Both,,,91,23,,91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF,30100721,CDM,,,,Both,,,872,218,,872,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU PHOSPHATIDYLETHANOL, BLD",30100723,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CHILDHOOD ALLERGY PROFILE IGE,30100724,CDM,,,,Both,,,55,14,,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ALPHA-FETOPROTEIN SERUM,30100725,CDM,,,,Both,,,339,85,,339,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TESTOSTERONE TOTAL (MALE),30100726,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HOMOCYSTEINE,30100727,CDM,,,,Both,,,189,47,,189,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL MY ENCEPHALOPATHY AUTO-IMMUNE EVAL, SER",30100729,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU BUPRENORPHINE, QUANT URINE",30100737,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AST (NASH FIBROSURE),30100742,CDM,,,,Both,,,43,11,,43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ALT (NASH FIBROSURE),30100743,CDM,,,,Both,,,43,11,,43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU TRIGLYCERIDES (NASH FIBROSURE),30100744,CDM,,,,Both,,,43,11,,43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU METHADONE METABOLITE, QUANT, URINE",30100762,CDM,,,,Both,,,95,24,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL  QU BENZODIAZEPINES, QUANT, URINE",30100765,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU BARBITURATES, QUANT, URINE",30100766,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU PROPOXYPHENE METABOLITE, QUANT URINE",30100767,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU AMPHETAMINES, QUANT, URINE",30100768,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU PHENCYCLIDINE, QUANT, URINE",30100769,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL OPIATES 1 OR MORE, QUANT",30100770,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU OPIATES EXANDED, QUANTITATIVE, UR",30100771,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL MY OREXIN-A HYPOCRETIN-1, CSF",30100772,CDM,,,,Both,,,810,203,,810,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LACTATE DEHYDROGENASE LDH,30100774,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU LAC/PYRUVATE,30100782,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU CITRIC ACID, URINE W/ CREATININE",30100783,CDM,,,,Both,,,95,24,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE (REG CW VB),30100800,CDM,,,,Both,,,32,8,,32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MY MAGNESIUM FECES,30100808,CDM,,,,Both,,,130,33,,130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MY PHOSPHORUS FECES,30100809,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE,30100811,CDM,,,,Both,,,190,48,,190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU NICKEL, SERUM/PLASMA",30100812,CDM,,,,Both,,,69,17,,69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MECONIUM 14  PANEL,30100813,CDM,,,,Both,,,190,48,,190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY; VIRUS NES,30100814,CDM,,,,Both,,,90,23,,90,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU OPIOIDS & OPIATE ANALOGS 1/2,30100820,CDM,,,,Both,,,286,72,,286,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CYSTATIN C,30100827,CDM,,,,Both,,,118,30,,118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL,30100831,CDM,,,,Both,,,136,34,,136,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL PROTEIN WB; IM ID FOR BANDS, CRMP-5",30100832,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NATRIURETIC PEPTIDE,30100836,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL THYROID STIMULATING HORMONE,30100838,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU NON-URINE SPECIFIC GRAVITY,30100839,CDM,,,,Both,,,20,5,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FREE THYROXINE,30100848,CDM,,,,Both,,,55,14,,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRUG ASSAY ADALIMUMAB,30100849,CDM,,,,Both,,,223,56,,223,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOASSAY ANALYTE QUANT RADIOIMMONOASSAY MUSK AB,30100852,CDM,,,,Both,,,560,140,,560,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBSTETRIC PANEL W/HIV,30100853,CDM,,,,Both,,,243,61,,243,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY LIPOPROTEIN PLA2,30100860,CDM,,,,Both,,,117,29,,117,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PROTEIN E-PHORESIS/URINE/CSF,30100862,CDM,,,,Both,,,66,17,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRUG ASSAY FELBAMATE,30100864,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRUG ASSAY ITRACONAZOLE,30100865,CDM,,,,Both,,,89,22,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF DIRECT MEASUREMENT FREE ESTRADIOL,30100866,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRUG ASSAY AMIODARONE,30100867,CDM,,,,Both,,,47,12,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CREATINE KINASE TOTAL,30100869,CDM,,,,Both,,,28,7,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CREATINE KINASE ISOENZYMES,30100870,CDM,,,,Both,,,46,12,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ONCOTYPE TESTING,30100872,CDM,,,,Both,,,4420,1105,,4420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PORPHYRINS FECES QUANTITATIVE,30100873,CDM,,,,Both,,,185,46,,185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED,30100875,CDM,,,,Both,,,90,23,,90,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF OSTEOCALCIN,30100877,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF PROSTAGLANDIN,30100878,CDM,,,,Both,,,185,46,,185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF PHOSPHATASE ACID PROSTATIC,30100880,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SEX HORMONE BINDING GLOBULIN (SHBG),30100882,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TESTOSTERONE RESPONSE PANEL,30100883,CDM,,,,Both,,,176,44,,176,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LIPOPROTEIN BLD QUAN PART,30100884,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBSTETRIC PANEL,30100887,CDM,,,,Both,,,120,30,,120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL EL-1 FECAL QUANTITATIVE,30100888,CDM,,,,Both,,,160,40,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IG LIGHT CHAINS FREE EACH,30100889,CDM,,,,Both,,,55,14,,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASAY OF INTERLEUKIN-6 (IL-6),30100890,CDM,,,,Both,,,175,44,,175,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY NEPHELOMETRY NOT SPEC,30100891,CDM,,,,Both,,,46,12,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LIPID PANEL,30100892,CDM,,,,Both,,,43,11,,43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF C-PEPTIDE,30100896,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GLIADIN AB EA IG CLASS,30100897,CDM,,,,Both,,,56,14,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AQAPRN-4 ANTB FLO CYTMTRY EA NMOFC,30100898,CDM,,,,Both,,,342,86,,342,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASES BLOOD PH ONLY,30100900,CDM,,,,Both,,,36,9,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MASS SPECTROMETRY QUAL/QUAN,30100903,CDM,,,,Both,,,835,209,,835,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS - BUNDLED CHARGE,30100904,CDM,,,,Both,,,41,10,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS - BUNDLED CHARGE,30100905,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GTT - ADDED SAMPLES - GTT 2 HOUR,30100906,CDM,,,,Both,,,41,10,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GTT - ADDED SAMPLES - GTT 3 HOUR,30100907,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GTT - ADDED SAMPLES - GTT 4 HOUR,30100908,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GTT - ADDED SAMPLES - GTT 5 HOUR,30100909,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUANTITATIVE BLOOD GLUCOSE - GTT FASTING,30100910,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUANTITATIVE BLOOD GLUCOSE - POC BEDSIDE,30100911,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY THIOPURINE S-METHYLTRANSFERASE,30100912,CDM,,,,Both,,,56,14,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY TRIIODOTHYRONINE (T3),30100913,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FREE ASSAY (FT-3),30100914,CDM,,,,Both,,,54,14,,54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SUGARS SINGLE QUAL,30100915,CDM,,,,Both,,,18,5,,18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHLORIDE OTHER SOURCE,30100916,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HEMOGLOBIN PLASMA,30100918,CDM,,,,Both,,,31,8,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF PROTEIN OTHER,30100919,CDM,,,,Both,,,13,3,,13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP BLOOD GASES W/O2 SATURATION,30100921,CDM,,,,Both,,,197,49,,197,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MUCOPOLYSACCHARIDES,30100923,CDM,,,,Both,,,185,46,,185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ASSAY OF TRANSFERRIN,30100924,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTI-MULLERIAN HORMONE (AMH),30100927,CDM,,,,Both,,,112,28,,112,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,30100929,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASSAY OF TESTOSTERONE FREE,30100930,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HEPATITIS B ANTIBODY QUANT,30200002,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL PNEUMOCCOCCAL AB, IGG 14 SEROTYPES",30200003,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL THYROID PEROXIDASE ANTIBODY,30200004,CDM,,,,Both,,,87,22,,87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SKIN TEST TUBERCULOSIS INTRADERMAL,30200007,CDM,,,,Both,,,38,10,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SKIN TEST CANDIDA,30200008,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLUORESCENT TREPONEMAL ANTIBODIES,30200011,CDM,,,,Both,,,78,20,,78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY BORDETELLA,30200024,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL BRUCELLA ANTIBODY, IGM",30200030,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BLASTOMYCES ANTIBODY BY COMP FIXATION,30200035,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL CHRONIC URTICARIA INDX, PERIOX.ABS",30200044,CDM,,,,Both,,,89,22,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DONOR SPECIFIC ANTIGEN,30200046,CDM,,,,Both,,,500,125,,500,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY FRANCISELLA TULARENSIS,30200047,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL RICKETTSIA AB PNL, SPOTTED FEVER, IGG",30200055,CDM,,,,Both,,,109,27,,109,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL RICKETTSIA AB PNL, SPOTTED FEVER, IGM",30200056,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL 1433 PRION PROTEIN AG QUANT(CJD),30200070,CDM,,,,Both,,,98,25,,98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TSPOT TB,30200071,CDM,,,,Both,,,339,85,,339,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SEROTONIN RELEASE PNL, LOVENOX",30200073,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC B CELLS, TOTAL COUNT",30200074,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA,30200076,CDM,,,,Both,,,62,16,,62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA,30200078,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA,30200079,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL 1433 ANTIGEN, IMA QUANT.",30200081,CDM,,,,Both,,,89,22,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SACCHAROMYCES CEREVISIAE, IGG",30200082,CDM,,,,Both,,,94,24,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ENCEPHALITIS ABCSFADENOVIRUS AB(CF),30200100,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ENCEPHILITIS ABCSFLCM AB IGG,30200113,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ENCEPHALITIS ABCSFST.LOUIS AB IGG,30200116,CDM,,,,Both,,,72,18,,72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ENCEPHALIT ABCSFVARICELLA ZOSTER AB,30200117,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL THYROGLOBULIN ANTIBODY,30200121,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMUNOFIX E-PHORESIS SERUM,30200125,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL PHOSPHATIDYLSERINE AB(IGG, IGA, IGM)",30200129,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ENCEPHALITIS ABCSFLACROSSE AB IGM,30200136,CDM,,,,Both,,,72,18,,72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ENCEPHALITIS ABCSFEAST.EQUIN AB,IGM",30200137,CDM,,,,Both,,,72,18,,72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ENCEPHALITIS ABCSFWEST.EQUIN AB,IGM",30200139,CDM,,,,Both,,,72,18,,72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ENCEPHALITIS ABCSFMEASLES AB,IGM",30200142,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ENCEPHALITIS ABCSFMUMPS AB,IGM",30200143,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AR TORCH IGMHSV 1/2 IGM,30200149,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AR TORCH IGM TOXOPLASA IGM,30200151,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RHEUMATOID FACTOR IGM,30200154,CDM,,,,Both,,,47,12,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOFIX ELECTROPHOTHER SPEC,30200157,CDM,,,,Both,,,147,37,,147,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANTIBODY SCREEN, RBC AB",30200158,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANTIBODY ID (RBC), PANEL",30200159,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC COMPATIBILITY TEST, AHG;EA UNIT",30200161,CDM,,,,Both,,,263,66,,263,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY NEUTRALIZATION,30200162,CDM,,,,Both,,,303,76,,303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SEROTONIN RELEASE PNL,UNFRACT.HEPARIN",30200164,CDM,,,,Both,,,379,95,,379,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY HIV-1,30200174,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY HIV-2,30200175,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VDRL ANTIGEN TITER,30200178,CDM,,,,Both,,,27,7,,27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INFLUENZA A/B ANTIGEN EIA,30200183,CDM,,,,Both,,,107,27,,107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DIPHTHERIA AB IGG,30200192,CDM,,,,Both,,,79,20,,79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL F TULARENSIS AB,30200193,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL Q FEVER IGM PHASE 1 TITER,30200199,CDM,,,,Both,,,63,16,,63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL Q FEVER IGM PHASE 2 TITER,30200200,CDM,,,,Both,,,63,16,,63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RPR TITER,30200203,CDM,,,,Both,,,27,7,,27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ATYPICAL P-ANCA TITER,30200204,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MYELOPEROXIDASE ANTIBODY (MPO),30200206,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LISTERIA ANTIBODY,30200208,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BACTERIUM ANTIBODY NOS,30200211,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PM-SCI ANTIBODY,30200212,CDM,,,,Both,,,135,34,,135,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PENTA SCREEN INHIB A,30200213,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ISLET CELL ANTIBODY,30200214,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LEPTOSPIRA AB TITER,30200215,CDM,,,,Both,,,79,20,,79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL R TYPHI IGG TITER,30200216,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL R TYPHI IGM TITER,30200217,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL C4 BINDING PROTEIN,30200218,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SCLERODERMA ANTIBODY,30200223,CDM,,,,Both,,,107,27,,107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU SJOGREN SSA AB,30200226,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TETANUS ANTITOXOID,30200229,CDM,,,,Both,,,58,15,,58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BARTONELLA SPECIES IGG TITER,30200234,CDM,,,,Both,,,35,9,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BARTONELLA SPECIES IGM TITER,30200235,CDM,,,,Both,,,35,9,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BARTONELLA HENSELAE IGM TITER,30200237,CDM,,,,Both,,,35,9,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CMV T CELL IMMUNITY VIABILITY,30200247,CDM,,,,Both,,,292,73,,292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LEGIONELLA ANTIBODY PNEUMOPHILIA AB IGM,30200248,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LEGIONELLA ANTIBODY PNEUMOPHILIA AB IGG,30200249,CDM,,,,Both,,,55,14,,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ANA IFA W/REFLEX,30200254,CDM,,,,Both,,,41,10,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU LYME DISEASE AB W/ REFLEX,30200264,CDM,,,,Both,,,58,15,,58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY HELICOBACTER PYLORI,30200268,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ALLERGEN, BALD CYPRESS",30200272,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL ALLERGEN, HELMINTHOSPORIUM SATIVUM/DRECSHLERA",30200273,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ALLERGEN SPECIFIC IGE,30200278,CDM,,,,Both,,,23,6,,23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ASPERGILLUS FUMIGATUS IGG,30200279,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HEPARIN INDUCED ANTIBODY,30200281,CDM,,,,Both,,,62,16,,62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ANTI STREPTOCOCCAL DNASE B,30200282,CDM,,,,Both,,,41,10,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU  IMMUNOFIXATION CRYOGLOBULIN,30200284,CDM,,,,Both,,,141,35,,141,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CRYPTOCOCCUS ANTIBODIES,30200288,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU RHEUMATOID FACTOR SCREEN W/ REFLEX SYNOVIAL FLUID,30200289,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU RHEUMATOID FACTOR LA TITER (SYNOVIAL FLUID),30200290,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HSV 1 IGG TYPE SPECIFIC,30200292,CDM,,,,Both,,,39,10,,39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HSV 2 IGG TYPE SPECIFIC,30200293,CDM,,,,Both,,,66,17,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU COLORADO TICK FEVER TOTAL,30200298,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CRYPTOCOCCAL,30200305,CDM,,,,Both,,,100,25,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU B CELL,30200310,CDM,,,,Both,,,130,33,,130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU T CELL,30200311,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HIV 1 AB DIFF,30200312,CDM,,,,Both,,,36,9,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ANA TITER AND PATTERN REFLEX ONLY,30200316,CDM,,,,Both,,,38,10,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU DNA (DS) AB,30200317,CDM,,,,Both,,,55,14,,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU LUPUS PROF CARDIOLIPIN IGM,30200319,CDM,,,,Both,,,87,22,,87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU COMPLEMENT COMPONENT C1Q,30200320,CDM,,,,Both,,,42,11,,42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU TRYPANOSOMA CRUZI AB IGM,30200353,CDM,,,,Both,,,83,21,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU TRYPANOSOMA CRUZI AB IGG,30200354,CDM,,,,Both,,,90,23,,90,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CYCLIC CITRULLINATED PEPTIDE,30200357,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CENTROMERE B,30200379,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLUORESCENT AB; SCRN EA AB 2,30200382,CDM,,,,Both,,,154,39,,154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU MUMPS VIRUS ANTIBODY IGG,30200392,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU STRATIFY JCV AB REFLEX,30200395,CDM,,,,Both,,,584,146,,584,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HISTAMINE RELEASE,30200396,CDM,,,,Both,,,110,28,,110,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU MILK COMPONENT PANEL,30200399,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,30200400,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CANCER ANTIGEN  15-3,30200402,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRP HIGH SENSITIVITY,30200403,CDM,,,,Both,,,167,42,,167,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ISLET CELL ANTIBODY,30200408,CDM,,,,Both,,,110,28,,110,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLUORESCENT AB; SCRN EA AB,30200409,CDM,,,,Both,,,74,19,,74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU RUBELLA AB IGM (TORCH),30200416,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU TOXOPLASMA AB IGM (TORCH),30200417,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL,30200418,CDM,,,,Both,,,24,6,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CYTOMEGALOVIRUS AB IGM (TORCH),30200419,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HSV 1 IGM IFA (TORCH),30200420,CDM,,,,Both,,,40,10,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HSV 2 IGM IFA (TORCH),30200421,CDM,,,,Both,,,66,17,,66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU MI-2 AUTOANTIBODIES,30200423,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NATURAL KILLER CELLS TOTAL COUNT,30200431,CDM,,,,Both,,,107,27,,107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL T CELLS ABSOLUTE CD4&CD8 COUNT RATIO,30200433,CDM,,,,Both,,,123,31,,123,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AEL LYME DISEASE AB W/ REFLEX,30200437,CDM,,,,Both,,,58,15,,58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST,30200439,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MY NMDA-R AB CBA,30200440,CDM,,,,Both,,,469,117,,469,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLUORESCENT ANTIBODY TITER NMO AB,30200444,CDM,,,,Both,,,485,121,,485,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MY CASPR2-IGG CBA,30200446,CDM,,,,Both,,,270,68,,270,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ISLET CELL AB,30200448,CDM,,,,Both,,,165,41,,165,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLUORESCENT AB; SCRN EA AB,30200449,CDM,,,,Both,,,205,51,,205,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL MY AMPA-R AB IF TITER ASSAY,",30200450,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MY DPPX AB IFA TITER,30200452,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MY GABA-B-R AB IF TITER ASSAY,30200453,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLUORESCENT AB; TITER EA AB,30200455,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY,30200456,CDM,,,,Both,,,485,121,,485,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ANA MULTIPLEX W/REFLEX TO 11 AB CASCADE,30200462,CDM,,,,Both,,,41,10,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU EXTRACTABLE NUCLEAR AG AB,30200464,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU RUBELLA IMMUNE STATUS,30200468,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HLA CLASS I&II ANTIBODY QUAL,30200471,CDM,,,,Both,,,170,43,,170,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SARS-COV-2 COVID-19 ANTIBODY,30200474,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IA TUMOR AG QUANT CA 19-9,30200475,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ALLERG SP IGG QUAN OR SEMIQUAN,30200481,CDM,,,,Both,,,47,12,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NEUTRALIZATION TEST VIRAL,30200482,CDM,,,,Both,,,175,44,,175,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,30200483,CDM,,,,Both,,,252,63,,252,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY HISTOPLASMA,30200484,CDM,,,,Both,,,165,41,,165,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INVESTIG TRANSFUSION REACTION,30200485,CDM,,,,Both,,,455,114,,455,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY LYMPHOCYTIC CHORIOMENINGITIS,30200486,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LEISHMANIA ANTIBODY,30200487,CDM,,,,Both,,,109,27,,109,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY HAEMOPHILUS INFLUENZA,30200488,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTISTREPTOLYSIN O SCREEN,30200489,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PARTICLE AGGLUTINATION TITER EACH ANTIBODY,30200490,CDM,,,,Both,,,81,20,,81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNODIFFUSION OUCHTERLONY,30200491,CDM,,,,Both,,,39,10,,39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY ASPERGILLUS,30200492,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANCA SCREEN EACH ANTIBODY,30200494,CDM,,,,Both,,,39,10,,39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VOLTAGE-GTD CA CHNL ANTB EA,30200495,CDM,,,,Both,,,213,53,,213,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMUNFIX E-PHORSIS/URINE/CSF,30200496,CDM,,,,Both,,,117,29,,117,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATITIS A ANTIBODY,30200497,CDM,,,,Both,,,42,11,,42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY TREPONEMA PALLIDUM,30200498,CDM,,,,Both,,,47,12,,47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS,30200500,CDM,,,,Both,,,36,9,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANCA TITER EACH ANTIBODY,30200502,CDM,,,,Both,,,39,10,,39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MITOCHONDRIAL ANTIBODY EACH,30200504,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACTIN SMOOTH MUSCLE ANTIBODY EACH,30200505,CDM,,,,Both,,,36,9,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AQUAPORIN-4 ANTB ELISA,30200506,CDM,,,,Both,,,570,143,,570,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ENDOMYSIAL ANTIBODY EACH IG CLASS,30200507,CDM,,,,Both,,,115,29,,115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AQAPRN-4 ANTB FLO CYTMTRY EA NMOTC,30200508,CDM,,,,Both,,,240,60,,240,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MOG-IGG1 ANTB CBA EACH,30200509,CDM,,,,Both,,,538,135,,538,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AQUAPORIN-4 ANTB CBA EACH,30200510,CDM,,,,Both,,,497,124,,497,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIBODY HERPES SIMPLEX TYPE 2,30200511,CDM,,,,Both,,,160,40,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES,30200513,CDM,,,,Both,,,48,12,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH,30200514,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARDIOLIPIN ANTIBODY EACH IG CLASS,30200515,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DNA ANTIBODY NATIVE/DOUBLE STRANDED,30200516,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD,30200517,CDM,,,,Both,,,56,14,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS,30200519,CDM,,,,Both,,,30,8,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENVIRONMENTAL CULTURES,30200520,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD,30200522,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL,30200523,CDM,,,,Both,,,31,8,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT,30200524,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CULTURE TYPING GAS/HIGH PRES LIQ CHROMATOGRAPHY,30200525,CDM,,,,Both,,,40,10,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD,30200526,CDM,,,,Both,,,31,8,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACETYLCHOLINE RECEPTOR (ACHR); MODULATING ANTIBODY,30200527,CDM,,,,Both,,,46,12,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACETYLCHOLINE RECEPTOR (ACHR); BINDING ANTIBODY,30200528,CDM,,,,Both,,,46,12,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACETYLCHOLINE RECEPTOR (ACHR); BLOCKING ANTIBODY,30200529,CDM,,,,Both,,,46,12,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MUSCLE-SPECIFIC KINASE (MUSK) ANTIBODY,30200530,CDM,,,,Both,,,560,140,,560,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACETYLCHOLINE RECEPTOR (ACHR); MODULATING ANTIBODY (MY),30200531,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACETYLCHOLINE RECEPTOR (ACHR); MODULATING ANTIBODY (QST),30200533,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACETYLCHOLINE RECEPTOR (ACHR); BINDING ANTIBODY (QST),30200534,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA,30200536,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA,30200537,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY HERPES SMPLX TYPE 1,30200538,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY HERPES SMPLX TYPE 2,30200539,CDM,,,,Both,,,65,16,,65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY MUMPS,30200540,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY RUBELLA,30200541,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY RUBEOLA,30200542,CDM,,,,Both,,,43,11,,43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY TOXOPLASMA IGM,30200543,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY VARICELLA-ZOSTER,30200544,CDM,,,,Both,,,43,11,,43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS,30200547,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE,30200548,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY CYTOMEGALOVIRUS CMV,30200549,CDM,,,,Both,,,49,12,,49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY CYTOMEGALOVIRUS CMV IGM,30200550,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA,30200551,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IA INFECTIOUS AGT ANTIBODY QUAL/SEMIQ 1STEP METH,30200552,CDM,,,,Both,,,46,12,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SEDIMENTATION RATE NONAUTOMATED,30500002,CDM,,,,Both,,,36,9,,36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PLATELET COUNT,AUTO",30500004,CDM,,,,Both,,,41,10,,41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ADAMTS 13 INHIBITOR,30500005,CDM,,,,Both,,,230,58,,230,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACTIVATED COAGULATION TIME,30500009,CDM,,,,Both,,,18,5,,18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LUPUS ANTICOAGULANT PANEL,30500010,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BETA2 GLYCOPROTEIN IGG,30500012,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HEPARIN ANTIXA FONDAPARINUX(ARIXTRA),30500013,CDM,,,,Both,,,80,20,,80,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPUN HEMATOCRIT,30500014,CDM,,,,Both,,,28,7,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU VW MULTIMERIC FACTOR 8 ACTIVITY,30500015,CDM,,,,Both,,,121,30,,121,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU VW MULTIMERIC FACTOR ANTIGEN,30500016,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU VW MULTIMERIC RISTOCETIN COFACTOR,30500017,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TEG ANALYSISFIBRINOGEN ACTIVITY,30500021,CDM,,,,Both,,,129,32,,129,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP HEMATOCRIT,30500026,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PROTEIN C FUNCTIONAL,30500030,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PROTEIN S FUNCTIONAL,30500031,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTITHROMBIN ANTIGEN,30500033,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRVVT CONFIRMATION,30500034,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DRVVT 1:1 DILUTION,30500035,CDM,,,,Both,,,40,10,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMOGLOBIN S REDUCTION TEST,30500036,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WBC W AUTO DIFF,30500037,CDM,,,,Both,,,28,7,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CLOTTING; FACTOR XIII - FIBRIN STABILIZING,30500039,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU APT FETAL HGB,30500044,CDM,,,,Both,,,31,8,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU FACTOR VIII ANTIGEN,30500045,CDM,,,,Both,,,198,50,,198,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PROTEIN C ANTIGEN,30500046,CDM,,,,Both,,,98,25,,98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PROTEIN S TOTAL ANTIGEN,30500047,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU  FACTOR VIII ACTIVITY,30500048,CDM,,,,Both,,,142,36,,142,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU NIJMEGEN ASSAY REFLEX ONLY,30500049,CDM,,,,Both,,,142,36,,142,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU VW APTT,30500050,CDM,,,,Both,,,58,15,,58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU LUPUS PROF THROMBIN CLOT TIME,30500052,CDM,,,,Both,,,44,11,,44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PT MIXING STUDIES,30500055,CDM,,,,Both,,,21,5,,21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU IMMEDIATE PTT-LA,30500056,CDM,,,,Both,,,28,7,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU INCUBATED PTT-LA,30500057,CDM,,,,Both,,,28,7,,28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU FACTOR IX ACTIVITY,30500061,CDM,,,,Both,,,89,22,,89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU FACTOR XII ACTIVITY,30500063,CDM,,,,Both,,,83,21,,83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU FACTOR V ACTIVITY,30500065,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU FACTOR VII ACTIVITY,30500066,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU PROTEIN C ACTIVITY (V T HYPERCOAG PANEL W/ RFLX),30500068,CDM,,,,Both,,,98,25,,98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AT III ACTIVITY (VT HYPERCOAG PANEL W/RFLX),30500071,CDM,,,,Both,,,98,25,,98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU FVIII ACTIVITY (VT HYPERCOAG PANEL W/RFLX),30500072,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RETICULATED PLATELET ASSAY,30500077,CDM,,,,Both,,,90,23,,90,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RETICULOCYTE/HGB CONCENTRATE,30500078,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QU CLOTTING INHIBITOR PROTEIN S FREE,30500079,CDM,,,,Both,,,132,33,,132,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BLOOD COUNT HEMATOCRIT,30500080,CDM,,,,Both,,,10,3,,10,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BLOOD COUNT HEMOGLOBIN,30500081,CDM,,,,Both,,,10,3,,10,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AUTOMATED RBC COUNT,30500082,CDM,,,,Both,,,16,4,,16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOTTING: FACTOR VIII VW FACTOR AG,30500086,CDM,,,,Both,,,78,20,,78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FACTOR 8 VWF MULTIMRIC,30500087,CDM,,,,Both,,,78,20,,78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPARIN ASSAY,30500088,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT",30500089,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FUNCTIONAL PLASMINOGEN,30500090,CDM,,,,Both,,,98,25,,98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CLOTTING FACTOR X STUART-PROWER,30500092,CDM,,,,Both,,,333,83,,333,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FACTOR INHIBITOR TEST,30500093,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CLOTTING FUNCT ACTIVITY,30500094,CDM,,,,Both,,,223,56,,223,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FACTOR INHIBITOR TEST MAYO,30500095,CDM,,,,Both,,,249,62,,249,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHROMOGENIC SUBSTRATE ASSAY,30500096,CDM,,,,Both,,,38,10,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CONSLTJ COMPRE REVIEW REPRT REFERRED MATRL,30500097,CDM,,,,Both,,,321,80,,321,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE,30500098,CDM,,,,Both,,,31,8,,31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE MARROW SLIDE CREATION AND BONE MARROW DIFFERENTIAL,30500099,CDM,,,,Both,,,40,10,,40,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AFB SMEAR,30600001,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACID FAST BACILLUS SMEAR & CUL,30600002,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GRAM STAIN,30600004,CDM,,,,Both,,,39,10,,39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUNGUS SMEAR,30600005,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU O&P EXAM CONC,30600006,CDM,,,,Both,,,30,8,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KOH PREP,30600007,CDM,,,,Both,,,29,7,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANTIMICROBIAL SUSCEPTIBILITYMIC INDV,30600009,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INFLUENZA VIRUS MULT TYPES,1ST TWO TYPES",30600010,CDM,,,,Both,,,347,87,,347,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL C. DIFF TOXIN B BY PCR,30600012,CDM,,,,Both,,,145,36,,145,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL VAGINITIS PANEL CANDIDA ALBICANS PROBE,30600013,CDM,,,,Both,,,123,31,,123,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL VAGINITIS PANEL, GARDNERELLA PROBE",30600014,CDM,,,,Both,,,120,30,,120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL VAGINITIS PANEL, TRICHOMONAS PROBE",30600015,CDM,,,,Both,,,182,46,,182,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HIV1 RNA PCR QUALITATIVE TMA,30600019,CDM,,,,Both,,,209,52,,209,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOXIGENIC C. DIFFICILE BY PCR,30600020,CDM,,,,Both,,,149,37,,149,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HISTOPLASMA ANTIGEN,30600021,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHLAMYDIA TRACHOMATIS BY PCR,30600022,CDM,,,,Both,,,182,46,,182,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL HPYLORI, STOOL, EIA",30600023,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CMV DNA QUANTITATIVE BY PCR,30600024,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ENTEROVIRUS PROBE&REVRS TRNS,30600039,CDM,,,,Both,,,121,30,,121,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SYNERGY,MIC 96 WELL PLATE",30600040,CDM,,,,Both,,,94,24,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SYNERGY,MLC 96 WELL PLATE",30600041,CDM,,,,Both,,,110,28,,110,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ENTAMOEBA HISTOLYTICA ANTIGEN,30600042,CDM,,,,Both,,,58,15,,58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HIV-1 QUANT&REVRSE TRNSCRPJ,30600044,CDM,,,,Both,,,441,110,,441,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATITIS C REVRS TRNSCRPJ,30600045,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ,30600048,CDM,,,,Both,,,210,53,,210,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEP B SURF ANT CONFIRM,30600049,CDM,,,,Both,,,35,9,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HIV-1 DRUG RESISTANCE PROT REGION,30600060,CDM,,,,Both,,,1533,383,,1533,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HIV-1 DRUG RESISTANCE OTHER REGION,30600061,CDM,,,,Both,,,705,176,,705,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC M KANSAS II PROBE IDENTIFICATION,30600065,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HPV HIGH-RISK TYPES,30600067,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CULTURE PATHOGENIC ORGANISM SCREEN ONLY,30600069,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRICHOMONAS RAPID TEST,30600073,CDM,,,,Both,,,107,27,,107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AMPLIFIED PROBE(S) TECHNIQUE DNA PCR,30600074,CDM,,,,Both,,,338,85,,338,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CANDIDA SPECIES DNA PROBE,30600075,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYCOPLASMA GENITALIUM DNA PROBE,30600076,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYCOPLASMA HOMINIS DNA PROBE,30600077,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UREAPLASMA UREALYTICUM DNA PROBE,30600078,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE,30600081,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CULTURE TYPING ADDED METHOD,30600082,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ACTINOMYCETES SENSITIVITY,30600083,CDM,,,,Both,,,198,50,,198,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL M. PNEUMONIAE, AMPLIFIED PROBE",30600087,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ANAEROBIC BACTERIA MIC PANEL,30600093,CDM,,,,Both,,,203,51,,203,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CMV ANTIVIRAL RESISTANCE,30600096,CDM,,,,Both,,,754,189,,754,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URINE CULTURE/COLONY COUNT,30600098,CDM,,,,Both,,,34,9,,34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP SYNCYTIAL AG IA,30600100,CDM,,,,Both,,,39,10,,39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM,30600101,CDM,,,,Both,,,145,36,,145,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP VIRUS MULTIPLEX AMP PROBE TECH 3-5 TARGETS,30600103,CDM,,,,Both,,,704,176,,704,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SURE SWAB HSV 1 DNA, PCR",30600105,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SURE SWAB HSV 2 DNA, PCR",30600106,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL SURESWAB CANDIDIASIS, PCR",30600109,CDM,,,,Both,,,294,74,,294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARBAPENEMASES,30600111,CDM,,,,Both,,,124,31,,124,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STPCR,30600112,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU FUNPCR,30600115,CDM,,,,Both,,,503,126,,503,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU BCTPCR,30600116,CDM,,,,Both,,,322,81,,322,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU NTMPCR,30600117,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU CYCLOSPORA EXAM,30600124,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU ISOSPORA EXAM,30600125,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLO-TEST,30600130,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU BARTONELLA DNA QUAL PCR,30600139,CDM,,,,Both,,,229,57,,229,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU MICROSPORIDIA EXAM,30600140,CDM,,,,Both,,,45,11,,45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HSV6 DNA QN PCR,30600141,CDM,,,,Both,,,314,79,,314,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU WEST NILE VIRUS RNA CSF,30600145,CDM,,,,Both,,,348,87,,348,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MICROBIOLOGY PROCEDURE,30600148,CDM,,,,Both,,,94,24,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU M AVIUM INTRACELLULARE DNA QL R/T PCR,30600150,CDM,,,,Both,,,198,50,,198,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU INFECTIOUS AGENT DRUG SUSCEPTIBILITY,30600151,CDM,,,,Both,,,448,112,,448,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU INFECTIOUS AGENT GENOTYPE,30600152,CDM,,,,Both,,,875,219,,875,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HERPES SIMPLEX/VARI ZOSTER,30600153,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU MTB BY PCR TISSUE BLOCK,30600157,CDM,,,,Both,,,395,99,,395,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU TROPHERYMA WHIPPLEI PCR TISSUE BLOCK,30600158,CDM,,,,Both,,,596,149,,596,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU BARTONELLA PCR TB,30600159,CDM,,,,Both,,,707,177,,707,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU RAPID VIRAL RESP CULTURE,30600165,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU RSV ANTIGEN, DFA",30600166,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU RSV RNA, QUAL REAL TIME PCR",30600168,CDM,,,,Both,,,206,52,,206,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HISTOPLASMA QUAN ANTIGEN,30600169,CDM,,,,Both,,,96,24,,96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HERPES SIMPLEX/VARICELLA ZOSTER CULTURE,30600174,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT,30600175,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL,30600176,CDM,,,,Both,,,33,8,,33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ,30600177,CDM,,,,Both,,,153,38,,153,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AGAR PROPORTION SUSCEPTIBILITY,30600183,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AFB ID 1,30600184,CDM,,,,Both,,,53,13,,53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AFB 3,30600186,CDM,,,,Both,,,46,12,,46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM,30600187,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AFB 3,30600188,CDM,,,,Both,,,320,80,,320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU VZV DNA, QUANT REAL TIME PCR",30600193,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ,30600194,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU CULTURE, BACTERIA, OTHER",30600197,CDM,,,,Both,,,32,8,,32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU HSV CULTURE REFLEX,30600200,CDM,,,,Both,,,24,6,,24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AEL OVA & PARASITES,30600202,CDM,,,,Both,,,29,7,,29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AEL O& P,30600203,CDM,,,,Both,,,56,14,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL MY CRYPTOCCOCCUS AG TITER, URINE",30600204,CDM,,,,Both,,,174,44,,174,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYCOPLASMA GENITALIUM,30600205,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESPIRATORY VIRUS PANEL 12-25 TARGETS,30600210,CDM,,,,Both,,,1068,267,,1068,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMPLIFIED NA PROBE,30600211,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SARS-COV-2 COVID-19 ANTIBODY,30600214,CDM,,,,Both,,,105,26,,105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SARS-COV-2 COVID-19 AMP PRB LOW THROUGHPUT,30600215,CDM,,,,Both,,,250,63,,250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC IADNA-DNA/RNA PROBE TQ 12-25, GI PATHOGEN PANEL",30600216,CDM,,,,Both,,,1350,338,,1350,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU TROPHERYMA WHIPPLEI QUAL PCR,30600219,CDM,,,,Both,,,190,48,,190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GENET VIRUS ISOLATE HSV,30600221,CDM,,,,Both,,,113,28,,113,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HERPES S NA QUAN,30600223,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DET,30600225,CDM,,,,Both,,,20,5,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SARSCOV & INF VIR A&B AG IA,30600229,CDM,,,,Both,,,185,46,,185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VARICELLA-ZOSTER VIRUS, RAPID METHOD, CULTURE",30600235,CDM,,,,Both,,,123,31,,123,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CANDIDA NA AMPLIFIED PROBE,30600236,CDM,,,,Both,,,345,86,,345,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION,30600237,CDM,,,,Both,,,289,72,,289,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ,30600238,CDM,,,,Both,,,212,53,,212,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CYTOMEG DNA AMP PROBE,30600239,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HIV-1 PROBE&REVERSE TRNSCRPJ,30600240,CDM,,,,Both,,,179,45,,179,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA HERPES SOMPLX VIRUS QUANTIFICATION,30600241,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIV-1 PROBE&REVERSE TRNSCRPJ,30600243,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIV-1 QUANT&REVRSE TRNSCRPJ,30600245,CDM,,,,Both,,,289,72,,289,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATITIS C PROBE&RVRS TRNSC,30600246,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRICHOMONAS VAGINALIS AMPLIF,30600247,CDM,,,,Both,,,114,29,,114,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AGENT NOS ASSAY W/OPTIC,30600248,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ,30600249,CDM,,,,Both,,,20,5,,20,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP VIRUS 6-11 TARGETS,30600250,CDM,,,,Both,,,546,137,,546,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEGION PNEUMO DNA AMP PROB,30600251,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ORTHOPOXVIRUS AMP PRB EACH,30600253,CDM,,,,Both,,,213,53,,213,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IAAD IA CRYPTOSPORIDIUM,30600254,CDM,,,,Both,,,56,14,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CULTURE TYPE IMMUNOLOGIC,30600255,CDM,,,,Both,,,23,6,,23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL,30600256,CDM,,,,Both,,,75,19,,75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IAAD IA CLOSTRIDIUM DIFFICILE TOXIN,30600257,CDM,,,,Both,,,38,10,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SUSCEPTIBLTY STDY ANTIMICROBIAL MIC,30600258,CDM,,,,Both,,,210,53,,210,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SUSCEPTIBLTY ANTIMICROBIAL MIC,30600259,CDM,,,,Both,,,360,90,,360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA ANAPLASMA PHAGOCYTOPHILUM AMPLIFED PRB TQ,30600260,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA BABESIA MICROTI AMPLIFIED PROBE TECHNIQUE,30600261,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA BORRELIA MIYAMOTOI AMPLIFIED PRB TECHNIQUE,30600262,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IADNA EHRLICHIA CHAFFEENSIS AMPLIFIED PROBE TQ,30600263,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM,30600264,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC HOMOGENIZATION, TISSUE, FOR CULTURE",30600265,CDM,,,,Both,,,19,5,,19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CULTURE SCREEN ONLY,30600266,CDM,,,,Both,,,38,10,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GIARDIA AG IA,30600267,CDM,,,,Both,,,110,28,,110,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11,30600268,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HPV TYPES 16 & 18 ONLY,30600269,CDM,,,,Both,,,120,30,,120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL CHROMOSOME ANALYSIS, 1520 CELL COUNT",31000001,CDM,,,,Both,,,646,162,,646,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PAS,31000002,CDM,,,,Both,,,177,44,,177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PEROXIDASE (PEROX),31000003,CDM,,,,Both,,,1334,334,,1334,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SUDAN BLACK (SUDAN B),31000004,CDM,,,,Both,,,177,44,,177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BONE DECAL, GROSS & MICROSCOPIC",31000005,CDM,,,,Both,,,130,33,,130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CONSULT DURING SURGERY (NO FS),31000006,CDM,,,,Both,,,113,28,,113,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FROZEN SECTION 1SPEC,31000007,CDM,,,,Both,,,279,70,,279,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FROZEN SECTION, (EACH ADDITIONAL",31000008,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GROSS ONLY EXAMINATION,31000009,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GROSS & MICROSCOPIC, BASIC EXAM",31000010,CDM,,,,Both,,,173,43,,173,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GROSS & MICROSCOPIC, SMALL DIAGNO",31000011,CDM,,,,Both,,,354,89,,354,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SPECIAL STAINS, MICROORGANISMS",31000012,CDM,,,,Both,,,225,56,,225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYTOLOGY SELECT CELLULR ENH TECH INTP,31000013,CDM,,,,Both,,,512,128,,512,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GROSS & MICROSCOPIC, DIAGNOSTIC E",31000014,CDM,,,,Both,,,231,58,,231,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GROSS & MICRO LG OR ORGAN EXAM,31000015,CDM,,,,Both,,,681,170,,681,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GROSS & MICRO COMPLEX DIAG. EXAM,31000016,CDM,,,,Both,,,1004,251,,1004,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SPECIAL STAINS, ROUTINE (EACH)",31000017,CDM,,,,Both,,,177,44,,177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE MARROW BIOPSY INTERP.,31000018,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOFLORESCENCE PER SPECIMEN,31000019,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE,31000020,CDM,,,,Both,,,337,84,,337,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYTOPATHOLOGY FILTER METHOD ONLY INTP,31000021,CDM,,,,Both,,,180,45,,180,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GROSS & MICROSCOPIC,BREAST",31000022,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GROSS & MICROSCOPIC,BREAST/COLON",31000023,CDM,,,,Both,,,1004,251,,1004,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RAPID CHROMOSOME ANALYSIS,31000029,CDM,,,,Both,,,915,229,,915,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ISH SINGLE ANTIBODY STAIN W/ INTRP,31000034,CDM,,,,Both,,,270,68,,270,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACIS IMAGE ANALYSIS,31000035,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL CHROM ANALYTISSUE, BONE MARROW, BLD",31000036,CDM,,,,Both,,,467,117,,467,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INTRAOPERATIVE EVALUATION, BIOPSY ADEQUACY",31000037,CDM,,,,Both,,,1334,334,,1334,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL CHROMOSOME ANALYSIS, TISSUE BIOPSY",31000038,CDM,,,,Both,,,510,128,,510,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PAROXY.NOCTURN, HGBWBC, IST MARKER",31000039,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PNHCD59 EACH ADDITIONAL,31000040,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHROMOSOME ANALYSIS-20-25 CELLS,31000043,CDM,,,,Both,,,424,106,,424,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RBC DNA GENOTYPING,31000048,CDM,,,,Both,,,418,105,,418,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MICROSLIDE CONSULT W/SLIDE PREP,31000060,CDM,,,,Both,,,311,78,,311,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMUNOHISTO ANTIBODY SLIDE,31000061,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IHC2 ANTIBODIES, STAIN",31000064,CDM,,,,Both,,,240,60,,240,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FISH MANUAL MULTIPLEX TC,31000065,CDM,,,,Both,,,874,219,,874,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMMUNOCYTOCHEMISTRY EA ADD STAIN,31000066,CDM,,,,Both,,,212,53,,212,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FISH 1ST PROBE MANUAL,31000067,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FISH MANUAL ADDITIONAL PROBE,31000068,CDM,,,,Both,,,195,49,,195,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HPV FISH PROBE FIRST STAIN,31000069,CDM,,,,Both,,,381,95,,381,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HPV FISH PROBE EA ADD STAIN,31000070,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROSTATE BIOPSY,31000071,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL HISTOCHEMICAL STAIN GROUP III,31000074,CDM,,,,Both,,,1334,334,,1334,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MOLECULAR PATH PROCEDURE LEVEL 6,31000076,CDM,,,,Both,,,1144,286,,1144,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MOLECULAR PATH PROCEDURE LEVEL 7,31000079,CDM,,,,Both,,,2242,561,,2242,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL PANCA INDIRECT IMMUNO FLOR, IGG SPECIFIC",31000084,CDM,,,,Both,,,744,186,,744,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOFLORESCENCE PER SPECIMEN EA ADD,31000087,CDM,,,,Both,,,197,49,,197,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL KIT D816 MUTATION ANALYSIS,31000088,CDM,,,,Both,,,477,119,,477,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GROSS & MICROSCOPIC RADICAL PROSTATECTOMY,31000091,CDM,,,,Both,,,1004,251,,1004,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GROSS & MICROSCOPIC LUNG RESECTION,31000092,CDM,,,,Both,,,1004,251,,1004,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GROSS & MICROSCOPIC BARRETT'S ESOPHAGUS,31000093,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHRONIC EPSINOPHILIC LEUKEMIA,31000098,CDM,,,,Both,,,731,183,,731,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MELANOMA GROSS AND MICROSCOPIC,31000099,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AML M3 (PML/RARA) BY FISH,31000104,CDM,,,,Both,,,804,201,,804,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL BCR/ABL BY FISH,31000107,CDM,,,,Both,,,768,192,,768,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LYMPHOMA DIFFUSE LARGE B-CELL BCL6 BY FISH,31000108,CDM,,,,Both,,,874,219,,874,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FOLLICULAR BCL2/IGH BY FISH,31000109,CDM,,,,Both,,,874,219,,874,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL XL RARA (17Q21) BY FISH,31000110,CDM,,,,Both,,,804,201,,804,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LYMPHOMA BURKITT BY FISH,31000111,CDM,,,,Both,,,874,219,,874,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL B-CELL IGH BY FISH,31000113,CDM,,,,Both,,,874,219,,874,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LYMPHOMA ALCL ALKP 2P23,31000114,CDM,,,,Both,,,660,165,,660,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MULTIPLE MYELOMA FISH PANEL P53,31000124,CDM,,,,Both,,,446,112,,446,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH,31000125,CDM,,,,Both,,,192,48,,192,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NP IMMUNOFLUORESCENCE PER SPECIMEN EA,31000128,CDM,,,,Both,,,178,45,,178,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IN-SITU HYBRIDIZATION STAIN 1ST INITIAL,31000129,CDM,,,,Both,,,401,100,,401,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IN-SITU HYBRIDIZATION STAIN EA ADDL,31000130,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NP MICROSLIDE CONSULTATION,31000131,CDM,,,,Both,,,176,44,,176,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GROSS ONLY EXAMINATION WITH MICROSCOPIC EXAM,31000132,CDM,,,,Both,,,48,12,,48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GMS1 (SILVER STAIN),31000133,CDM,,,,Both,,,228,57,,228,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MORPHOMETRIC ANALYSIS,31000134,CDM,,,,Both,,,387,97,,387,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ADDITIONAL IHC STAIN ONLY,31000135,CDM,,,,Both,,,212,53,,212,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KAPPA IN-SITU HYBRIDIDIZATION,31000136,CDM,,,,Both,,,260,65,,260,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL DNASE SENSITIVITY (IBD),31000138,CDM,,,,Both,,,195,49,,195,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU AFB ID SEQ & STAIN PARAFF,31000146,CDM,,,,Both,,,421,105,,421,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO FLT3 GENE ANALYSIS,31000147,CDM,,,,Both,,,371,93,,371,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO IGK GENE REARRANGEMENT,31000148,CDM,,,,Both,,,894,224,,894,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO KIT GENE ANALYSIS TARGETED,31000149,CDM,,,,Both,,,1430,358,,1430,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO TRB GENE REARRANGEMENT,31000151,CDM,,,,Both,,,1107,277,,1107,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO HER2 FISH,31000152,CDM,,,,Both,,,874,219,,874,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO MICRODISSECTION SURGICAL PATHOLOGY,31000153,CDM,,,,Both,,,367,92,,367,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACCELERATE PHENOTEST MIC,31000155,CDM,,,,Both,,,450,113,,450,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACCELERATE PHENOTEST ORGANISM ID,31000156,CDM,,,,Both,,,450,113,,450,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL QU BLADDER CANCER, FISH",31000157,CDM,,,,Both,,,957,239,,957,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL QU FIBRO-ACTI TIEST PANEL,31000158,CDM,,,,Both,,,276,69,,276,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL EGFR GENE ANALYSIS COMMON VARIANTS,31000160,CDM,,,,Both,,,811,203,,811,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOFLUOR ANTB 1ST STAIN,31000161,CDM,,,,Both,,,744,186,,744,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL UAMS HLA CLASS I LOW RESOLUTION A, B, C TYPING",31000164,CDM,,,,Both,,,1009,252,,1009,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL KRAS GENE TEST (KIRSTEN RAT SARCOMA),31000165,CDM,,,,Both,,,557,139,,557,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRAF GENE ANALYSIS V600 VARIANT(S),31000166,CDM,,,,Both,,,439,110,,439,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MOLECULAR ANALYSIS,31000167,CDM,,,,Both,,,620,155,,620,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MOPATH PROCEDURE LEVEL 8,31000171,CDM,,,,Both,,,3804,951,,3804,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NP MICROSLIDE CONSULTATION,31000172,CDM,,,,Both,,,152,38,,152,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS,31000173,CDM,,,,Both,,,2346,587,,2346,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NP SOLID ORGAN NEOPLASM GSAP 5-50 DNA/DNA&RNA ALYS,31000176,CDM,,,,Both,,,1495,374,,1495,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GEN SEQ ANALYS HEMATOLYMPHOID NEO 5-50 GENE,31000177,CDM,,,,Both,,,2610,653,,2610,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL JAK2 GENE TRGT SEQUENCE ALYS,31000178,CDM,,,,Both,,,463,116,,463,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MPL GENE SEQ ALYS EXON 10,31000179,CDM,,,,Both,,,463,116,,463,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPSTEIN-BARR VIRUS (EBV) ISH ON PARAFFIN,31000180,CDM,,,,Both,,,360,90,,360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GENOMIC SEQ ANALYS,31000181,CDM,,,,Both,,,1495,374,,1495,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FETAL CONGENITAL ABNOR ASSAY FOUR ANALYTES,31000182,CDM,,,,Both,,,384,96,,384,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IDH1 COMMON VARIANTS,31000186,CDM,,,,Both,,,483,121,,483,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IDH2 COMMON VARIANTS,31000187,CDM,,,,Both,,,739,185,,739,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MPL GENE ANALYSIS COMMON VARIANTS,31000188,CDM,,,,Both,,,376,94,,376,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MYD88 GENE ANALYSIS P.LEU265 (L265P),31000189,CDM,,,,Both,,,439,110,,439,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL GLIOMA: IDH1/IDH2 BY NGS,31000191,CDM,,,,Both,,,626,157,,626,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MGMT GENE PROMOTER METHYLATION ANALYSIS,31000192,CDM,,,,Both,,,311,78,,311,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEXT GENERATION SEQUENCING MI PROFILE,31000193,CDM,,,,Both,,,2920,730,,2920,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IHC STAINING (CARIS),31000194,CDM,,,,Both,,,329,82,,329,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IHC (CARIS) TESTING,31000195,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IHC (CARIS) TESTING,31000196,CDM,,,,Both,,,329,82,,329,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TP53 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,31000197,CDM,,,,Both,,,824,206,,824,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIGHT MICROSCOPY FROZEN TISSUE,31000198,CDM,,,,Both,,,170,43,,170,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL KRAS GENE ADDL VARIANTS,31000200,CDM,,,,Both,,,484,121,,484,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO CYTOGENOMIC NEOPLASIA MICROARRAY ANALYSIS,31000203,CDM,,,,Both,,,2900,725,,2900,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MORPHOMETRIC ANALYSIS,31000204,CDM,,,,Both,,,329,82,,329,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 3D ECHO IMG CGEN CAR ANOMAL,31000205,CDM,,,,Both,,,1004,251,,1004,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL KRAS GENE ANALYSIS VARIANTS IN EXON 2,31000206,CDM,,,,Both,,,557,139,,557,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,31000207,CDM,,,,Both,,,256,64,,256,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IMMUNOHISTO ANTB 1ST STAIN,31000208,CDM,,,,Both,,,329,82,,329,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CYTOGENOMIC MIP ARRAY,31000215,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FISH AUTOMATED MULTIPLEX PROBE,31000216,CDM,,,,Both,,,580,145,,580,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB,31000218,CDM,,,,Both,,,543,136,,543,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FETAL ANEUPLOIDY TRISOM RISK,31000219,CDM,,,,Both,,,1988,497,,1988,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CYTOGENOMIC MIP ARRAY,31000220,CDM,,,,Both,,,2200,550,,2200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL LIGHT MICROSCOPY FROZEN (TECHNICAL),31000221,CDM,,,,Both,,,217,54,,217,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO JAK2 TARGETED SEQUENCE ANALYSIS,31000223,CDM,,,,Both,,,463,116,,463,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG,31000224,CDM,,,,Both,,,357,89,,357,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONSULT ON IN-PATIENT SLIDE(S),31000225,CDM,,,,Both,,,178,45,,178,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONSULT ON OUT-PATIENT SLIDE(S),31000226,CDM,,,,Both,,,191,48,,191,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL AMYLOID PROTEIN,31000227,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IRON LIVER,31000228,CDM,,,,Both,,,120,30,,120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PIK3CA MUTATION ANALYSIS,31000229,CDM,,,,Both,,,525,131,,525,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1,31000233,CDM,,,,Both,,,865,216,,865,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SOLID TUMOR GENE FUSION ASSAY,31000330,CDM,,,,Both,,,900,225,,900,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL NRAS SEQUENCING,31000431,CDM,,,,Both,,,560,140,,560,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FISH, MALT LYMPHOMA, AP12/MALT, T(11;18)",31000432,CDM,,,,Both,,,230,58,,230,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ONKOSIGHT ADVANCED PROFILE,31000433,CDM,,,,Both,,,8029,2007,,8029,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL SO NEO GSAP DNA ALYS/DNA&RNA CPY NMBR MCRSTL INS,31000439,CDM,,,,Both,,,3100,775,,3100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHRONIC LYMPHOID NEOPLASM,31000440,CDM,,,,Both,,,1899,475,,1899,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL MGMT GENE PROMOTER METHYLATION ANALYSIS,31000441,CDM,,,,Both,,,693,173,,693,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYTOPATH C/V AUTO FLUID (LIQ BASE PAP),31100001,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FINE NEEDLE ASP IMMEDIATE STUDY 1ST EVAL,31100002,CDM,,,,Both,,,303,76,,303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVAL. OF FINE NEEDLE ASP. INTERP.,31100003,CDM,,,,Both,,,279,70,,279,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CYTOLOGY, EXTENDED STUDY",31100004,CDM,,,,Both,,,181,45,,181,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CYTOLOGY CONCENTRATION TECH,31100005,CDM,,,,Both,,,180,45,,180,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL CYTOL, CX OR VAG\PHYS INTERP.",31100006,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CYTOPATHOLOGY, FLUIDS, WSHGS OR BRSHGS",31100007,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CYTOPATHOLOG, SMEARS, OTHER SOURCE",31100008,CDM,,,,Both,,,121,30,,121,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYTO FINE NEEDLE ASPIRATE IMMED EA ADDL,31100015,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MISCELLANEOUS FLOW CYTOMETRY,31100019,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PNHCD55,31100020,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL PNHCD59,31100021,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL CHROMOSOME ANALTISSUE CULTURE,31100023,CDM,,,,Both,,,397,99,,397,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FLOW CYTOMETRY, FIRST MARKER",31100024,CDM,,,,Both,,,673,168,,673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FLOW CYTOMETRY, EACH ADD. MARKER",31100025,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL ARRAY CGH MOLECULAR KAROTYPING,31100027,CDM,,,,Both,,,2242,561,,2242,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL RBC BAND 3 PROTEIN REDUCTION,31100028,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLOW CYTOMETRY FIRST MARKER,31100029,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLOW CYTOMETRY EACH ADD MARKER,31100030,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CP CERV/VAG ATL MANUAL SCRN,31100038,CDM,,,,Both,,,56,14,,56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYTOPATH NON-GYN PREP/SCREEN,31100039,CDM,,,,Both,,,306,77,,306,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO FLOW CYTOMETRY,31100040,CDM,,,,Both,,,658,165,,658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IO TISSUE CULTURE FOR NEOPLASTIC DISORDERS, BONE MARROW, BLOOD",31100043,CDM,,,,Both,,,566,142,,566,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IO TISSUE CULTURE FOR NEOPLASTIC DISORDERS, SOLID TUMOR",31100044,CDM,,,,Both,,,793,198,,793,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL IO CHROMOSOME ANALYSIS 20-25 CELLS,31100045,CDM,,,,Both,,,800,200,,800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IO MOLECULAR CYTOGENETICS, DNA PROBE BY FISH",31100046,CDM,,,,Both,,,250,63,,250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IO MOLECULAR CYTOGENETICS, FISH ANALYZE 25-99 CELLS",31100047,CDM,,,,Both,,,197,49,,197,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RL IO MOLECULAR CYTOGENETICS, FISH ANALYZE 100-300 CELLS",31100048,CDM,,,,Both,,,384,96,,384,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLOW CYTOMETRY INTERP 9-15 MARKERS,31100054,CDM,,,,Both,,,148,37,,148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL FLOWCYTOMETRY/TC ADD-ON,31100055,CDM,,,,Both,,,133,33,,133,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RL TISSUE CULTURE BONE MARROW,31100056,CDM,,,,Both,,,360,90,,360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBTAINING SCREEN PAP SMEAR,31100057,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FRACTURE ASSESSMENT VIA DXA,32000001,CDM,,,,Both,,,174,44,,174,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GI TUBE(LONG)PLACE,FLUORO & FILMS",32000007,CDM,,,,Both,,,303,76,,303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOGRAM, EPIDURAL",32000009,CDM,,,,Both,,,3049,762,,3049,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DISCOGRAM LUMBAR,32000010,CDM,,,,Both,,,11279,2820,,11279,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABDOMEN ACUTE ABDOMEN SERIES,32000016,CDM,,,,Both,,,582,146,,582,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMALL BOWEL SERIES W/DOUBLE CONTRAST STUDY,32000017,CDM,,,,Both,,,624,156,,624,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BARIUM ENEMA SINGLE CONTRAST,32000018,CDM,,,,Both,,,688,172,,688,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BARIUM ENEMA DOUBLE CONTRAST,32000019,CDM,,,,Both,,,722,181,,722,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHOLANGIOGRAM SURGERY/OR,32000020,CDM,,,,Both,,,382,96,,382,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLUORO GUIDANCE UP TO 1 HOUR,32000022,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPINE 1 VIEW SPECIFY LEVEL,32000023,CDM,,,,Both,,,281,70,,281,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CERVICAL 2 OR 3 VIEWS,32000024,CDM,,,,Both,,,344,86,,344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CERVICAL SPINE 4-5 VIEWS ROUTINE,32000025,CDM,,,,Both,,,364,91,,364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CERV COMP;INCLUD OBL, FLEX, EXT",32000026,CDM,,,,Both,,,390,98,,390,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENO EXTREM, BILAT S&I",32000027,CDM,,,,Both,,,3653,913,,3653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY DISCOGRAM CERV/THOR,32000028,CDM,,,,Both,,,5461,1365,,5461,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGRAM COMPLETE,32000029,CDM,,,,Both,,,440,110,,440,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EYE FOREIGN BODY PLAIN FILMS,32000030,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHOLANGIOGRAPHY ADDL SET  OR,32000031,CDM,,,,Both,,,348,87,,348,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SWALLOWING FUNCTION VIDEO,32000032,CDM,,,,Both,,,380,95,,380,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FACIAL BONES; <3V,32000033,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FACIAL BONE MIN 3V,32000034,CDM,,,,Both,,,297,74,,297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NASAL BONE MIN 3V,32000035,CDM,,,,Both,,,297,74,,297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MANDIBLE 4 VIEW,32000036,CDM,,,,Both,,,387,97,,387,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TMJ JOINT, BILAT, OPEN & CLOSED MOUTH",32000037,CDM,,,,Both,,,246,62,,246,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ORBIT 4 VIEWS,32000038,CDM,,,,Both,,,387,97,,387,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PANELIPSE,32000039,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GALL BLADDER ORAL CHOLECYSTOGRAM,32000040,CDM,,,,Both,,,371,93,,371,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GI SERIES; SINGLE CONTRAST STUDY,32000041,CDM,,,,Both,,,371,93,,371,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GI SERIES; DOUBLE CONTRAST STUDY,32000046,CDM,,,,Both,,,605,151,,605,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMALL BOWEL SERIES W/SINGLE CONTRAST STUDY,32000048,CDM,,,,Both,,,621,155,,621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LUMBAR SPINE BENDING ONLY 2-3 VIEWS,32000049,CDM,,,,Both,,,318,80,,318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LUMBAR SPINE 2-3 VIEWS,32000050,CDM,,,,Both,,,397,99,,397,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LUMBAR MIN 4V,32000051,CDM,,,,Both,,,461,115,,461,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LUMBAR SPINE COMPLETE W/BENDING MIN 6VWS,32000052,CDM,,,,Both,,,478,120,,478,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MASTOID <3V PER SIDE,32000054,CDM,,,,Both,,,217,54,,217,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MASTOID MIN 3V PER SIDE,32000055,CDM,,,,Both,,,300,75,,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FLUORO GUIDE TX SPINE,THER INJ",32000056,CDM,,,,Both,,,331,83,,331,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PELVIS; 1 OR 2 VIEWS,32000058,CDM,,,,Both,,,324,81,,324,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PELVIS MIN 3V,32000059,CDM,,,,Both,,,339,85,,339,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SACROILLIAC JOINTS (3V OR LESS),32000060,CDM,,,,Both,,,328,82,,328,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SACRUM AND COCCYX MIN 2V,32000061,CDM,,,,Both,,,314,79,,314,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARANASAL SINUSES< 3V,32000062,CDM,,,,Both,,,252,63,,252,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARANASAL SINUSES MIN 3 VIEWS,32000063,CDM,,,,Both,,,297,74,,297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV PYELOGRAM ROUTINE,32000064,CDM,,,,Both,,,859,215,,859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV PYELOGRAM WITH TOMOGRAPHY,32000065,CDM,,,,Both,,,970,243,,970,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC IV PYELOGRAM, RAPID SEQUENCE",32000066,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RETROGRADE PYELOGRAM W/WO KUB,32000067,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTOGRAM RS&I MIN 3V,32000068,CDM,,,,Both,,,642,161,,642,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RIBS BILATERAL (MINIMUM 3V),32000070,CDM,,,,Both,,,338,85,,338,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STERNO CLAVICULAR JOINTS 3V,32000071,CDM,,,,Both,,,313,78,,313,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY PHARYNGEAL & SPEECH,32000072,CDM,,,,Both,,,403,101,,403,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SACROILIAC JOINTS 3 OR MORE V,32000077,CDM,,,,Both,,,335,84,,335,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHUNTOGRAM PREV NONVASC,32000078,CDM,,,,Both,,,795,199,,795,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SKULL; < 4VIEWS,32000079,CDM,,,,Both,,,375,94,,375,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SKULL MIN 4 VIEWS,32000080,CDM,,,,Both,,,389,97,,389,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SKULL OPTIC FORAMINA,32000081,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELLA TURCICA,32000082,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STERNUM 2 VIEWS,32000083,CDM,,,,Both,,,297,74,,297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERINEOGRAM SEX DETERM,32000084,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOLUMBAR SPINE 2V,32000085,CDM,,,,Both,,,292,73,,292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACIC SPINE 2V,32000086,CDM,,,,Both,,,278,70,,278,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACIC SPINE 3V,32000087,CDM,,,,Both,,,354,89,,354,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACIC SPINE 4V,32000088,CDM,,,,Both,,,366,92,,366,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MANUAL APPLIC STRESS BY MD  JOINT XRAY,32000090,CDM,,,,Both,,,174,44,,174,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CISTERNOGRAM,32000091,CDM,,,,Both,,,1196,299,,1196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP (RETRO PANCREATOGRAM),32000095,CDM,,,,Both,,,795,199,,795,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE AGE STUDY,32000096,CDM,,,,Both,,,209,52,,209,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED FLUORO PROCEDURE,32000103,CDM,,,,Both,,,428,107,,428,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BONE DENSITY,DXA, AXIAL SKELETON",32000109,CDM,,,,Both,,,397,99,,397,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BONE DENSITY,DXA, APPENDICULAR SKELETON",32000110,CDM,,,,Both,,,196,49,,196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MANDIBLE, 3V OR LESS",32000113,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TMJ JOINT, UNILAT, OPEN & CLOSED MOUTH",32000114,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FOREIGN BODY, CHILD, NOSE TO RECTUM, 1V",32000116,CDM,,,,Both,,,219,55,,219,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FB REMOVAL, ESOP W BALLOON CATHETER",32000117,CDM,,,,Both,,,740,185,,740,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE CATH UNDER XR,32000119,CDM,,,,Both,,,914,229,,914,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RIBS, UNILAT LT, WITH PA CHEST MIN 3V",32000120,CDM,,,,Both,,,313,78,,313,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RIBS;BILAT, W/PA CHEST MIN 4 V",32000121,CDM,,,,Both,,,345,86,,345,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOGRAM, RENAL, BILAT, SELECT",32000123,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERAPEUTIC ENEMA,32000124,CDM,,,,Both,,,662,166,,662,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PERITONEOGRAM, AFTER INJ AIR OR CONTRAST",32000125,CDM,,,,Both,,,874,219,,874,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SURGICAL SPECIMEN XRAY,32000126,CDM,,,,Both,,,951,238,,951,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY MAMMARY DUCT,32000128,CDM,,,,Both,,,475,119,,475,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY MAMMARY DUCT MULTIPLE,32000130,CDM,,,,Both,,,513,128,,513,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ESOPHAGUS, UPPER/CERVICAL/PHARYNX",32000131,CDM,,,,Both,,,400,100,,400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LYMPHANGIOGRAM, ARM/LEG, UNILAT",32000132,CDM,,,,Both,,,903,226,,903,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LYMPHANGIOGRAM, ARM/LEG, BILAT",32000133,CDM,,,,Both,,,2329,582,,2329,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LYMPHANGIOGRAM, ABD/PELVIS, UNILAT",32000134,CDM,,,,Both,,,5816,1454,,5816,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOGRAM, ADENAL, BILAT, SELECTIVE",32000135,CDM,,,,Both,,,8401,2100,,8401,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOGRAM, ADENAL, LT, SELECTIVE",32000136,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,32000138,CDM,,,,Both,,,676,169,,676,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,32000139,CDM,,,,Both,,,542,136,,542,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIL DUCT DIL TRANSHEPATIC PERC W/WO,32000141,CDM,,,,Both,,,1271,318,,1271,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DRAINAGE CATHETER, CHANGE PERC",32000144,CDM,,,,Both,,,740,185,,740,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FISTULA/ABSCESSOGRAM STUDY,32000147,CDM,,,,Both,,,862,216,,862,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FLUORO,GUIDE NDLE LOC(BX,ASPIR)",32000148,CDM,,,,Both,,,983,246,,983,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATIC VENOGRAM W/O HEMODYNAMIC,32000149,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATIC VENO W HEMODYNAMIC EVAL,32000150,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LYMPHANGIO PELVIC/ABD BILAT,32000151,CDM,,,,Both,,,5700,1425,,5700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INFERIOR VENA CAVA W SERIALOGRAPHS,32000152,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENOUS SAMPLING VIA CATHW/WO ANGIO,32000153,CDM,,,,Both,,,8401,2100,,8401,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VISCERAL ANGIO SELECT (W/WO FLUSH),32000154,CDM,,,,Both,,,9372,2343,,9372,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUPERIOR VENA CAVA W FILMS,32000155,CDM,,,,Both,,,2329,582,,2329,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CORPORA CAVERNOSOGRAPHY,32000156,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FALLOPIAN TUBE RECANNULAZATION,32000157,CDM,,,,Both,,,795,199,,795,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC OSSEOUS SURVEY, AXIAL & APPENDICULAR",32000159,CDM,,,,Both,,,574,144,,574,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC OSSEOUS SURVEY, LIMITED",32000160,CDM,,,,Both,,,414,104,,414,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC OSSEOUS SURVEY, INFANT",32000161,CDM,,,,Both,,,283,71,,283,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CVC/PICC FLUORO GUIDANCE (+),32000162,CDM,,,,Both,,,509,127,,509,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MYELOGRAM, 2 OR MORE REGIONS",32000163,CDM,,,,Both,,,1181,295,,1181,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC UNLISTED, RADIOGRAPHIC PROCEDURE",32000164,CDM,,,,Both,,,619,155,,619,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSURE DEVICE PLACEMENT,32000165,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOGRAM, SUPERIOR SAGITTAL SINUS",32000166,CDM,,,,Both,,,5816,1454,,5816,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC PLACEMENT/FEEDING TUBE,32000167,CDM,,,,Both,,,795,199,,795,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACIC MYELOGRAM,32000168,CDM,,,,Both,,,1196,299,,1196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LUMBAR MYELOGRAM,32000169,CDM,,,,Both,,,1196,299,,1196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CERVICAL MYELOGRAM,32000170,CDM,,,,Both,,,1196,299,,1196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIALOGRAM,32000171,CDM,,,,Both,,,475,119,,475,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HYSTEROSALPINGOGRAM,32000172,CDM,,,,Both,,,976,244,,976,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTOURETHROGRAM (VOIDING),32000173,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URETHROGRAM RETROGRADE,32000174,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATHETER BIOPSY S&I,32000175,CDM,,,,Both,,,1306,327,,1306,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TRANSCATH, EMBOLIZ;ANY METHOD",32000176,CDM,,,,Both,,,2914,729,,2914,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PORTOGRAPHY W HEMODYNAMIC EVAL,32000177,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PORTOGRAPHY W/O HEMODYNAMIC EVAL,32000178,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDO T ANEURYSM INVOLV LSC(PROC),32000179,CDM,,,,Both,,,927,232,,927,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDO T ANEURYSM NOT INVOLV LSC (PRO,32000180,CDM,,,,Both,,,794,199,,794,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDO T ANEURYSM PROX EXT (PROC),32000181,CDM,,,,Both,,,530,133,,530,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDO THORACIC REVISION (PROC),32000182,CDM,,,,Both,,,465,116,,465,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXISTING CATH ANGIOGR FOR F/U,32000183,CDM,,,,Both,,,5816,1454,,5816,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC JOINT SURVEY, 1 VIEW, 2 OR MORE JOINTS",32000184,CDM,,,,Both,,,198,50,,198,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AC JOINTS BILATERAL,32000197,CDM,,,,Both,,,277,69,,277,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE (AP STANDING) BILATERAL,32000206,CDM,,,,Both,,,352,88,,352,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE LENGTH STUDY,32000214,CDM,,,,Both,,,264,66,,264,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LOWER EXT TOMOGRAM,32000215,CDM,,,,Both,,,338,85,,338,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC NECK, SOFT TISSUE",32000217,CDM,,,,Both,,,168,42,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP IN DEPARTMENT,32000218,CDM,,,,Both,,,795,199,,795,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CA SCRN BARIUM ENEMA(NONMEDICARE),32000219,CDM,,,,Both,,,469,117,,469,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RIBS UNILATERAL RIGHT(MINIMUM 2VS),32000220,CDM,,,,Both,,,297,74,,297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RIBS UNILATERAL LEFT(MININUM 2VS),32000221,CDM,,,,Both,,,297,74,,297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLAVICLE COMPLETE RT,32000224,CDM,,,,Both,,,273,68,,273,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLAVICLE COMPLETE LT,32000225,CDM,,,,Both,,,273,68,,273,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCAPULA COMPLETE RT,32000228,CDM,,,,Both,,,296,74,,296,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCAPULA COMPLETE LT,32000229,CDM,,,,Both,,,296,74,,296,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER 1V RT,32000230,CDM,,,,Both,,,222,56,,222,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER 1V LT,32000231,CDM,,,,Both,,,222,56,,222,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER COMPLETE 2+ VIEWS RT,32000232,CDM,,,,Both,,,296,74,,296,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER COMPLETE 2+ VIEWS LT,32000233,CDM,,,,Both,,,296,74,,296,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERUS MIN 2V RT,32000236,CDM,,,,Both,,,277,69,,277,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERUS MIN 2V LT,32000237,CDM,,,,Both,,,277,69,,277,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 2V RT,32000240,CDM,,,,Both,,,235,59,,235,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 2V LT,32000241,CDM,,,,Both,,,235,59,,235,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 3V RT,32000244,CDM,,,,Both,,,253,63,,253,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 3V LT,32000245,CDM,,,,Both,,,253,63,,253,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOREARM 2V RT,32000246,CDM,,,,Both,,,284,71,,284,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOREARM 2V LT,32000247,CDM,,,,Both,,,284,71,,284,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UPPER EXT(INFANT) 2V RT,32000250,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UPPER EXT(INFANT) 2V LT,32000251,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 2V RT,32000252,CDM,,,,Both,,,194,49,,194,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 2V LT,32000253,CDM,,,,Both,,,194,49,,194,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 3V RT,32000256,CDM,,,,Both,,,243,61,,243,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 3V LT,32000257,CDM,,,,Both,,,243,61,,243,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 2V RT,32000258,CDM,,,,Both,,,236,59,,236,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 2V LT,32000259,CDM,,,,Both,,,236,59,,236,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 3V RT,32000262,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 3V LT,32000263,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FINGER(S) , MIN 2 VIEWS, RT",32000266,CDM,,,,Both,,,226,57,,226,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FINGER(S), MIN 2 VIEWS, LT",32000267,CDM,,,,Both,,,226,57,,226,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 1-2 VIEWS RT,32000282,CDM,,,,Both,,,333,83,,333,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 1-2 VIEWS LT,32000283,CDM,,,,Both,,,333,83,,333,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 3 VIEW RT,32000284,CDM,,,,Both,,,352,88,,352,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 3 VIEW LT,32000285,CDM,,,,Both,,,352,88,,352,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 4+VIEW LT,32000286,CDM,,,,Both,,,358,90,,358,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 4+VIEW RT,32000287,CDM,,,,Both,,,358,90,,358,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIBIA/FIB 2V RT,32000288,CDM,,,,Both,,,338,85,,338,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIBIA/FIB 2V LT,32000289,CDM,,,,Both,,,338,85,,338,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LOWER EXT 2V RT(INFANT),32000292,CDM,,,,Both,,,319,80,,319,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LOWER EXT 2V LT (INFANT),32000293,CDM,,,,Both,,,319,80,,319,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE 2V RT,32000294,CDM,,,,Both,,,364,91,,364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE 2V LT,32000295,CDM,,,,Both,,,364,91,,364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE MIN 3V RT,32000296,CDM,,,,Both,,,395,99,,395,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE MIN 3V LT,32000297,CDM,,,,Both,,,395,99,,395,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOOT 2V RT,32000300,CDM,,,,Both,,,232,58,,232,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOOT 2V LT,32000301,CDM,,,,Both,,,232,58,,232,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOOT MIN 3V RT,32000304,CDM,,,,Both,,,406,102,,406,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOOT MIN 3V LT,32000305,CDM,,,,Both,,,406,102,,406,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEEL MIN 2V RT,32000308,CDM,,,,Both,,,214,54,,214,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEEL MIN 2V LT,32000309,CDM,,,,Both,,,214,54,,214,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TOE(S), MIN 2 VIEWS,  RT",32000313,CDM,,,,Both,,,231,58,,231,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UROGRAPHY ANTEGRADE RS&I BILATERAL,32000318,CDM,,,,Both,,,979,245,,979,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UROGRAPHY ANTEGRADE RS&I RT,32000319,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UROGRAPHY ANTEGRADE RS&I LT,32000320,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DILATION URETER(S) OR URETHRA, RAD S&I RT",32000326,CDM,,,,Both,,,3154,789,,3154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DILATION URETER(S) OR URETHRA, RAD S&I LT",32000327,CDM,,,,Both,,,3154,789,,3154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DILATION URETER(S) OR URETHRA, RAD S&I BIL",32000328,CDM,,,,Both,,,3154,789,,3154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENOGRAM EXTREMITY UNIL RT,32000329,CDM,,,,Both,,,2329,582,,2329,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENOGRAM EXTREMITY UNIL LT,32000330,CDM,,,,Both,,,2329,582,,2329,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOGRAM, RENAL, RT, SELECTIVE",32000335,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOGRAM, RENAL, LT, SELECTIVE",32000336,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOGRAM, JUGULAR, CATH, LT",32000337,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOGRAM, JUGULAR, CATH, RT",32000338,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TOE(S),MIN 2 VIEWS,  LT",32000365,CDM,,,,Both,,,231,58,,231,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RIBS, UNILAT RT, WITH PA CHEST MIN 3V",32000367,CDM,,,,Both,,,313,78,,313,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILATE FOR STRICTURE/OBSTR,32000368,CDM,,,,Both,,,740,185,,740,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DXA BONE DENSITY STUDY,32000369,CDM,,,,Both,,,223,56,,223,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DRAINAGE CATHETER, CHANGE PERC BIL",32000370,CDM,,,,Both,,,2865,716,,2865,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RENAL STONE EXTRACTION,32000372,CDM,,,,Both,,,8187,2047,,8187,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC NEPHROLITHOTOMY OR PYELOLITHOTOMY; SIMPLE,32000373,CDM,,,,Both,,,14540,3635,,14540,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM OF FEMUR 1 VIEW BIL,32000375,CDM,,,,Both,,,254,64,,254,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERUS 1V RT,32000376,CDM,,,,Both,,,277,69,,277,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERUS 1V LT,32000377,CDM,,,,Both,,,277,69,,277,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC X-RAY EXAM ABDOMEN 1 VIEW,32000378,CDM,,,,Both,,,178,45,,178,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC X-RAY EXAM ABDOMEN 2 VIEWS,32000379,CDM,,,,Both,,,234,59,,234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC X-RAY EXAM ABDOMEN 3+ VIEWS,32000380,CDM,,,,Both,,,289,72,,289,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 4+VIEW BIL,32000382,CDM,,,,Both,,,537,134,,537,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RENAL CYST STUDY,32000384,CDM,,,,Both,,,1100,275,,1100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEETH COMPLETE FULL MOUTH,32000385,CDM,,,,Both,,,511,128,,511,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC X-RAY SM INT F-THRU STD,32000387,CDM,,,,Both,,,783,196,,783,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC X-RAY XM ESOPHAGUS 2CNTRST,32000388,CDM,,,,Both,,,408,102,,408,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM ENTIRE SPI 1 VW,32000408,CDM,,,,Both,,,177,44,,177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM ENTIRE SPI 2/3 VW,32000409,CDM,,,,Both,,,209,52,,209,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM ENTIRE SPI 4/5 VW,32000410,CDM,,,,Both,,,399,100,,399,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM ENTIRE SPI 6/> VW,32000411,CDM,,,,Both,,,489,122,,489,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM HIP UNI 1 VIEW,32000412,CDM,,,,Both,,,177,44,,177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM HIP UNI 2-3 VIEWS,32000413,CDM,,,,Both,,,163,41,,163,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM HIP UNI 4/> VIEWS,32000414,CDM,,,,Both,,,209,52,,209,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM HIPS BI 2 VIEWS,32000415,CDM,,,,Both,,,209,52,,209,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM HIPS BI 3-4 VIEWS,32000416,CDM,,,,Both,,,230,58,,230,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM HIPS BI 5/> VIEWS,32000417,CDM,,,,Both,,,399,100,,399,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM OF FEMUR 1,32000418,CDM,,,,Both,,,177,44,,177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM OF FEMUR 2/>,32000419,CDM,,,,Both,,,177,44,,177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY EXAM OF FEMUR 2/> BIL,32000420,CDM,,,,Both,,,253,63,,253,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI FETAL SNGL/1ST GESTATION,32000421,CDM,,,,Both,,,732,183,,732,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI FETAL EA ADDL GESTATION,32000422,CDM,,,,Both,,,569,142,,569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MED PHYSIC DOS EVAL RAD EXPS,32000424,CDM,,,,Both,,,772,193,,772,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONFIRMATION ABDOMEN 1 VIEW,32000429,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SNIFF TEST ONLY,32000430,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE 2V PORT  BILAT,32000668,CDM,,,,Both,,,546,137,,546,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE 3V PORT  BILAT,32000669,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 2V PORT  BILAT,32000670,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEET 2V PORT.  BILAT,32000671,CDM,,,,Both,,,348,87,,348,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEET 3V PORT  BILAT,32000672,CDM,,,,Both,,,608,152,,608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FINGER 2V PORT  BILAT,32000674,CDM,,,,Both,,,338,85,,338,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOREARM 2V PORT  BILAT,32000675,CDM,,,,Both,,,426,107,,426,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 2V PORT  BILAT,32000676,CDM,,,,Both,,,344,86,,344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 3V PORT  BILAT,32000677,CDM,,,,Both,,,397,99,,397,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEEL 2V PORT.  BILAT,32000678,CDM,,,,Both,,,321,80,,321,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERUS 2V PORT  BILAT,32000681,CDM,,,,Both,,,415,104,,415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 1-2V PORT.  BILAT,32000682,CDM,,,,Both,,,499,125,,499,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 1-2V BILAT,32000683,CDM,,,,Both,,,499,125,,499,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LOWER EXT. (INFANT) 2V PORT.  BILAT,32000684,CDM,,,,Both,,,479,120,,479,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PATELLA 2V PORT.  BILAT,32000685,CDM,,,,Both,,,499,125,,499,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER COMPLETE 2+ VIEWS BILAT,32000686,CDM,,,,Both,,,444,111,,444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/FIB 2V PORT.   BILAT,32000687,CDM,,,,Both,,,506,127,,506,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UPPER EXT. (INFANT) 2V  BILAT,32000688,CDM,,,,Both,,,451,113,,451,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLAVICLE ROUTINE  BILAT,32000689,CDM,,,,Both,,,381,95,,381,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOREARM 2V ROUTINE  BILAT,32000690,CDM,,,,Both,,,426,107,,426,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERUS 2V ROUTINE  BILAT,32000691,CDM,,,,Both,,,415,104,,415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 2V PORT  BILAT,32000692,CDM,,,,Both,,,292,73,,292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 3V PORT  BILAT,32000693,CDM,,,,Both,,,365,91,,365,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE 1V PORT  BILAT  (M52),32000694,CDM,,,,Both,,,546,137,,546,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE 1V ROUTINE  BILAT  (M52),32000695,CDM,,,,Both,,,546,137,,546,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE 2V ROUTINE  BILAT,32000696,CDM,,,,Both,,,546,137,,546,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE 3V ROUTINE  BILAT,32000697,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLAVICLE PORT.  BILAT,32000698,CDM,,,,Both,,,381,95,,381,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 1V PORT.  BILAT  (M52),32000699,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 1V ROUTINE  BILAT  (M52),32000700,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 2V ROUTINE  BILAT,32000701,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 3V PORT  BILAT,32000702,CDM,,,,Both,,,379,95,,379,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW 3V ROUTINE  BILAT,32000703,CDM,,,,Both,,,379,95,,379,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEET 1V PORT.  BILAT (M52),32000704,CDM,,,,Both,,,348,87,,348,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEET 1V ROUTINE  BILAT (M52),32000705,CDM,,,,Both,,,348,87,,348,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEET 2V ROUTINE  BILAT,32000706,CDM,,,,Both,,,348,87,,348,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEET 3V ROUTINE  BILAT,32000707,CDM,,,,Both,,,608,152,,608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FINGER 2V ROUTINE  BILAT,32000709,CDM,,,,Both,,,338,85,,338,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOREARM 1V PORT.  BILAT (M52),32000710,CDM,,,,Both,,,426,107,,426,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOREARM 1V ROUTINE  BILAT (M52),32000711,CDM,,,,Both,,,426,107,,426,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 1V PORT.  BILAT (M52),32000712,CDM,,,,Both,,,344,86,,344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 1V ROUTINE  BILAT (M52),32000713,CDM,,,,Both,,,344,86,,344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 2V ROUTINE  BILAT,32000714,CDM,,,,Both,,,344,86,,344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAND 3V ROUTINE  BILAT,32000715,CDM,,,,Both,,,397,99,,397,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEEL 2V ROUTINE  BILAT,32000716,CDM,,,,Both,,,321,80,,321,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERUS 1V PORT.  BILAT (M52),32000720,CDM,,,,Both,,,415,104,,415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERUS 1V ROUTINE  BILAT (M52),32000721,CDM,,,,Both,,,415,104,,415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE 3V ROUTINE  BILAT,32000722,CDM,,,,Both,,,527,132,,527,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LOWER EXT. (INFANT) 2V  BILAT,32000723,CDM,,,,Both,,,479,120,,479,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PATELLA 2V ROUTINE  BILAT,32000724,CDM,,,,Both,,,499,125,,499,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCAPULA PORTABLE  BILAT,32000725,CDM,,,,Both,,,444,111,,444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCAPULA ROUTINE  BILAT,32000726,CDM,,,,Both,,,444,111,,444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER 1V  ROUTINE  BILAT,32000727,CDM,,,,Both,,,332,83,,332,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER 1V PORT  BILAT,32000728,CDM,,,,Both,,,332,83,,332,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER 3V ROUTINE/BURSITIS  BILAT,32000729,CDM,,,,Both,,,444,111,,444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/FIB 2V ROUTINE  BILAT,32000730,CDM,,,,Both,,,506,127,,506,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TOES ROUTINE,  MIN 2 VIEWS,  BILAT",32000731,CDM,,,,Both,,,346,87,,346,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TOES PORT., MIN 2 VIEWS,  BILAT",32000732,CDM,,,,Both,,,346,87,,346,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 1V ROUTINE  BILAT (M52),32000733,CDM,,,,Both,,,292,73,,292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 1V PORT.  BILAT (M52),32000734,CDM,,,,Both,,,292,73,,292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 2V ROUTINE  BILAT,32000735,CDM,,,,Both,,,292,73,,292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST 3V ROUTINE  BILAT,32000736,CDM,,,,Both,,,365,91,,365,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TMJ ARTHROGRAM RIGHT,32200008,CDM,,,,Both,,,569,142,,569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TMJ ARTHROGRAM LEFT,32200009,CDM,,,,Both,,,569,142,,569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ARTHROGRAM,TMJ,BILAT;S&I",32200010,CDM,,,,Both,,,853,213,,853,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER ARTHROGRAM RT,32200011,CDM,,,,Both,,,766,192,,766,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER ARTHROGRAM LT,32200012,CDM,,,,Both,,,766,192,,766,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW ARTHROGRAM RT,32200013,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW ARTHROGRAM LT,32200014,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST ARTHROGRAM RT,32200015,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST ARTHROGRAM LT,32200016,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIP ARTHROGRAM RT,32200017,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIP ARTHROGRAM LT,32200018,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE ARTHROGRAM RT,32200021,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE ARTHROGRAM LT,32200022,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE ARTHROGRAM RT,32200023,CDM,,,,Both,,,619,155,,619,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLE ARTHROGRAM LT,32200024,CDM,,,,Both,,,619,155,,619,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER ARTHROGRAM BIL,32200025,CDM,,,,Both,,,1149,287,,1149,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIP ARTHROGRAM BIL,32200026,CDM,,,,Both,,,1034,259,,1034,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEE ARTHROGRAM BIL,32200027,CDM,,,,Both,,,1138,285,,1138,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST ARTHROGRAM BIL,32200028,CDM,,,,Both,,,854,214,,854,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO, PELVIC, SELECTIVE OR SUPRASELECT",32300003,CDM,,,,Both,,,8401,2100,,8401,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO, ABD, W BILAT LOW EXTRO(STEP,ETC)",32300004,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO, SPINAL, SELECTIVE",32300005,CDM,,,,Both,,,9819,2455,,9819,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO, ADRENAL, LT, SELECTIVE",32300006,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO, INTERNAL MAMMARY",32300007,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO, ADRENAL, RT, SELECTIVE",32300008,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACIC AO W/O SERIALOGRAPHY,32300012,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PULMONARY ANGIO NONSELECT,32300013,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO, ADRENAL, BILAT, SELECTIVE",32300018,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PULMONARY BILATERAL (SELECTIVE),32300021,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC AORTOGRAPHY, ABDOMINAL",32300023,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO EXTREM, BILAT S&I",32300024,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIOGRAPHY, SELECTIVE,EACH ADD'L VESSEL",32300025,CDM,,,,Both,,,3105,776,,3105,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AORTOGRAPHY THORACIC,32300026,CDM,,,,Both,,,8401,2100,,8401,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO EXTREM, UNILAT RT S&I",32300037,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANGIO EXTREM, UNILAT LT S&I",32300038,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PULMONARY, ANGIO, SELECTIVE RIGHT",32300045,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PULMONARY, ANGIO, SELECTIVE LEFT",32300046,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC X-RAY EXAM CHEST 1 VIEW,32400007,CDM,,,,Both,,,171,43,,171,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC X-RAY EXAM CHEST 2 VIEWS,32400008,CDM,,,,Both,,,173,43,,173,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC X-RAY EXAM CHEST 3 VIEWS,32400009,CDM,,,,Both,,,153,38,,153,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC X-RAY EXAM CHEST 4+ VIEWS,32400010,CDM,,,,Both,,,213,53,,213,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONFIRMATION CHEST X-RAY,32400011,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMO TX ADMN IV PUSH TQ 1/1ST SBST/DRUG,33100001,CDM,,,,Both,,,762,191,,762,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMO TX ADMN IV PUSH TQ EA SBST/DRUG,33100002,CDM,,,,Both,,,387,97,,387,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMO TX ADMN SUBQ/IM NONHORMONAL ANTINEO,33100003,CDM,,,,Both,,,468,117,,468,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMO TX ADMN SUBQ/IM HORMONAL ANTINEO,33100004,CDM,,,,Both,,,209,52,,209,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CHEMO.INJECTION W LUMBAR PUNCTURE, INC.",33100005,CDM,,,,Both,,,1308,327,,1308,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMO TX ADMIN INTRAART PUSH TQ,33100006,CDM,,,,Both,,,489,122,,489,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMO INJ VIA SQ RESERVOIR,33100007,CDM,,,,Both,,,414,104,,414,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MULTILEAF COLLIMATOR PER IMRT PLAN,33300001,CDM,,,,Both,,,7680,1920,,7680,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DOSIMETRY CALCULATIONS,33300003,CDM,,,,Both,,,867,217,,867,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TP/SAFS MIN,33300004,CDM,,,,Both,,,881,220,,881,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TP/SAFS INTERM,33300005,CDM,,,,Both,,,2020,505,,2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TP/SAFS COMPLEX,33300006,CDM,,,,Both,,,2344,586,,2344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TPP,PARTICLAS,HEMI TOTAL",33300010,CDM,,,,Both,,,2046,512,,2046,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DOS (EG,TLD,MICRODOS)",33300014,CDM,,,,Both,,,938,235,,938,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TDD & CONSTR SIMPLE,33300015,CDM,,,,Both,,,1502,376,,1502,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TDD & CONSTR INTERM,33300016,CDM,,,,Both,,,1606,402,,1606,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TDD & CONSTR COMPLEX,33300017,CDM,,,,Both,,,1776,444,,1776,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONT MED RAD PHYS CONSUL,33300018,CDM,,,,Both,,,915,229,,915,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SP MED RAD PHYS CONSUL,33300019,CDM,,,,Both,,,928,232,,928,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LOCAL/VERIF 1 PORT,33300020,CDM,,,,Both,,,525,131,,525,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC HYPERTHERMIA, EXTER SUPERFICIAL",33300021,CDM,,,,Both,,,393,98,,393,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC HYPERTHERMIA,EXTERNAL DEEP",33300022,CDM,,,,Both,,,3251,813,,3251,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HYPERTHER GEN INTERS PROBE =/<5,33300023,CDM,,,,Both,,,3078,770,,3078,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HYPERTHERM GEN INTERS PROBE >5,33300024,CDM,,,,Both,,,4618,1155,,4618,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADIATION TRTMT ORTHO VOLTAGE PER DAY,33300025,CDM,,,,Both,,,210,53,,210,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADIATION TRMT SIMPLE >1MEV,33300026,CDM,,,,Both,,,411,103,,411,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADIATION TRMT INTERMED >1MEV,33300030,CDM,,,,Both,,,454,114,,454,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADIATION TRMT COMPLEX >1MEV,33300034,CDM,,,,Both,,,1258,315,,1258,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPECIAL TRMT,33300038,CDM,,,,Both,,,3510,878,,3510,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC UNLIS PROC,MED RAD PHYS,DOS,T",33300039,CDM,,,,Both,,,474,119,,474,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 3-D RADIOTHERAPY PLAN,33300040,CDM,,,,Both,,,8342,2086,,8342,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMRT PLANNING,33300041,CDM,,,,Both,,,7332,1833,,7332,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US INTERSTITIAL RADIOELEMENT APPLICATION,33300043,CDM,,,,Both,,,728,182,,728,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HPERTHERM GEN INTRACAVITY PROBE(S),33300046,CDM,,,,Both,,,2360,590,,2360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESPIRATOR MOTION MGMT SIMUL,33300047,CDM,,,,Both,,,1557,389,,1557,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TELETHX ISODOSE PLAN SIMPLE,33300048,CDM,,,,Both,,,1689,422,,1689,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TELETHX ISODOSE PLAN CPLX,33300049,CDM,,,,Both,,,3046,762,,3046,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRACHYTX ISODOSE PLAN SIMPLE,33300050,CDM,,,,Both,,,580,145,,580,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRACHYTX ISODOSE INTERMED,33300051,CDM,,,,Both,,,2903,726,,2903,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRACHYTX ISODOSE COMPLEX,33300052,CDM,,,,Both,,,3019,755,,3019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NTSTY MODUL RAD TX DLVR SMPL,33300056,CDM,,,,Both,,,3204,801,,3204,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NTSTY MODUL RAD TX DLVR CPLX,33300057,CDM,,,,Both,,,3454,864,,3454,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDANCE FOR RADIATION TREATMENT,33300058,CDM,,,,Both,,,768,192,,768,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SBRT DELIVERY PER FRACTION,33300059,CDM,,,,Both,,,11922,2981,,11922,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEUTRON BEAM TX COMPLEX,33300060,CDM,,,,Both,,,1150,288,,1150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR,33300061,CDM,,,,Both,,,17149,4287,,17149,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RADIATION TREATMENT DELIVERY, 6-10MEV, MCAID OK ONLY",33300062,CDM,,,,Both,,,1258,315,,1258,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RADIATION TREATMENT DELIVERY, 11-19MEV, MCAID OK ONLY",33300063,CDM,,,,Both,,,1258,315,,1258,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMOTX ADMN PRTL CAVITY PORT/CATH,33500001,CDM,,,,Both,,,489,122,,489,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG,33500002,CDM,,,,Both,,,1225,306,,1225,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMOTHERAPY ADMN IV INFUSION TQ EA HR,33500003,CDM,,,,Both,,,224,56,,224,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR,33500004,CDM,,,,Both,,,386,97,,386,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP,33500005,CDM,,,,Both,,,489,122,,489,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMO IA INFUSION UP TO 1 HR,33500006,CDM,,,,Both,,,374,94,,374,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMO IA INFUSE EACH ADDL HR,33500007,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED CHEMOTHERAPY PROCEDURE,33500008,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMO EXTEND IV INFUS W/PUMP,33500009,CDM,,,,Both,,,683,171,,683,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INJ RA DRUG DX STUDY,34000001,CDM,,,,Both,,,578,145,,578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FDG DX PSD UT 45 MCI,34000003,CDM,,,,Both,,,1044,261,,1044,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THYROID IMAGING W/BLOOD FLOW,34000004,CDM,,,,Both,,,578,145,,578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THYROID UPTAKE, SING/MULTI, MEASUREMENT",34000005,CDM,,,,Both,,,578,145,,578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THYROID IMAGING (INCL VAS FLOW),34000006,CDM,,,,Both,,,578,145,,578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARATHYROID PLANAR IMAGING(W SUBSTRACT),34000007,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARATHYROID PLANAR IMAGING W SPECT,34000008,CDM,,,,Both,,,1014,254,,1014,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARATHYROID PLANAR W SPECT & CT LOCALIZE,34000009,CDM,,,,Both,,,1139,285,,1139,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRA-ARTERIAL RPHARM RX,34000010,CDM,,,,Both,,,467,117,,467,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRAIN IMAGING VASC FLOW ONLY,34100001,CDM,,,,Both,,,750,188,,750,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTROESOPHAGEAL REFLUX STUDY,34100003,CDM,,,,Both,,,709,177,,709,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THYROID CA WHOLE BODY,34100007,CDM,,,,Both,,,1965,491,,1965,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CR 51 RED CELL VOLUME (MASS),34100009,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BONE MARROW IMAGING, WHOLE BODY",34100011,CDM,,,,Both,,,1155,289,,1155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARATHYROID IMAGING,34100013,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE SCAN (3 PHASE),34100016,CDM,,,,Both,,,2113,528,,2113,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE SCAN (WHOLE BODY),34100017,CDM,,,,Both,,,2496,624,,2496,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE &/JOINT IMAGING LIMITED AREA,34100018,CDM,,,,Both,,,770,193,,770,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRAIN MIN 4V W  VASCULAR FLOW,34100020,CDM,,,,Both,,,1532,383,,1532,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CSF LEAKAGE LOCALIZATION,34100022,CDM,,,,Both,,,2002,501,,2002,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTRIC EMPTYING SCAN,34100023,CDM,,,,Both,,,2299,575,,2299,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIVER & SPLEEN STATIC ONLY,34100025,CDM,,,,Both,,,653,163,,653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LUNG PERFUSION SCAN,34100026,CDM,,,,Both,,,653,163,,653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GI BLEEDING SCAN,34100027,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED RESP PROCEDURE,34100028,CDM,,,,Both,,,945,236,,945,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOCARDIAL SPECT PLANAR,34100033,CDM,,,,Both,,,2159,540,,2159,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MECKELS SCAN,34100034,CDM,,,,Both,,,653,163,,653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIDNEY W VASC F&F W PHARM,34100035,CDM,,,,Both,,,962,241,,962,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TESTICULAR W VASC FLOW,34100036,CDM,,,,Both,,,653,163,,653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIDNEY MORPH W VASCULAR F&F W/O PHARM,34100037,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIDNEY MORPH W VASCULAR FLOW,34100038,CDM,,,,Both,,,743,186,,743,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URETERAL REFULX STUDY,34100039,CDM,,,,Both,,,653,163,,653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADIOISOTOPE VENOGRAM (BILATERAL),34100043,CDM,,,,Both,,,980,245,,980,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP LOC TUMOR MULTIPLE,34100044,CDM,,,,Both,,,1015,254,,1015,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LYMPHANGIOSCAN,34100045,CDM,,,,Both,,,1309,327,,1309,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MUGA, MULTI VW, REST OR STRESS",34100046,CDM,,,,Both,,,1661,415,,1661,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DYNAMIC CARDIAC FLOW SHUNT,34100047,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FIRST PASS CARDIAC,34100048,CDM,,,,Both,,,1510,378,,1510,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VENOUS THROMBOSIS IMAGING,ACUTE,PEPTIDE",34100051,CDM,,,,Both,,,2002,501,,2002,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOCARD SPECT/SGL WM/EF IF PERFORMED,34100052,CDM,,,,Both,,,2002,501,,2002,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOCARD SPECT/MULT WM/EF IF PERFORMED,34100053,CDM,,,,Both,,,2996,749,,2996,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOCARD PERF/SGL/PLAN WM/EF IF PERFORMED,34100054,CDM,,,,Both,,,2002,501,,2002,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOCARD PERF/MUL/PLAN WM/EF IF PERFORMED,34100055,CDM,,,,Both,,,2318,580,,2318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHUNT PATENCY TEST,34100056,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CSF SHUNT EVALUATION,34100057,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP TUMOR LOC WHOLE BODY 2+DAYS,34100059,CDM,,,,Both,,,3279,820,,3279,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RENAL IMAGING,34100060,CDM,,,,Both,,,653,163,,653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PLASMA VOLUME I 125, SINGLE STUDY",34100061,CDM,,,,Both,,,2159,540,,2159,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASCULAR FLOW IMAGING,34100062,CDM,,,,Both,,,653,163,,653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP LOC TUMOR SPECT,34100064,CDM,,,,Both,,,2002,501,,2002,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP DISTRIBUTION; SINGLE AREA,34100065,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC C-14 UREA BREATH TEST,34100066,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BONE MARROW IMAGING, MULTIPLE STUDY",34100067,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BONE MARROW IMAGING, LIMITED STUDY",34100068,CDM,,,,Both,,,653,163,,653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MUGA, SINGLE VW, REST OR STRESS",34100069,CDM,,,,Both,,,1623,406,,1623,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KIDNEY W F&F MULT W/WO PHAR,34100070,CDM,,,,Both,,,1249,312,,1249,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADIOISOTOPE VENOGRAM (UNILATERAL),34100071,CDM,,,,Both,,,2159,540,,2159,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THYROID CA, METS, UPTAKE",34100072,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NP 59 ADRENAL SCAN,34100073,CDM,,,,Both,,,2002,501,,2002,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP LOC TUMOR WHOLEBODY,34100074,CDM,,,,Both,,,2654,664,,2654,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PULMONARY VENT & PERFUSION IMAGING,34100075,CDM,,,,Both,,,2094,524,,2094,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUANT DIFF PULMONARY PERFUSION INC IMAGE,34100076,CDM,,,,Both,,,578,145,,578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUANT DIFF PULM PERF & VENT INC IMAGE,34100077,CDM,,,,Both,,,792,198,,792,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATOBILLIARY IMAGING INCL GALLBLADDER,34100078,CDM,,,,Both,,,1489,372,,1489,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPATOBIL IMAGE INC GALLBLADDER W/DRUG,34100079,CDM,,,,Both,,,2496,624,,2496,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPLEEN IMAGING ONLY,34100080,CDM,,,,Both,,,684,171,,684,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RED CELL SEQUESTRATION,34100081,CDM,,,,Both,,,905,226,,905,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTRIC EMPTYING IMAG STUDY W/SMALL BOWEL TRANSIT,34100082,CDM,,,,Both,,,692,173,,692,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTRIC EMPTYING IMAG STUDY W/SMALL BOWEL AND COLON TRANSIT,34100083,CDM,,,,Both,,,918,230,,918,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIVER IMAGE STATIC ONLY,34100084,CDM,,,,Both,,,2159,540,,2159,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE &/JOINT IMAGING MULTIPLE AREAS,34100085,CDM,,,,Both,,,3599,900,,3599,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP LOCLZJ TUM SPECT W/CT 1,34100086,CDM,,,,Both,,,2849,712,,2849,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP LOCLZJ TUM SPECT 2 AREAS,34100087,CDM,,,,Both,,,2849,712,,2849,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP LOCLZJ TUM SPECT W/CT 2,34100088,CDM,,,,Both,,,3232,808,,3232,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP THERAPY IV ADMISTRATION,34200001,CDM,,,,Both,,,1170,293,,1170,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP THERAPY ORAL ADMINISTRATION,34200002,CDM,,,,Both,,,1064,266,,1064,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP INTRACAVITARY ADMIN,34200003,CDM,,,,Both,,,4115,1029,,4115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RP THERAPY BY IV INFUSION,34200004,CDM,,,,Both,,,1170,293,,1170,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRACAVIRADIOELEMENT APP SIMPL,34200005,CDM,,,,Both,,,2360,590,,2360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRACAVIRADIOELEMENT APP INTERM,34200006,CDM,,,,Both,,,2810,703,,2810,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRACAVI RADIOELEMENT APP COMPLE,34200007,CDM,,,,Both,,,1227,307,,1227,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SUPERVISION,HANDLING OF RADIOELEM",34200008,CDM,,,,Both,,,304,76,,304,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INF OR INST/RADIOELE SOLUTION,34200009,CDM,,,,Both,,,395,99,,395,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSTIT RADIOELE APPLIC COMPLEX,34200012,CDM,,,,Both,,,2267,567,,2267,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SURFACE APPL OF RAD SOURCE,34200013,CDM,,,,Both,,,358,90,,358,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HDR RDNCL SKN SURF BRACHYTX LESION DIAMETER UP TO 2.0CM,34200014,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HDR RDNCL SKN SURF BRACHYTX LESION DIAMETER OVER 2.0CM,34200015,CDM,,,,Both,,,529,132,,529,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HDR RDNCL NTRSTL/ICAV BRCHTX 1 CHANNEL,34200016,CDM,,,,Both,,,1448,362,,1448,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HDR RDNCL NTRSTL/ICAV BRCHTX 2-12 CHANNELS,34200017,CDM,,,,Both,,,1658,415,,1658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HDR RDNCL NTRSTL/ICAV BRCHTX OVER 12 CHANNELS,34200018,CDM,,,,Both,,,1868,467,,1868,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED CLINICAL BRACHYTHERAPY,34200019,CDM,,,,Both,,,230,58,,230,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I131 DIAGNOSTIC CAPS 4MCI,34300001,CDM,,,,Both,,,235,59,,235,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I123 MIBG DX PSD UT 15 MCI,34300002,CDM,,,,Both,,,7307,1827,,7307,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M PYP PSD UT 25 MCI,34300003,CDM,,,,Both,,,115,29,,115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INPNT STAY RADIOLABELED ITEM,34300005,CDM,,,,Both,,,1,0.01,,1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M MDP PSD UT 30MCI,34300006,CDM,,,,Both,,,152,38,,152,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M MIRALUMA PSD,34300013,CDM,,,,Both,,,183,46,,183,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IN111 IN OCTREOSCAN PSD UT 6 MCI,34300016,CDM,,,,Both,,,9335,2334,,9335,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M MYOVIEW PSD,34300017,CDM,,,,Both,,,381,95,,381,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TC99M PERTECHNETATE, PER MCI",34300018,CDM,,,,Both,,,62,16,,62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CERETEC DX PSD UT 25 MCI,34300019,CDM,,,,Both,,,2856,714,,2856,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M CHOLETEC PSD UT 15 MCI,34300020,CDM,,,,Both,,,91,23,,91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M SULFUR COL PSD UT 20MCI,34300021,CDM,,,,Both,,,485,121,,485,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M DTPA PSD UT 25 MCI,34300022,CDM,,,,Both,,,257,64,,257,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M MAA PSD UT 10 MCI,34300023,CDM,,,,Both,,,451,113,,451,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M HDP PSD UT 30 MCI,34300024,CDM,,,,Both,,,94,24,,94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M MAG3 PSD UT 15 MCI,34300025,CDM,,,,Both,,,1272,318,,1272,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GALLIUM 67 PER MCI,34300026,CDM,,,,Both,,,400,100,,400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THALLIUM PER MCI,34300027,CDM,,,,Both,,,266,67,,266,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC I123 DIAGNOSTIC, PER 100 UCI, UT 999",34300028,CDM,,,,Both,,,296,74,,296,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC XE133, PER 10 MCI VIAL",34300030,CDM,,,,Both,,,363,91,,363,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M CARDIOLITE PSD,34300031,CDM,,,,Both,,,183,46,,183,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IN 111 DTPA PER 0.5 MCI,34300033,CDM,,,,Both,,,9970,2493,,9970,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CERETEC LABELED DX PSD UT 25 MCI,34300037,CDM,,,,Both,,,3624,906,,3624,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INDIUM 111 WBC OXYQUINOLINE PER 0.5 MCI,34300038,CDM,,,,Both,,,3612,903,,3612,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC99M LABELED RBC PSD UT 30MCI,34300041,CDM,,,,Both,,,1312,328,,1312,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC 99M SULFUR COL FILTERED PSD UT 20MCI,34300042,CDM,,,,Both,,,485,121,,485,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC99 TILMANOCEPT DIAG 0.5MCI,34300044,CDM,,,,Both,,,773,193,,773,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IODINE I-123 IOFLUPANE =< 5 MCI,34300045,CDM,,,,Both,,,5015,1254,,5015,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GA-68 PSMA (ILLUCCIX) PER MCI,34300047,CDM,,,,Both,,,2350,588,,2350,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CU-64 DOTATATE,34300048,CDM,,,,Both,,,9500,2375,,9500,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GALLIUM GA68 DOTATATE PER 0.1 MCI,34300049,CDM,,,,Both,,,139,35,,139,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC99M DTPA AEROSOL UT 75 MCI,34300050,CDM,,,,Both,,,257,64,,257,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRONTIUM 89 TX PER MCI,34400002,CDM,,,,Both,,,7170,1793,,7170,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC P32 SODIUM PHOSPHATE PER MCI,34400003,CDM,,,,Both,,,688,172,,688,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC METASTRON PER MCI,34400004,CDM,,,,Both,,,2611,653,,2611,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC YTTRIUM 90 ZEVALIN TX PSD UT 40MCI,34400005,CDM,,,,Both,,,103144,25786,,103144,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I131 SODIUM IOD CAP TX PER MCI,34400006,CDM,,,,Both,,,78,20,,78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT THORACIC SPINE W & W/O CONTRAST,35000001,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LTD OR LOCALIZED FU STUDY,35000002,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA NECK W/WO CONT W POST PROCESS,35000003,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA CHEST W/WO CONT W POST PROCESS,35000004,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA ABDOMEN W/WO CONT & POST PR,35000005,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT CHEST W/O CONTRAST,35000008,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  CHEST W CONTRAST,35000009,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT 3D RECON,35000010,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA ABD AO/BILAT RO W/WO CONT & PP,35000011,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT HEART W/O EVAL CORONARY CALCIUM,35000012,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA PELVIS W/WO CONT/W POST PROCESS,35000013,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CT GUIDANCE, TISSUE ABLATION",35000014,CDM,,,,Both,,,1820,455,,1820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT SCAN FOR NDL PLACEMENT,35000015,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CT PROCEDURE, UNLISTED",35000016,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT BONE DENSITY AXIAL SKELETON,35000017,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEAD STEREOTACTIC LOC CT GUIDANCE,35000018,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT GUIDANCE FOR RADIATION THERAPY,35000019,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA ABD & PELVIS W/WO CONTRAST,35000020,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA UPR EXTRM W/O & W/DYE LT,35000021,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA UPR EXTRM W/O & W/DYE RT,35000022,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA UPR EXTRM W/O & W/DYE BIL,35000023,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA LWR EXT W/WO CONT LT,35000024,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  KNEE W/O CONTR.  BILAT  (BIOMET),35000025,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA UPR EXTRM W & W/O CONTR  W PP  BILAT,35000026,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA LWR EXT W & W/O CONTR  W PP  BILAT,35000027,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  ANKLES W/O CONTR.  BILAT,35000028,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  ELBOW W/O CONTR.  BILAT,35000029,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  FEET W/O CONTR.  BILAT,35000030,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  FEMUR W/O CONTR.  BILAT,35000031,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  FOREARM W/O CONTR.  BILAT,35000032,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  HAND W/O CONTR.  BILAT,35000033,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  HEELS W/O CONTR.  BILAT,35000034,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  HUMERI W/O CONTR.  BILAT,35000035,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  TIB/FIB W/O CONTR.  BILAT,35000036,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MYELOGRAPHY LUMBAR INJ C, T, OR L 2 OR MORE REGIONS",35000038,CDM,,,,Both,,,6361,1590,,6361,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT CALCIUM SCORE BHEART HEALTHY PKG,35000039,CDM,,,,Both,,,50,13,,50,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT COLONOGRAPHY DX,35000040,CDM,,,,Both,,,260,65,,260,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT COLONOGRAPHY W/DYE,35000041,CDM,,,,Both,,,466,117,,466,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  NECK W/O CONTRAST,35100001,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA HEAD W&WO CONTRA,35100002,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  CT HEAD W CONTRAST,35100003,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT ORBIT/EAR/FOS SA W&W/O,35100004,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  CT HEAD WO CONTRAST,35100005,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  HEAD W & W/O CONTRAST,35100006,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  NECK W CONTRAST,35100007,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT MAXILLOFACIAL/SINUSES W/O,35100008,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  ORBIT SELLA FOSSA OR OMI EAR W/O,35100009,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT ORBITS SELL PF EAR W/,35100010,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT FACIAL BONES/SINUSES W CONTAST,35100011,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT FACIAL BONES/SINUSES W/WO CONTRAST,35100012,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  NECK W/WO CONTRAST,35100013,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA HEAD W&WO CONTRAST STROKE,35100014,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  ABD & PELVIS W/O,35200001,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  ABD & PELVIS W CONTRAST,35200002,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  ABD & PELVIS W/WO,35200003,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  PELVIS W/WO CONTRAST,35200004,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  ABDOMEN W/O CONTRAST,35200005,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  ABDOMEN W CONTRAST,35200006,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT PELVIS W/O CONTRAST MATERIAL,35200007,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  PELVIS W CONTRAST,35200008,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  CERVICAL SPINE W & WO CONTRAST,35200009,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  CERVICAL SPINE W CONTRAST,35200011,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  THORACIC SPINE W CONTRAST,35200012,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  CERVICAL SPINE W/O CONTRAST,35200013,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  THORACIC SPINE W/O CONTRAST,35200014,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  LUMBAR SPINE W/O CONTRAST,35200015,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  ABDOMEN W/WO CONTRAST,35200021,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  CHEST W/WO CONTRAST,35200022,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LUMBAR SPINE W CONTRAST,35200023,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LUMBAR SPINE W/WO CONTRAST,35200024,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT UPPER EXTREMITY W/O CONTRAST MATERIAL LT,35200025,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT UPPER EXTREMITY W/O CONTRAST MATERIAL RT,35200028,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT UPPER EXTREMITY W/O CONTRAST MATERIAL BILAT,35200037,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT EXTREMITY UPPER BILAT W CONTRAST,35200038,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  EXTREMITY UPPER RIGHT W CONTRAST,35200039,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  EXTREMITY UPPER LEFT W CONTRAST,35200040,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT EXTREMITY UPPER BILAT W/WO CONTRAST,35200041,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  EXTREMITY UPPER RIGHT W/WO CONTRAST,35200042,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT  EXTREMITY UPPER LEFT W/WO CONTRAST,35200043,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LOWER EXTREMITY W/O CONTRAST LT,35200045,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LOWER EXTREMITY W/O CONTRAST RT,35200046,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LOWER EXTREMITY W/O CONTRAST BILATERAL,35200057,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LOWER EXTREMITY W/CONTRAST BILATERAL,35200058,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LOWER EXTREMITY W/CONTRAST RT,35200059,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LOWER EXTREMITY W/CONTRAST LT,35200060,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LWR EXTREMITY W/WO CONTRAST BIL,35200061,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LWR EXTREMITY W/WO CONTRAST RT,35200062,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT LWR EXTREMITY W/WO CONTRAST LT,35200063,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA LWR EXT W/WO CONT RT,35200064,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTA HRT W/3D IMAGE,35200065,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT HRT W/3D IMAGE,35200066,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT THORAX LOW DOSE LUNG CA SCREEN W/O CONTRAST,35200069,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT THORAX LOW DOSE LUNG CA FOLLOW UP W/O CONTRAST,35200070,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CT 3D RECON ON INDEP WORK STATION,35900001,CDM,,,,Both,,,1471,368,,1471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE,36000001,CDM,,,,Both,,,2581,645,,2581,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN T/A/L > 4.0 CM,36000002,CDM,,,,Both,,,2334,584,,2334,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NASO/ORO GASTRIC TUBE PLMT REQ PHYS&FLUOR GDN,36000003,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC PILONIDAL CYST OR SINUS; COMPLICATED,36000004,CDM,,,,Both,,,3490,873,,3490,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRACHEOSTOMY EMERGENCY PROC TRANSTRACHEAL,36000005,CDM,,,,Both,,,2072,518,,2072,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,36000007,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,36000008,CDM,,,,Both,,,3207,802,,3207,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON,36000009,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY BONE OPEN SUPERFICIAL,36000010,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BX ANORECTAL WALL ANAL APPROACH,36000011,CDM,,,,Both,,,4422,1106,,4422,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX,36000014,CDM,,,,Both,,,3207,802,,3207,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC D & C DX&/THER NONOBSTETRICAL,36000015,CDM,,,,Both,,,5331,1333,,5331,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON,36000016,CDM,,,,Both,,,2477,619,,2477,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL,36000017,CDM,,,,Both,,,10678,2670,,10678,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSURECT,36000018,CDM,,,,Both,,,9747,2437,,9747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOTOMY W/CARDIAC MASSAGE,36000020,CDM,,,,Both,,,1390,348,,1390,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMNIOCENTESIS DIAGNOSIC,36000021,CDM,,,,Both,,,971,243,,971,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D LEG/ANKLE ABSCESS/HEMATOMA,36000022,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE SMALL INTESTINE,36000023,CDM,,,,Both,,,3014,754,,3014,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONSCOPY FLEX W/CONTROL BLEED ANY METHOD,36000024,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION EPIDURAL BLOOD/CLOT PATCH,36000025,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERTION INTRA AORTIC BALLOON ASSIST DEV PRQ,36000026,CDM,,,,Both,,,13673,3418,,13673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPHTH XM&EVAL ANES W/WO MANJ GLOBE LMTD,36000027,CDM,,,,Both,,,4070,1018,,4070,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSORAL BRUSH/WASH,36000029,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONSCOPY FLEXIBLE W/REMOVAL FB,36000030,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DBRDMT FX&/DISLC SUBQ T/M/FBONE,36000031,CDM,,,,Both,,,4174,1044,,4174,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC,36000032,CDM,,,,Both,,,1322,331,,1322,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONSCOPY FLEXIBLE W/BALLOON DILATION,36000033,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLSC FLEX W/RMVL TUMOR POLYP LESION HOT BX FORCEP,36000034,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP DIAG W/SPECIMEN COLLECT BRUSH/WASH,36000035,CDM,,,,Both,,,6261,1565,,6261,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY FLX DX W/WO COLLJ SPECIMENS,36000036,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PELVIC EXAM W/ANESTHESIA OTHER THAN LOCAL,36000037,CDM,,,,Both,,,2721,680,,2721,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ ELTRD CAR VEN SYS ATTCH PM/CVDFB PLS GEN,36000038,CDM,,,,Both,,,18318,4580,,18318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX,36000040,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRIDE BONE MUSCLE &/FASCIA 20 SQ CM/<,36000041,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARING/CUTTING BENIGN HYPERKERATOTIC SNG,36000042,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARING/CUTTING BENIGN LESION 2-4 LESION,36000043,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARING/CUTTING BENIGN LESION 5+ LESION,36000044,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRIDE NAIL(S) ANY METHOD 6+,36000046,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PINCH GRAFT 1/MLT C> SM ULCER TIP/OTH AREA 2CM,36000048,CDM,,,,Both,,,802,201,,802,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<,36000049,CDM,,,,Both,,,2696,674,,2696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 CM<,36000050,CDM,,,,Both,,,1877,469,,1877,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<,36000051,CDM,,,,Both,,,1877,469,,1877,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM<,36000052,CDM,,,,Both,,,1307,327,,1307,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<,36000053,CDM,,,,Both,,,1877,469,,1877,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<,36000054,CDM,,,,Both,,,1307,327,,1307,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<,36000055,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FTH/GFT FREE W/DIR CLSR N/E/E/L EA 20 SQ CM/<,36000056,CDM,,,,Both,,,1877,469,,1877,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPLIT AGRFT T/A/L 1ST 100 CM/</1% BDY INFT/CHLD,36000057,CDM,,,,Both,,,3204,801,,3204,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,36000058,CDM,,,,Both,,,2400,600,,2400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %,36000059,CDM,,,,Both,,,3204,801,,3204,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %,36000060,CDM,,,,Both,,,2400,600,,2400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,36000062,CDM,,,,Both,,,2730,683,,2730,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX,36000063,CDM,,,,Both,,,973,243,,973,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL FOREIGN BODY DEEP THIGH/KNEE,36000064,CDM,,,,Both,,,13618,3405,,13618,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY MULTILAY COMPRES LEG (BELOW KNEE),36000065,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SECONDARY CLOSURE WOUND/DEHSN EXTSV/COMPLIC,36000066,CDM,,,,Both,,,3572,893,,3572,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ADJ TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM,36000067,CDM,,,,Both,,,10166,2542,,10166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ADJ TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<,36000068,CDM,,,,Both,,,2860,715,,2860,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES F/E/E/N/L 0.5 CM/<,36000069,CDM,,,,Both,,,1057,264,,1057,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ADJ TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<,36000070,CDM,,,,Both,,,2711,678,,2711,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, T/A/L 0.5CM/<",36000072,CDM,,,,Both,,,196,49,,196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, T/A/L 0.6-1.0CM",36000073,CDM,,,,Both,,,246,62,,246,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, T/A/L 1.1-2.0CM",36000074,CDM,,,,Both,,,311,78,,311,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, T/A/L >2.0CM",36000075,CDM,,,,Both,,,367,92,,367,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, S/N/H/F/G 0.5CM/<",36000076,CDM,,,,Both,,,399,100,,399,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, S/N/H/F/G 0.6-1.0",36000077,CDM,,,,Both,,,450,113,,450,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, S/N/H/F/G 1.1-2.0",36000078,CDM,,,,Both,,,501,125,,501,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, S/N/H/F/G >2.0CM",36000079,CDM,,,,Both,,,552,138,,552,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, F/E/N/L  0.5CM/<",36000080,CDM,,,,Both,,,254,64,,254,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, F/E/N/L 0.6-10CM",36000081,CDM,,,,Both,,,413,103,,413,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, F/E/N/L  1.1-2.0CM",36000082,CDM,,,,Both,,,573,143,,573,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SHAVE LES, F/E/N/L >2.0CM",36000083,CDM,,,,Both,,,732,183,,732,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES TRUNK/ARM/LEG 0.5 CM/<,36000084,CDM,,,,Both,,,1057,264,,1057,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES TRUNK/ARM/LEG 0.6-1.0 CM,36000085,CDM,,,,Both,,,1227,307,,1227,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES TRUNK/ARM/LEG 1.1-2.0 CM,36000086,CDM,,,,Both,,,1397,349,,1397,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR SUBCU FACE/SCALP <2CM,36000087,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR SUBCU FACE/SCALP 2CM OR >,36000088,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR FACE/SCALP SUBFASCIA <2CM,36000089,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR FACE/SCALP SUBFA 2CM OR >,36000090,CDM,,,,Both,,,4174,1044,,4174,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP W/BIOPSY SINGLE/MULTIPLE,36000091,CDM,,,,Both,,,5409,1352,,5409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES TRUNK/ARM/LEG 2.1-3.0 CM/>,36000092,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADICAL RESECTION TUMOR FACE/SCALP <2CM,36000093,CDM,,,,Both,,,3194,799,,3194,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES TRUNK/ARM/LEG 3.1-4.0 CM,36000095,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RADICAL RESECT TUMOR FACE/SCALP 2CM OR >,36000096,CDM,,,,Both,,,3457,864,,3457,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE,36000097,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES TRUNK/ARM/LEG >4.0 CM,36000098,CDM,,,,Both,,,1906,477,,1906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR NECK/THORAX SUBC <3CM,36000099,CDM,,,,Both,,,3857,964,,3857,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SGMDSC FLX W/RMVL TUMOR POLYP LESION HOT BX FORCEP,36000100,CDM,,,,Both,,,1242,311,,1242,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES S/N/H/F/G 0.5 CM/<,36000101,CDM,,,,Both,,,1057,264,,1057,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR NECK/THOR SUBC 3CM OR >,36000102,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ,36000103,CDM,,,,Both,,,1987,497,,1987,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES S/N/H/F/G 0.6-1.0 CM,36000104,CDM,,,,Both,,,1367,342,,1367,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR NECK/THOR SUBFASCIAL <5CM,36000105,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES S/N/H/F/G 1.1-2.0 CM,36000107,CDM,,,,Both,,,1678,420,,1678,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR NECK/THOR SUBFASC 5CM OR>,36000108,CDM,,,,Both,,,3309,827,,3309,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY,36000109,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES S/N/H/F/G 2.1-3.0 CM/>,36000110,CDM,,,,Both,,,1987,497,,1987,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR BACK/FLANK SUBCUT <3CM,36000111,CDM,,,,Both,,,1906,477,,1906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES S/N/H/F/G 3.1-4.0 CM,36000112,CDM,,,,Both,,,2297,574,,2297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR BACK/FLANK SUBCUT 3CM OR>,36000113,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES S/N/H/F/G > 4.0 CM,36000114,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR BACK/FLANK SUBFAS <5CM,36000115,CDM,,,,Both,,,7218,1805,,7218,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES F/E/E/N/L 0.6-1.0 CM,36000117,CDM,,,,Both,,,1367,342,,1367,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR BACK/FLANK SUBFAS 5CM OR>,36000118,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES F/E/E/N/L 1.1-2.0 CM,36000120,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR ABD WALL SUBFASCIAL <5CM,36000121,CDM,,,,Both,,,3168,792,,3168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES F/E/E/N/L 2.1-3.0 CM/>,36000122,CDM,,,,Both,,,1987,497,,1987,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR ABD WALL SUBFASCI 5CM OR>,36000123,CDM,,,,Both,,,3528,882,,3528,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY FLX CONTROL BLEEDING,36000124,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LES F/E/E/N/L 3.1-4.0 CM,36000125,CDM,,,,Both,,,2297,574,,2297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR ABD WALL SUBCUT < 3CM,36000126,CDM,,,,Both,,,2498,625,,2498,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SGMDSC FLX DIRED SBMCSL NJX ANY SBST,36000127,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION MAL LESION F/E/E/N/L > 4.0 CM,36000128,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR ABD WALL SUBCUT 3 CM OR >,36000129,CDM,,,,Both,,,2886,722,,2886,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM,36000130,CDM,,,,Both,,,2282,571,,2282,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR SHOULDER SUBC 3CM OR >,36000131,CDM,,,,Both,,,3247,812,,3247,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM,36000133,CDM,,,,Both,,,2282,571,,2282,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY NAIL UNIT SEP PROCEDURE,36000134,CDM,,,,Both,,,953,238,,953,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>,36000135,CDM,,,,Both,,,3247,812,,3247,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR UPPER ARM/ELBOW SUBC <3CM,36000136,CDM,,,,Both,,,2350,588,,2350,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION PILONIDAL CYST/SINUS SIMPLE,36000137,CDM,,,,Both,,,5193,1298,,5193,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR UP ARM/ELBOW SUBC 3CM OR>,36000138,CDM,,,,Both,,,3597,899,,3597,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION INTRALESIONAL /<7 LESIONS,36000139,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR UP ARM/ELBOW SUBFASC <5CM,36000140,CDM,,,,Both,,,2350,588,,2350,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION INTRALESIONAL >7 LESIONS,36000141,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR UP ARM/ELBOW SUBF 5CM OR>,36000142,CDM,,,,Both,,,3597,899,,3597,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM,36000143,CDM,,,,Both,,,1906,477,,1906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR S/N/A/G/TR/E 12.6-20.0CM,36000144,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>,36000145,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR S/N/A/G/TR/E 20.1-30.0CM,36000146,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM,36000147,CDM,,,,Both,,,1906,477,,1906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR S/N/A/G/TR/E >30.0CM,36000148,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3CM/>,36000149,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EX TUM/  MAL SFT TIS HAND/FNGR SUBFASC<1.5CM,36000150,CDM,,,,Both,,,2194,549,,2194,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EX TUM/ MAL SFT TIS HAND/FNGR SUBQ 1.5CM/>,36000151,CDM,,,,Both,,,3053,763,,3053,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EX TUM/ MAL SFT TIS HAND/FNGR SUBQ <1.5CM,36000152,CDM,,,,Both,,,2194,549,,2194,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EX TUM/ MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>,36000153,CDM,,,,Both,,,3053,763,,3053,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR PELVIS/HIP SUBF <5CM,36000154,CDM,,,,Both,,,1906,477,,1906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR PELVIS/HIP SUBF 5CM OR>,36000155,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM,36000156,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>,36000157,CDM,,,,Both,,,2999,750,,2999,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM,36000158,CDM,,,,Both,,,1906,477,,1906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/>,36000159,CDM,,,,Both,,,2192,548,,2192,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM,36000160,CDM,,,,Both,,,1906,477,,1906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>,36000161,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM,36000162,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/>,36000163,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM,36000164,CDM,,,,Both,,,1906,477,,1906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>,36000165,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>,36000166,CDM,,,,Both,,,2608,652,,2608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM,36000167,CDM,,,,Both,,,1906,477,,1906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,36000168,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL,36000169,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL,36000170,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL,36000171,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL,36000172,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL,36000173,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA,36000174,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT,36000175,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREP SITE T/A/L ADDL 100 SQ CM/1PCT,36000176,CDM,,,,Both,,,726,182,,726,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT,36000177,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT,36000178,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN T/A/L 3.0-4.0 CM,36000179,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIDRM AGRFT T/A/L 1ST 100 CM/</1% BDY INFT/CHLD,36000180,CDM,,,,Both,,,1970,493,,1970,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,36000181,CDM,,,,Both,,,1476,369,,1476,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<,36000182,CDM,,,,Both,,,1970,493,,1970,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/<,36000183,CDM,,,,Both,,,1476,369,,1476,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM,36000184,CDM,,,,Both,,,2969,742,,2969,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA,36000185,CDM,,,,Both,,,2224,556,,2224,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100,36000186,CDM,,,,Both,,,2969,742,,2969,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA,36000187,CDM,,,,Both,,,2224,556,,2224,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL,36000188,CDM,,,,Both,,,1057,264,,1057,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHANGE CYSTOSTOMY TUBE SIMPLE,36000189,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL TUN CVC W/O SUBQ PORT/PUMP,36000190,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FILLETED FINGER/TOE FLAP W/PREP RECT SITE,36000191,CDM,,,,Both,,,3572,893,,3572,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMPUTATION TOE INTERPHALANGEAL JOINT,36000192,CDM,,,,Both,,,5752,1438,,5752,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTRUCTION BENIGN LESIONS UP TO 14,36000193,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BEN TUMOR/CYST MAXILLA/ZYGOMA,36000194,CDM,,,,Both,,,8960,2240,,8960,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRYOABLATION  PROSTATE,36000195,CDM,,,,Both,,,16962,4241,,16962,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D CPLX POSTOP WND INF,36000197,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBR EXTENSV ECZEMA/INFECT SKN UP 10% BS,36000198,CDM,,,,Both,,,802,201,,802,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBR EXZ/INF SKIN; EA ADDTL 10%,36000199,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DBRDMT W/RMVL FM FX&/DISLC SKN&SUBQ TISS,36000200,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRID SUBQ TISSUE FIRST 20 SQ CM OR <,36000201,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM SKN TAGS ANY AREA UP&W/15,36000202,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL SK TGS ANY AREA EA ADD'L 10,36000203,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRIM NONDYSTROPHIC NAILS ANY NUMBER,36000204,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRIDEMENT NAIL(S) ANY METHOD 1-5,36000205,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AVULSION NAIL PLATE PART/COMP SIMPLE 1,36000206,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION NAIL MATRIX PERM REMOVAL,36000207,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR NAIL BED,36000208,CDM,,,,Both,,,802,201,,802,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WEDGE EXC SKIN NAIL FOLD,36000209,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR S/N/A/G/TR/E 2.5CM/<,36000210,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR S/N/A/G/TR/E  2.6-7.5CM,36000211,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR S/N/A/G/TR/E 7.6-12.5CM,36000212,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR F/E/E/N/L/M 2.5CM/<,36000213,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR F/E/E/N/L/M 2.6CM-5.0CM,36000214,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR F/E/E/N/L/M 5.1CM-7.5CM,36000215,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR F/E/E/N/L/M 7.6CM-12.5CM,36000216,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX SUPERFICIAL WND DEHISC SMPL,36000217,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX SUPERFICIAL WND DEHIS W/PACK,36000218,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR S/A/T/EXT 2.5 CM/<,36000219,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR S/A/T/EXT 2.6-7.5 CM,36000220,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR S/A/T/EXT 7.6-12.5 CM,36000221,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR S/A/T/EXT 12.6-20.0CM,36000222,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR S/A/T/EXT 20.1-30.0 CM,36000223,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR S/A/T/EXT > 30.0 CM,36000224,CDM,,,,Both,,,2624,656,,2624,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR N-HF/GENIT 2.5CM/<,36000225,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR N-HF/GENIT 2.6-7.5 CM,36000226,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR N-HF/GENIT 7.6-12.5CM,36000227,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR FACE/MM 2.5 CM/<,36000228,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR FACE/MM 2.6-5.0 CM/>,36000229,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR FACE/MM 5.1-7.5 CM,36000230,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR FACE/MM 7.6-12.5 CM,36000231,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR TRUNK 1.1 CM-2.5 CM,36000232,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR TRUNK 2.6 CM-7.5 CM,36000233,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR TRUNK EACH ADDITIONAL 5 CM/<,36000234,CDM,,,,Both,,,776,194,,776,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR SCALP/ARM/LEG 1.1 CM-2.5 CM,36000235,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR SCALP/ARM/LEG 2.6 CM-7.5 CM,36000236,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR SCALP/ARM/LEG EA ADDL 5 CM/<,36000237,CDM,,,,Both,,,776,194,,776,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR F/C/C/M/N/AX/G/H/F 1.1 CM-2.5 CM,36000238,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR F/C/C/M/N/AX/G/H/F 2.6 CM-7.5 CM,36000239,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR F/C/C/M/N/AX/G/H/F EA ADDL .5 CM/<,36000240,CDM,,,,Both,,,776,194,,776,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR E/N/E/L 1.1-2.5 CM,36000242,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR E/N/E/L 2.6-7.5 CM,36000243,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPLEX RPR E/N/E/L EA ADDL 5 CM/<,36000244,CDM,,,,Both,,,776,194,,776,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INITIAL TX 1ST DEGREE BURN LOCAL TX,36000245,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRS&/DBRDMT PRTL THKNS BURNS INIT/SBSQ SM,36000246,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRS&/DBRDMT PRTL THKNS BURNS INIT/SBSQ MED,36000247,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRS&/DBRDMT PRTL THKNS BURNS INIT/SBSQ LGE,36000248,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESCHAROTOMY FIRST INCISION,36000249,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D ABSCESS SIMPLE/SINGLE,36000250,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC  I&D ABSCESS ABCESS COMPLICATED/MULT,36000251,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D PILONIDAL CYST SIMPLE,36000252,CDM,,,,Both,,,1403,351,,1403,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INCISION & REMOVAL FB SUBQ TISS SIMPLE,36000253,CDM,,,,Both,,,768,192,,768,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INCISION & REMOVAL FB SUBQ TISS COMPL,36000254,CDM,,,,Both,,,2626,657,,2626,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE,36000256,CDM,,,,Both,,,2420,605,,2420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP,36000257,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,36000258,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSE TX OF NASAL BONE FX W/MANIP AND W/ STABILIZ,36000260,CDM,,,,Both,,,4820,1205,,4820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TMJ DISLOCATION INT /SUB,36000261,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D SHOULDER DEEP ABSCESS/HEMATOMA,36000263,CDM,,,,Both,,,4177,1044,,4177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS,36000264,CDM,,,,Both,,,1159,290,,1159,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CLAVICULAR FX WO MANIP,36000265,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CLAVICULAR FX W MANIP,36000266,CDM,,,,Both,,,2148,537,,2148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SCAPULAR FX WO MANIP,36000267,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SCAPULAR FX W MANIP,36000268,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PROX HUMERAL FX WO MANIP,36000269,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PROX HUMERAL  FX W MANIP,36000270,CDM,,,,Both,,,3148,787,,3148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX GR TUBEROSITY FX WO MANIP,36000271,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX GR TUBEROSITY FX W MANIP,36000272,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL SHLDR DISL W MANI WO AN,36000273,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SHLDR DISLOC & FX GT W MAN,36000274,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL FB UPPER ARM/ELBOW SUBC,36000275,CDM,,,,Both,,,2420,605,,2420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL FB UPPER ARM/ELBOW DEEP,36000276,CDM,,,,Both,,,4174,1044,,4174,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX HUMERAL SHAFT FRACTURE W/O MANIPULATION,36000277,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ,36000278,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ,36000279,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ,36000280,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX HUMERAL EPICONDY FX MEDIAL/LAT W/O MANJ,36000281,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX HUMERAL EPICONDY FX MEDIAL/LAT W/MANJ,36000282,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ELBOW DISLOCATION W/O ANES,36000283,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ,36000284,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX RADIAL HEAD/NECK FX W/O MANIPULATION,36000285,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX RADIAL HEAD/NECK FX W/MANIPULATION,36000286,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ULNAR FRACTURE PROXIMAL END W/O MANJ,36000287,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ULNAR FRACTURE PROXIMAL END W MANJ,36000288,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TXRADIAL SHAFT FRACTURE W/O MANIPULATION,36000289,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX RADIAL SHAFT FRACTURE W/MANIPULATION,36000290,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ULNAR SHAFT FRACTURE W/O MANIPULATION,36000291,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ULNAR SHAFT FRACTURE W/MANIPULATION,36000292,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX RADIAL&ULNAR SHAFT FRACTURES W/O MANJ,36000293,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ,36000294,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CARPAL BONE FX W/O MANJ EACH BONE,36000295,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CARPAL BONE FX W/MANJ EACH BONE,36000296,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ,36000297,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX DISTAL RADIOULNAR DISLOCATION W/MANJ,36000298,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TRANS SCAPHOPRILUNAR TYP FX DISLC W/MANJ,36000299,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN FINGER ABSC SIMPLE,36000300,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE FINGER ABSCESS COMPLICATED,36000301,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX METACARPAL FX W/O MANI EACH BONE,36000302,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX METACARPAL FX W/MANI EACH BONE,36000303,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CARPO/METACARPAL DISLC THUMB W/MANJ,36000304,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CARPO/METACARPAL FX DISLC THUMB W/MANJ,36000305,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES,36000306,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES,36000307,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA,36000308,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA,36000309,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ARTICULAR FX INVG MTCARPHLNGL/IPHAL JT W/O,36000310,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ARTICULAR FX INVG MTCARPHLNGL/IPHAL JT W/,36000311,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA,36000312,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX DSTL PHLNGL FX FNGR/THMB W/MANJ EA,36000313,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX IPHAL JT DISLC W/MANJ W/O ANES,36000314,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FEMORAL SHAFT FX W/O MANIPULATION,36000315,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ,36000316,CDM,,,,Both,,,2148,537,,2148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ,36000317,CDM,,,,Both,,,732,183,,732,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ,36000318,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PATELLAR FRACTURE W/O MANIPULATION,36000319,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TIBIAL FX PROXIMAL W/O MANIPULATION,36000320,CDM,,,,Both,,,762,191,,762,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX KNEE DISLOCATION W/O ANESTHESIA,36000321,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PATELLAR DISLOCATION W/O ANESTHESIA,36000322,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC  CL TX  ANKLE DISLOCATION W/O ANESTHESIA,36000323,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE LEG/ANKLE,36000324,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM FB FOOT SUBCUTANEOUS,36000325,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY CAST SHOULDER SPICA,36000326,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY CAST SHOULDER HAND LONG ARM,36000327,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY CAST ELBOW FINGER SHORT ARM,36000328,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY CAST HAND&LOWER FOREARM GAUNTLET,36000329,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY LONG ARM SPLINT SHOULDER HAND,36000330,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY SHORT ARM SPLINT FOREARM HAND STATIC,36000331,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY SHORT ARM SPLINT DYNAMIC,36000332,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY FINGER SPLINT STATIC,36000333,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY FINGER SPLINT DYNAMIC,36000334,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRAPPING THORAX,36000335,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRAPPING SHOULDER,36000336,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRAPPING ELBOW/WRIST,36000337,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRAPPING HAND/FINGER,36000338,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY LONG LEG CAST THIGH TOE,36000339,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY SHORT LEG CAST BELOW KNEE TOE,36000340,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY SHORT LEG CAST WALKING/AMBULATORY,36000341,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY PATELLAR TENDON BEARING CAST,36000342,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ADDING WALKER PREVIOUSLY APPLIED CAST,36000343,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY LONG LEG SPLINT THIGH ANKLE/TOES,36000344,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY SHORT LEG SPLINT CALF FOOT,36000345,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRAPPING HIP,36000346,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRAPPING KNEE,36000347,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRAP ANKLE OR FOOT,36000348,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRAPPING OF TOES,36000349,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC STRAPPING, UNNA BOOT",36000350,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WINDOWING OF CAST,36000352,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WEDGING OF CAST NOT CLUBFOOT CAST,36000353,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE CASTING OR STRAPPING,36000354,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM FB INTRANASAL,36000355,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONTROL NASAL HEMORRH ANT SIMPLE,36000356,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONTROL NASAL HEMORRH ANT COMPLEX,36000357,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST,36000358,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,36000359,CDM,,,,Both,,,2322,581,,2322,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LARYNGOSCOPY INDIRECT W/REMOVAL FB,36000360,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VNPNXR <3 YEARS PHYS SKILL FEMORAL/JUGULAR VEIN,36000361,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VNPNXR <3 YEARS PHYS SKILL SCALP VEIN,36000362,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VNPNXR <3 YEARS PHYS SKILL OTHER VEIN,36000363,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VEINPUNCTURE AGE 3 YEARS/> PHYS SKILL,36000364,CDM,,,,Both,,,595,149,,595,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PUSH TRANSFUSION BLOOD 2 YR/UNDER,36000365,CDM,,,,Both,,,1062,266,,1062,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ NON TUNNELED CVC AGE < 5 YR,36000366,CDM,,,,Both,,,5816,1454,,5816,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ NON TUNNELED CVC AGE 5 YR/>,36000367,CDM,,,,Both,,,5043,1261,,5043,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,36000368,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE NEEDLE INTRAOSSEOUS INFU,36000369,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPR LIP FULL THICKNESS VERMILION ONLY,36000370,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPR LIP FULL THICKNESS HALF/< VERTICAL HEIGHT,36000371,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL,36000372,CDM,,,,Both,,,1835,459,,1835,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL EMBEDDED FB VESTIBULE MOUTH COMP,36000373,CDM,,,,Both,,,1199,300,,1199,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<,36000374,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPLX,36000375,CDM,,,,Both,,,1199,300,,1199,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPR LAC 2.5 CM/< MOUTH&/ANT TWOTHIRDS TONGUE,36000376,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPR LAC 2.5 CM/< PST ONETHIRD TONGUE,36000377,CDM,,,,Both,,,762,191,,762,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX,36000378,CDM,,,,Both,,,1199,300,,1199,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DR ABSC CYST HEMATOM DENTOALVE,36000379,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D ABSCESS PERITONSILLAR,36000380,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE FOREIGN BODY PHARYNX,36000381,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER,36000382,CDM,,,,Both,,,3787,947,,3787,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ NON NDWELLG BLADDER CATHETER,36000383,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D VULVA/PERINEAL ABSCESS,36000384,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLPORRHAPHY SUTURE INJURY VAGINA,36000385,CDM,,,,Both,,,4622,1156,,4622,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC,36000386,CDM,,,,Both,,,2504,626,,2504,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,36000387,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR,36000388,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP,36000389,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP,36000390,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLEPHAROTOMY DRAINAGE ABSCESS EYELID,36000391,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL EMBEDDED FOREIGN BODY EYELID,36000392,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE,36000393,CDM,,,,Both,,,1429,357,,1429,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX,36000394,CDM,,,,Both,,,2305,576,,2305,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL FB XTRNL AUDITORY CANAL W/O ANES,36000395,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE IMPACTED EAR WAX W/INSTRUMENT UNI,36000396,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARDIOPULMONARY RESUSCITATION,36000397,CDM,,,,Both,,,1134,284,,1134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,36000398,CDM,,,,Both,,,1391,348,,1391,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVAC SUBUNGUAL HEMATOMA,36000399,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTERIAL CATH SAMPLE/MON/TRAN,36000400,CDM,,,,Both,,,1552,388,,1552,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTER CATH SAMP/MON/TRA CUTDOW,36000401,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONTROL OROPHARYNGEAL HEMORRH; SIMPLE,36000403,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,36000404,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATHETER ASPIRATION NASOTRACHEAL SPX,36000406,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYST W INS OF INDWELLING URETER STENT,36000407,CDM,,,,Both,,,4842,1211,,4842,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR,36000408,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,36000409,CDM,,,,Both,,,3498,875,,3498,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D HEMATOMA SEROMA/FLUID COLLECTION,36000410,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,36000411,CDM,,,,Both,,,2475,619,,2475,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY MULTILAYER COMPRESS ARM & HAND,36000414,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM,36000415,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM,36000416,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM,36000417,CDM,,,,Both,,,7953,1988,,7953,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM,36000418,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM,36000419,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM,36000420,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM,36000421,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM,36000422,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE NOSE,36000423,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROSTATE NEEDLE BIOPSY ANY APPROACH,36000426,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT,36000427,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN,36000428,CDM,,,,Both,,,1211,303,,1211,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL GUIDEWIRE INSERTION,36000429,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY,36000430,CDM,,,,Both,,,5409,1352,,5409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS,36000431,CDM,,,,Both,,,5409,1352,,5409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSORAL BIOPSY,36000433,CDM,,,,Both,,,1139,285,,1139,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ,36000435,CDM,,,,Both,,,1074,269,,1074,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX,36000436,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPENDEC INDICATED PURPOSE OTH MAJOR PX X SPX,36000437,CDM,,,,Both,,,3072,768,,3072,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SALPINGO OOPHORECTOMY COMPL/PRTL UNI/BI SPX,36000438,CDM,,,,Both,,,6619,1655,,6619,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OOPHORECTOMY PARTIAL/TOTAL UNI/BI,36000439,CDM,,,,Both,,,6618,1655,,6618,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERTION INDWELLING TUNNELED PLEURAL CATHETER,36000440,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX,36000441,CDM,,,,Both,,,6619,1655,,6619,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTRIC INTUBAT&ASPIRA W/PHYS SKILL/LAVAGE,36000442,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UMBILICAL VEIN CATH INSERTION,36000443,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSORAL LIGATION,36000444,CDM,,,,Both,,,3303,826,,3303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HYSTEROTOMY ABDOMINAL,36000445,CDM,,,,Both,,,7769,1942,,7769,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX,36000446,CDM,,,,Both,,,8008,2002,,8008,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC FNA BX W/O IMAGING GUIDANCE, 1ST LESION",36000447,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURSA,36000448,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CIRCUMCISION SURGICAL NEONATE <=28 DAYS,36000449,CDM,,,,Both,,,3820,955,,3820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DECLOT  W/THROMBO AGENT IMPLANT DEVICE/CATH,36000451,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT GASTROSTOMY TUBE PERCUTANEOUS,36000452,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA,36000453,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRO LONG GI TUBE SEPARATE PROCEDURE,36000454,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE,36000455,CDM,,,,Both,,,9747,2437,,9747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL DIAGNOSTIC BRUSH/WASH,36000456,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL INTRAUTERINE DEVICE IUD,36000457,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CIRCUMCISION SURGICAL AGE >28 DAYS,36000459,CDM,,,,Both,,,3820,955,,3820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT VAD EC SGL V,36000460,CDM,,,,Both,,,17856,4464,,17856,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERAPEUTIC APHERESIS PLASMA PHERESIS,36000461,CDM,,,,Both,,,2896,724,,2896,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG,36000462,CDM,,,,Both,,,8213,2053,,8213,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ORBITAL IMPLANT REMOVAL/REVISION,36000463,CDM,,,,Both,,,5825,1456,,5825,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CERCLAGE CERVIX PREGNANCY VAGINAL,36000464,CDM,,,,Both,,,4622,1156,,4622,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILATION LACRIMAL PUNCTUM W/WO IRRGATION,36000465,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB,36000466,CDM,,,,Both,,,10678,2670,,10678,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT,36000467,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEAS POST VOIDING RESIDUAL URINE&/BLDR CAP,36000468,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX,36000469,CDM,,,,Both,,,1261,315,,1261,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCHNG TRANSFUSION BLOOD OTHER/THAN NEW BORN,36000470,CDM,,,,Both,,,1210,303,,1210,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORALW/TRANSMURAL DRAIN CYST,36000471,CDM,,,,Both,,,8868,2217,,8868,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL INJECTION VARICES,36000472,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL LIGATION VARICES,36000473,CDM,,,,Both,,,2569,642,,2569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL PLACE GASTRO TUBE,36000474,CDM,,,,Both,,,2857,714,,2857,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL DILATE STRICTURE,36000475,CDM,,,,Both,,,2563,641,,2563,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL RMVL TUMOR POLYP LESION HOT BX,36000476,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL CONTROL BLEEDING,36000477,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY STOMA W/RMVL F  B,36000480,CDM,,,,Both,,,1216,304,,1216,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE,36000481,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLSC STOMA W/RMVL TUMOR POLYP LESION HOT BX FORCEP,36000482,CDM,,,,Both,,,1589,397,,1589,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA,36000483,CDM,,,,Both,,,10678,2670,,10678,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SGMDSC FLX DCMPRN VOLVULUS ANY METHOD,36000484,CDM,,,,Both,,,1242,311,,1242,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLSC FLEXIBLE W/RMVL TUMOR POLYP LESION SNARE TECH,36000485,CDM,,,,Both,,,2730,683,,2730,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NASAL/SINUS ENDO DX MAXILLARY SINUSOSCOPY,36000487,CDM,,,,Both,,,731,183,,731,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS,36000489,CDM,,,,Both,,,1589,397,,1589,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOSCOPY UPPER SMALL INTESTINE,36000490,CDM,,,,Both,,,2563,641,,2563,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY,36000491,CDM,,,,Both,,,3303,826,,3303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING,36000492,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN,36000493,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPECS,36000494,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN,36000495,CDM,,,,Both,,,1335,334,,1335,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN,36000496,CDM,,,,Both,,,1240,310,,1240,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMICAL CAUTERIZATION GRANULATION TISSUE,36000498,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN T/A/L 0.5 CM/<,36000499,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN T/A/L 0.6-1.0 CM,36000500,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN T/A/L 1.1- 2.0 CM,36000501,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN T/A/L 2.1- 3.0 CM,36000502,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN S/N/H/F/G 0.5 CM/<,36000503,CDM,,,,Both,,,2420,605,,2420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN S/N/H/F/G 0.6-1.0CM,36000504,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN S/N/H/F/G 1.1-2.0CM,36000505,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN S/N/H/F/G 2.1-3.0CM,36000506,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN S/N/H/F/G 3.1-4.0CM,36000507,CDM,,,,Both,,,2392,598,,2392,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN S/N/H/F/G > 4.0CM,36000508,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN F/E/E/N/L/M 0.5CM/<,36000509,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN F/E/E/N/L/M 0.6-1.0CM,36000510,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN F/E/E/N/L/M 1.1-2.0CM,36000511,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN F/E/E/N/L/M 2.1-3.0CM,36000512,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN F/E/E/N/L/M 3.1-4.0CM,36000513,CDM,,,,Both,,,2330,583,,2330,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXC BENIGN LES MRGN F/E/E/N/L/M > 4.0CM,36000514,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL DEVITAL TISS NSLCTV DBRDMT W/O ANES 1 SESS,36000515,CDM,,,,Both,,,303,76,,303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL SNARE TUMOR POLYP LESION,36000516,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX,36000517,CDM,,,,Both,,,1240,310,,1240,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX,36000518,CDM,,,,Both,,,1816,454,,1816,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE,36000519,CDM,,,,Both,,,2089,522,,2089,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY STOMA CONTROL BLEEDING,36000520,CDM,,,,Both,,,1589,397,,1589,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR,36000523,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR F/E/E/N/L/M 12.6CM-20.0CM,36000524,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR F/E/E/N/L/M 20.1CM-30.0CM,36000525,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMPL RPR F/E/E/N/L/M >30.0CM,36000526,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR N-HF/GENIT 12.6-20 CM,36000527,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR N-HF/GENIT 20.1-30.0 CM,36000528,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR N-HF/GENIT >30.0 CM,36000529,CDM,,,,Both,,,2816,704,,2816,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR FACE/MM 12.6-20.0CM,36000530,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR FACE/MM 20.1-30.0CM,36000531,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTMD WND RPR FACE/MM > 30.0 CM,36000532,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D BURSA FOOT,36000533,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,36000534,CDM,,,,Both,,,5752,1438,,5752,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE/BIVALVE GAUNTLET BOOT/BODY CAST,36000535,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL/BIVALVING FULL ARM/FULL LEG CAST,36000536,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLEPHAROPLASTY LOWER EYELID,36000537,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLEPHAROPLASTY UPPER EYELID,36000538,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY RIGID TOTAL CONTACT LEG CAST,36000539,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL,36000540,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR PATENT DUCTUS ARTERIOSUS LIGATION,36000542,CDM,,,,Both,,,12471,3118,,12471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR,36000543,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMNIOCENTESISS THER AMNIOTIC FLUID RDCTJ US GID,36000544,CDM,,,,Both,,,758,190,,758,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTO W/SIMPLE REMOVAL STONE & STENT,36000545,CDM,,,,Both,,,3849,962,,3849,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY STENT EA ADDL,36000546,CDM,,,,Both,,,1174,294,,1174,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY W/TRANSBRNCL LUNG BX 1 LOBE,36000548,CDM,,,,Both,,,5457,1364,,5457,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SUBCONJUNCTIVAL INJECTION,36000549,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX,36000550,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX,36000551,CDM,,,,Both,,,2445,611,,2445,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABDOM PARACENTESIS DX/THER W/O IMAG GUIDE,36000552,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NASOPHARYNGOSCOPY W/ENDOSCOPE SPX,36000553,CDM,,,,Both,,,252,63,,252,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL REMOVE FOREIGN BODY,36000554,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE/BIVALVE SHLD/HIP SPICA,36000555,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERTION CERVICAL DILATOR SEPARATE PROCEDURE,36000557,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS,36000558,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE,36000559,CDM,,,,Both,,,1864,466,,1864,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL BIOPSY SINGLE/MULTI,36000560,CDM,,,,Both,,,4200,1050,,4200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY BRNCHL/ENDOBRNCL BX 1+ SITES,36000561,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>,36000562,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRACHEOSTOMY FENESTRATION W/SKIN FLAPS,36000563,CDM,,,,Both,,,4437,1109,,4437,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLTR SKIN AGRFT T/A/L ADDL 1 SQ CM-75 SQ CM,36000564,CDM,,,,Both,,,372,93,,372,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<,36000565,CDM,,,,Both,,,2696,674,,2696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCHNG TRANSFUSION BLOOD NEWBORN,36000566,CDM,,,,Both,,,1120,280,,1120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INSJ PICC >5 YR, W/O PORT OR PUMP,  W/O IMAGING GUIDANCE",36000567,CDM,,,,Both,,,2933,733,,2933,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRID MUSCLE/FASCIA 1ST 20SQCM OR <,36000569,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AVULSION NAIL PLATE PART/COMP EA ADDL,36000570,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL IMPLANT CONTRACEPT CAP,36000571,CDM,,,,Both,,,953,238,,953,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESCHAROTOMY ADD'L INCISION,36000572,CDM,,,,Both,,,281,70,,281,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POST TONSIL BLEED CONTROL COMPLEX,36000574,CDM,,,,Both,,,616,154,,616,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IRR CORPORA CAVERNOSA FOR PRIAPISM,36000575,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM<,36000576,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,36000577,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRIDEMENT OPEN WOUND 20 SQ CM/<,36000578,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN ABSC/HEMATOMA; NASAL; INT APPROACH,36000579,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRID BONE EA ADDL 20SQ CM OR <,36000580,CDM,,,,Both,,,1245,311,,1245,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSE TX NASAL BONE FX W/MANIP W/O STABILIZ,36000581,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX NASOMAXILLARY COMPLEX FRACTURE,36000582,CDM,,,,Both,,,13618,3405,,13618,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FX OF ORBIT W/O BLOWOUT W/O MANIP,36000583,CDM,,,,Both,,,1199,300,,1199,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FX ORBIT W/O BLOWOUT WITH MANIP,36000584,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PALATAL OR MAXILLARY FX,36000585,CDM,,,,Both,,,10166,2542,,10166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CRANIFACIAL SEP W/INTERDENTAL WIRE,36000586,CDM,,,,Both,,,10337,2584,,10337,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX MANDIB/ MAXIL ALVEOLAR RIDGE FX,36000587,CDM,,,,Both,,,10166,2542,,10166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX MANDIBULAR FX W/ INTERDENTAL FIX,36000588,CDM,,,,Both,,,8960,2240,,8960,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TEMPOROMANDIBULAR DISLOCAL COMPL,36000589,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D DEEP ABSCESS SOFT TIS NECK/THORAX,36000590,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D ABS NECK/THORAX W/PART RIB OSTECTOMY,36000591,CDM,,,,Both,,,5752,1438,,5752,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D OPEN DEEP ABS CERVICAL/THORACIC,36000592,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D OPEN DEEP ABS LUMBAR/SACRAL,36000593,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX VERTEB BODY FX W/O MANIP INCL CAST,36000594,CDM,,,,Both,,,834,209,,834,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX VERTEB FX DISLOC REQ CAST BY MANIP,36000595,CDM,,,,Both,,,5752,1438,,5752,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D SHOULDER AREA; INFECTED BURSA,36000596,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX STERNOCLAVICULAR DISL W/O MANIP,36000597,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX STERNOCLAVICULAR DISLOCAL W/MANIP,36000598,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ACROMIOCLAVICULAR DISLOC W/O MANIP,36000599,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ACROMIOCLAVICULAR DISLOC; W/MANIP,36000600,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SHLDR DIS W/SURG/ANA NECK FX W/MAN,36000601,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D UPPER ARM/ELBOW AREA DEEP ABS,36000602,CDM,,,,Both,,,4177,1044,,4177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D UPPER ARM OR ELBOW AREA; BURSA,36000603,CDM,,,,Both,,,3057,764,,3057,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX HUM CONDY FX MEDIAL/LAT W/O MANIP,36000604,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX HUM COND FX MEDIAL/LAT W/MANIP,36000605,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX MONTEGGIA FX DISLOC ELBOW W/MANIP,36000606,CDM,,,,Both,,,2148,537,,2148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D FOREARM AND/OR WRIST DEEP ABS,36000607,CDM,,,,Both,,,5752,1438,,5752,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D FOREARM AND/OR WRIST; BURSA,36000608,CDM,,,,Both,,,2475,619,,2475,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXPLORE W/REMOVE DEEP FB FOREARM/WRIST,36000609,CDM,,,,Both,,,3075,769,,3075,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX RAD SHAFT FX (GALEAZZI FX/DISLOC),36000610,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX OF ULNAR STYLOID FRACTURE,36000611,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX LUNATE DISLOCATION W/ MANIPULATION,36000612,CDM,,,,Both,,,2148,537,,2148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN TENDON SHEATH DIGIT AND/OR PALM EA,36000613,CDM,,,,Both,,,4750,1188,,4750,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DRAINAGE OF PALMAR BURSA; SINGLE, BURSA",36000614,CDM,,,,Both,,,5752,1438,,5752,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE OF PALMAR BURSA; MULTIPLE BURSA,36000615,CDM,,,,Both,,,4750,1188,,4750,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTHR W/EXPL DRAIN/REM FB CMC JOINT,36000616,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTHR W/EXPL DRAIN/REM FB MCPHL JOINT EA,36000617,CDM,,,,Both,,,10166,2542,,10166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARTHR W/EXPL DRAIN/REM FB INPHL JOINT EA,36000618,CDM,,,,Both,,,10166,2542,,10166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX DISTAL EXTENSOR TENDON FINGER,36000619,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX MCP FX W/MANIP W/EXT FIX EA BONE,36000620,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D PELVIS OR HIP JOINT AREA DEEP ABS,36000621,CDM,,,,Both,,,4989,1247,,4989,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D PELVIS/HIP JOINT AREA INFECTED BURSA,36000622,CDM,,,,Both,,,2696,674,,2696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX OF COCCYGEAL FRACTURE,36000624,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ACETABUL (HIP SOCKET) FX W/O MANIP,36000625,CDM,,,,Both,,,780,195,,780,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ACETA FX W/MANIP W OR WO SKEL TRAC,36000626,CDM,,,,Both,,,1461,365,,1461,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FEM FX PROXIMAL END NECK W/O MANIP,36000627,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FEM FX PROX W/MANIP W/WO SKEL TRAC,36000628,CDM,,,,Both,,,2830,708,,2830,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SUBTROCHANTERIC FEM FX WO MANIP,36000629,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SUBTRO FEM FX W/MANIP W/WO SKL TRC,36000630,CDM,,,,Both,,,1430,358,,1430,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX GREATER TROCHANTERIC FX WO MANIP,36000631,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FEM FX PROXIMAL END HEAD W/MANIP,36000632,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D DEEP ABS/BURSA/HEM THIGH/KNEE REGION,36000633,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SUP/TRAN FEM FX W/WO EXT WO MANIP,36000634,CDM,,,,Both,,,739,185,,739,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SUP/TRAN FEM FX W/MANIP W/WO TRAC,36000635,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX DIS FEM EPIPHYSEAL SEP WO MANIP,36000636,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX DISTAL FEM SEP W/MANIP W/WO TRAC,36000637,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TIBIAL FX PROX W/WO MANIP W/TRAC,36000638,CDM,,,,Both,,,4750,1188,,4750,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SPINE &/OR TUB FX KNEE W/WO MANIP,36000639,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D LEG OR ANKLE; INFECTED BURSA,36000640,CDM,,,,Both,,,4989,1247,,4989,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FX DIS TIB W/WO ANES WO MANIP,36000641,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FX DIS TIB W/WO ANES W/TRAC,36000642,CDM,,,,Both,,,2148,537,,2148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PROX TIBIOFIB JOINT DISLO REQ ANES,36000643,CDM,,,,Both,,,4750,1188,,4750,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX ANK DIS REQ ANES W/WO PER SKEL FIX,36000644,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D FASCIA W/WO TEN SHEATH INV FT MULTI,36000645,CDM,,,,Both,,,5752,1438,,5752,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM FB FOOT DEEP,36000646,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM FB FOOT COMPLICATED,36000647,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SESAMOID FRACTURE,36000648,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX OF TALOTARSAL JOINT DISLOC WO ANES,36000649,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TARSOMETATARS JOINT DISLOC WO ANES,36000650,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE ABSCESS / HEMATOMA NASAL SEPTUM,36000651,CDM,,,,Both,,,826,207,,826,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN LYMPH ABS / LYMPHADENITIS SIMPLE,36000652,CDM,,,,Both,,,4817,1204,,4817,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN LYMPH ABS / LYMPHADENITIS EXTENS,36000653,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN ABS/HEM/VESTIBULE OF MOUTH SIMPLE,36000654,CDM,,,,Both,,,1379,345,,1379,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN ABS/HEM/VESTIBULE OF MOUTH COMPL,36000655,CDM,,,,Both,,,1199,300,,1199,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM FB FROM DENTOALVEOLAR STRUCTURE BONE,36000656,CDM,,,,Both,,,2072,518,,2072,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DRAINAGE OF ABSCESS OF PALATE, UVULA",36000657,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DRAINAGE OF ABSCESS; PAROTID, SIMPLE",36000658,CDM,,,,Both,,,2072,518,,2072,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DRAINAGE OF ABSCESS PAROTID, COMPLICATED",36000659,CDM,,,,Both,,,4820,1205,,4820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN ABS SUBMAXIL/SUBLINGUAL INTRAORAL,36000660,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE ABSCESS SUBMAXILLARY EXTERNAL,36000661,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D ABSCESS; RETROPHARYNGEAL; INTERNAL,36000662,CDM,,,,Both,,,4820,1205,,4820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D ABSCESS; RETROPHARYNGEAL; EXTERNAL,36000663,CDM,,,,Both,,,8960,2240,,8960,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D OF APPENDICEAL ABSCESS; OPEN,36000664,CDM,,,,Both,,,1113,278,,1113,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D DEEP SUPRALEVATOR PELVIRECTAL ABSC,36000666,CDM,,,,Both,,,4158,1040,,4158,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D PERIRECTAL OR ISCHIAL ABSCESS,36000667,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D SUPERF ABSCESS PERI/ISCHEAL,36000669,CDM,,,,Both,,,4304,1076,,4304,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D ISCHIORECTAL ABS,36000671,CDM,,,,Both,,,4304,1076,,4304,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTROY INTERNAL HEMORRHOIDS,36000673,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMORRHOIDOPEXY BY STAPLING,36000675,CDM,,,,Both,,,13618,3405,,13618,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN PERITONEAL ABSCESS OR CYST OPEN,36000677,CDM,,,,Both,,,2297,574,,2297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN SUBDIAPHRAGMATIC ABSCESS OPEN,36000679,CDM,,,,Both,,,1478,370,,1478,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE OF RETROPERITONEAL ABSCES OPEN,36000681,CDM,,,,Both,,,1587,397,,1587,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN EXTRAPERITONEAL LYMPHOCELE,36000683,CDM,,,,Both,,,1068,267,,1068,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE DUOD/JEJ TUBE PERC,36000684,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE G J TUBE PERC W/FLURO,36000685,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE OF PERIRENAL OR RENAL ABS OPEN,36000686,CDM,,,,Both,,,2945,736,,2945,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN PERIVESICAL/PREVESICAL SPACE ABS,36000688,CDM,,,,Both,,,4177,1044,,4177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLDR IRRIGATION SMPL LAVAGE&/INSTLJ,36000689,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE OF DEEP PERIURETHRAL ABSCESS,36000690,CDM,,,,Both,,,6654,1664,,6654,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE OF SKENE'S GLAND ABS OR CYST,36000691,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DR PERIN URINARY EXTRAVAS; UNCOMPLICATED,36000692,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DR PERIN URINARY EXTRAVAS; COMPLICATED,36000693,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INCISION AND DRAINAGE OF PENIS, DEEP",36000694,CDM,,,,Both,,,9747,2437,,9747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE OF SCROTAL WALL ABSCESS,36000695,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D VAGINAL HEMATOMA OB/POSTPARTUM,36000696,CDM,,,,Both,,,4817,1204,,4817,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D VAGINAL HEMATOMA  NOT OB,36000697,CDM,,,,Both,,,4177,1044,,4177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANT COLPORRHAPHY CYSTOLE W/WO URTHROCELE,36000698,CDM,,,,Both,,,10678,2670,,10678,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POST COLPORRHAPHY RECTOCELE W/WO PERIN,36000699,CDM,,,,Both,,,10678,2670,,10678,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMBINED ANTEROPOSTERIOR COLPORRHAPHY,36000700,CDM,,,,Both,,,10678,2670,,10678,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMB ANT/POST COLPORRHAPHY W ENTEROCELE,36000701,CDM,,,,Both,,,13618,3405,,13618,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PEREYRA PROC INC ANT COLPORRHAPHY,36000702,CDM,,,,Both,,,11960,2990,,11960,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE OF OVARIAN CYST(S) VAGINAL,36000703,CDM,,,,Both,,,5331,1333,,5331,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAINAGE OF OVARIAN CYST(S) ABDOMINAL,36000704,CDM,,,,Both,,,4039,1010,,4039,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN OVARIAN ABS VAGINAL APPROACH OPEN,36000705,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN OVARIAN ABS ABDOMINAL APPROACH,36000706,CDM,,,,Both,,,1586,397,,1586,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC I&D OF THYROGLOSSAL DUCT CYST, INFECTED",36000708,CDM,,,,Both,,,2072,518,,2072,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLLECTION CAPILLARY BLOOD SPECIMEN,36000710,CDM,,,,Both,,,32,8,,32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENIPUNCTURE CUTDOWN; 1YR OR YOUNGER,36000711,CDM,,,,Both,,,1120,280,,1120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENIPUNCTURE CUTDOWN; 1YR OR OLDER,36000712,CDM,,,,Both,,,1120,280,,1120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THROMBOLYSIS CEREBRAL; INTRAVEN INFUSION,36000713,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASPIRATION OFBLADDER; BY NEEDLE,36000714,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASPIRATION OFBLADDER; TROCAR/INTRACATH,36000715,CDM,,,,Both,,,1409,352,,1409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANES TRIGEMINAL NERVE ANY DIV/BRANCH,36000716,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX INTRPHGL JNT DIS SNGL W/MAN W/ANES,36000717,CDM,,,,Both,,,2285,571,,2285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WOUND EXPLORATION NECK,36000718,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WOUND EXPLORATION CHEST,36000719,CDM,,,,Both,,,2696,674,,2696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WOUND EXPLORATION TRUNK,36000720,CDM,,,,Both,,,2624,656,,2624,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXPL P WND EXTREM,36000721,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ TENDON ORIGIN/INSERTION,36000722,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRIG PT INJ(S) 3 > MUSCLE(S),36000723,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASPIRATION/INJECTION GANGLION CYST,36000724,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC REM IMPLANT SUPFCL(BURIED WIRE,PIN,ROD)",36000725,CDM,,,,Both,,,2350,588,,2350,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLD TX NASAL SEPTAL FX W/WO STABILIZATIN,36000726,CDM,,,,Both,,,4820,1205,,4820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLD TX MANDIBLE W/O MANIP,36000727,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLD TX MANDIBLE W/MANIP,36000728,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRADENTAL WIRING OTHER THAN FX,36000729,CDM,,,,Both,,,2072,518,,2072,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSED TREATMENT STERNUM FR,36000730,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX RADIAL & ULNAR FX W/O MA,36000732,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FRAC RADIUS/ULNA W MAN,36000733,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX NAVICULAR FX W/O MANIP,36000734,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX NAVICULAR FX W/MANIP,36000735,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FINGER FLEXOR TENDON REPAIR,36000736,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REP EXTENSR TENDN HAND W/O GRFT EA TENDO,36000737,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FINGER TENDON REPAIR EA WO GRF,36000738,CDM,,,,Both,,,10166,2542,,10166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FB REMOV HIP/PELV SQ,36000739,CDM,,,,Both,,,4817,1204,,4817,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FB REMOV HIP/PELV DEEP,36000740,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TRAUMA HIP DICLOC WO ANE,36000741,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SPONTA HIP DISLOC W/O AN,36000742,CDM,,,,Both,,,762,191,,762,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX POST HIP ARTHROPLAS DISLOC W/O ANE,36000743,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TIB SHFT FX WO MANIP,36000744,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TIB SHFT FX W MANIP,36000745,CDM,,,,Both,,,2148,537,,2148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX  MEDIAL ANKLE FX WO MAN,36000746,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX  MEDIAL ANKLE FX W MAN,36000747,CDM,,,,Both,,,2148,537,,2148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PROX FIB/SHAFT FX WO MAN,36000748,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PROX FIB/SHAFT FX W MAN,36000749,CDM,,,,Both,,,2148,537,,2148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX DSTL FIB FX WO MANIP,36000750,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX DISTL FIB FX W MANIP,36000751,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX BIMALLEOLAR FX W/O MAN,36000752,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX BIMALLEOLAR FX W MAN,36000753,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TRIMALLEOLAR FX W/O MAN,36000754,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TRIMALLEOLAR FX W MAN,36000755,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CLSD TX PROX TIB/FIB DISLOC, W/O ANEST",36000756,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC REPAIR FLEX TENDON FOOT, W/O GRAFT EACH",36000757,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR EXTEN TENDON FOOT W/O GRAFT EACH,36000758,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CALCANEAL FX WO MA,36000759,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX CALCANEAL FX W MA,36000760,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TALUS FX WO MANIP,36000761,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TALUS FX W MANIP,36000762,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TARSAL BONE FX W/O MAN,36000763,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TARSAL BONE FX W MAN,36000764,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX METATARSAL FX WO MANIP,36000765,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX METATARSAL FX W MANIP,36000766,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FX GT PHALANX(S) WO MANI,36000767,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FX GT PHALANX(S) W MANI,36000768,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FX PHALNX/PHALANG WO MAN,36000769,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX FX PHALANX/PHALANG W MAN,36000770,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TARSAL BONE DISLOC WO AN,36000771,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX MTP JNT DISLOC WO ANESTH,36000772,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX IP JOINT DISL WO ANESTH,36000773,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY PLASTER VALPEAU CAST,36000774,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY CAST CLUBFOOT,36000775,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX THIGH FX W/O MANIP,36000776,CDM,,,,Both,,,5752,1438,,5752,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX POST ANKLE FX W/O MANIP,36000777,CDM,,,,Both,,,1288,322,,1288,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL FX POST ANKLE FX W MANIP,36000778,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POSTERIOR NASAL PACKING SUBSQUENT,36000779,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LARYNGOSCOPY, FLEX W REM OF FB",36000780,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRACHEOBRONCHOSCOPY THRU EST TRACH INCSN,36000781,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY W/REMOVAL OF FB,36000782,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEST TUBE INSERTION,36000783,CDM,,,,Both,,,2154,539,,2154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOTOMY MAJOR CTRL TRAUM LUNG TEAR,36000784,CDM,,,,Both,,,2116,529,,2116,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR BLOOD VESSEL UPPER EXTREMITY,36000786,CDM,,,,Both,,,7828,1957,,7828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR BLOOD VESSEL HAND/FINGER,36000787,CDM,,,,Both,,,7828,1957,,7828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR BLOOD VESSEL INTRA ABDOMINAL,36000788,CDM,,,,Both,,,2299,575,,2299,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR BLOOD VESSEL LOWER EXTREMITY,36000789,CDM,,,,Both,,,2658,665,,2658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LARYNGOSCOPIC EXAM,36000790,CDM,,,,Both,,,2393,598,,2393,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR LIP FULL THICK>1/2 VERT,36000791,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSORAL BALLOON <30MM,36000792,CDM,,,,Both,,,3303,826,,3303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILATION ESOPHAGUS OVER GUIDEWIRE,36000793,CDM,,,,Both,,,3289,822,,3289,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPG/GSTR TAMP W/BALO SENGSTAKEN TYPE,36000795,CDM,,,,Both,,,1051,263,,1051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D RECTAL ABSCESS,36000796,CDM,,,,Both,,,2735,684,,2735,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I & D PERIANAL ABSCESS,36000797,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INCISE THROMBOS HEMORRHOID EXT,36000798,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMORRHOIDECTOMY INTERNAL BY RUBBER BAND,36000799,CDM,,,,Both,,,1275,319,,1275,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION EXTRNL THROMBOTIC HEMORRHOID,36000800,CDM,,,,Both,,,2735,684,,2735,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ SCLEROSING SOLUTION HEMORR,36000801,CDM,,,,Both,,,1275,319,,1275,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANOSCOPY;REMOVE FOREIGN BODY,36000802,CDM,,,,Both,,,1216,304,,1216,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ADJ TIS TRANS/REARRANGE E/N/E/L 10 SQ CM/<,36000805,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NASAL ENDO W/CONTROL NASAL HEMMORRHAGE,36000806,CDM,,,,Both,,,2393,598,,2393,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ TEMP NDWELLG BLADDER CATHETER COMP,36000807,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D EPIDIDYMIS TESTIS/SCROTAL,36000808,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D BARTHOLINS GLAND ABSCESS,36000809,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLPOCENTESIS,36000810,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERTION PESSARY DEVICE,36000811,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TWIST DRILL SUBDURAL/VENTRIC PUNCTURE,36000812,CDM,,,,Both,,,1681,420,,1681,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TWIST DRILL VENTRIC CATH/PRESSURE RECORD,36000813,CDM,,,,Both,,,1821,455,,1821,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TWIST DRILL EVAC/DRAIN SUBDURAL HEMATOMA,36000814,CDM,,,,Both,,,1964,491,,1964,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BURRHOLE EVAC/DRAIN EXTRADURAL HEMATOMA,36000815,CDM,,,,Both,,,1882,471,,1882,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BURRHOLE ASPIRATE HEMAT/CYST INTRACEREBR,36000816,CDM,,,,Both,,,1964,491,,1964,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BURRHOLE CATH,EEG ELECT,PRESSURE RECORD",36000817,CDM,,,,Both,,,1821,455,,1821,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH OTHR PERIPHERAL NRV,36000818,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEMPORARY TRANSCUTANEOUS PACIN,36000819,CDM,,,,Both,,,935,234,,935,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARDIOVERSION ELECTIVE INTERNAL,36000820,CDM,,,,Both,,,1140,285,,1140,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRUTCHFIELD OR GARDNER WELLS TONGS,36000821,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERITONEAL LAVAGE,36000822,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRITICAL CARE EACH ADDTL 30 MIN,36000825,CDM,,,,Both,,,1835,459,,1835,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CVC/PICC REPAIR TUN/NON TUN W/O PORT/PUMP,36000826,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INST SNG ELECTRODE PERM PAC/CARDIO DEFIB,36000827,CDM,,,,Both,,,14373,3593,,14373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INST 2 ELECTRODE PERM PAC/CARDIO DEFIB,36000828,CDM,,,,Both,,,14373,3593,,14373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE INDWELL TUNNEL PLEURAL CATH W CUF,36000830,CDM,,,,Both,,,1394,349,,1394,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD,36000833,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS PACE PULS GEN ONLY W/EXIST MULT LEAD,36000841,CDM,,,,Both,,,32811,8203,,32811,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS PACE CARDIODEFIB GEN W/EXIS SNG LEAD,36000843,CDM,,,,Both,,,40625,10156,,40625,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS/REP PACE CARDIODEFIB W/TRANS LEAD,36000844,CDM,,,,Both,,,66753,16688,,66753,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE & REPLACE PM GEN SINGLE,36000845,CDM,,,,Both,,,14373,3593,,14373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE & REPLACE PM GEN DUAL LEAD,36000846,CDM,,,,Both,,,18318,4580,,18318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE & REPLACE PM GEN MULTI LEAD,36000847,CDM,,,,Both,,,32811,8203,,32811,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT PULSE GEN W/DUAL LEADS,36000848,CDM,,,,Both,,,49479,12370,,49479,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT PULSE GEN W/MULTI LEADS,36000849,CDM,,,,Both,,,57869,14467,,57869,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE & REPLACE CVD GEN SINGLE LEAD,36000850,CDM,,,,Both,,,40625,10156,,40625,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE & REPLACE CVD GEN DUAL LEAD,36000851,CDM,,,,Both,,,40625,10156,,40625,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE & REPLACE CVD GEN MULTI LEAD,36000852,CDM,,,,Both,,,57869,14467,,57869,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE; ENDOCRINE SYSTEM,36000856,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BIOPSY, THYROID, PERCUTANEOUS",36000857,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ DISCOGRAM LUMBAR EACH,36000860,CDM,,,,Both,,,1013,253,,1013,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER,36000863,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER,36000864,CDM,,,,Both,,,157,39,,157,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL,36000865,CDM,,,,Both,,,11035,2759,,11035,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASPIR&/NJX RNL CYST/PELVIS NEEDLE PRQ,36000867,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEPHROSTOMY/NEPHROTOMY W/DRAINAGE,36000869,CDM,,,,Both,,,2299,575,,2299,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC UNLISTED PROCEDURE, BILIARY TRACT",36000871,CDM,,,,Both,,,3270,818,,3270,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC PLCMNT CCA STENT W EMBOL PROTECT,36000872,CDM,,,,Both,,,12631,3158,,12631,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC PLCMNT CCA STENT WO EMBOL PROTECT,36000873,CDM,,,,Both,,,12166,3042,,12166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT/REPLACE TEMTRANSVEN S ELECTRODE,36000874,CDM,,,,Both,,,14373,3593,,14373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT/REPLACE TEMTRANSVEN D ELECTRODE,36000875,CDM,,,,Both,,,14373,3593,,14373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRIM PRQ TRLUML MCHNL THRMBC 1ST VSL,36000876,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCRN COLONOSCOPY PT NOT HI RISK,36000878,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BX/EXC LYMPH NODE NEEDLE SUPERFICIAL,36000881,CDM,,,,Both,,,2420,605,,2420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION OF PERITONEAL/VENOUS SHUNT,36000882,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERC,36000883,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RENAL ARTERY ATHERECTOMY,36000884,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VISCERAL ARTERY ATHERECTOMY EA VESSEL,36000885,CDM,,,,Both,,,14037,3509,,14037,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA,36000886,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILIAC PTA INITIAL,36000888,CDM,,,,Both,,,9776,2444,,9776,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILIAC STENT INITIAL,36000889,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILIAC PTA EA ADDL,36000890,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILIAC STENT EA ADDL,36000891,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILIAC ATHERECTOMY EA,36000892,CDM,,,,Both,,,28765,7191,,28765,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEM/POP PTA,36000893,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEM/POP ATHERECTOMY,36000894,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEM/POP STENT,36000895,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEM/POP STENT & ATHERECTOMY,36000896,CDM,,,,Both,,,35697,8924,,35697,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL,36000898,CDM,,,,Both,,,28294,7074,,28294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/PERONEAL STENT & ATHERECTOMY INITIAL,36000899,CDM,,,,Both,,,28294,7074,,28294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/PERONEAL ATHERECTOMY EA ADDL,36000901,CDM,,,,Both,,,17638,4410,,17638,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/PERONEAL STENT INITIAL,36000902,CDM,,,,Both,,,28294,7074,,28294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/PER REVAS EA ADD VESS,36000903,CDM,,,,Both,,,11606,2902,,11606,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CER/T TRANSFORAM, EPIDRL,INJ,ADD'L",36000904,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LUMBAR TRANSFORAM,EPIDRL,INJ,SNGL",36000905,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LUMBAR TRANSFORAM,EPIDRL,INJ,ADD'L",36000906,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY,36000907,CDM,,,,Both,,,15691,3923,,15691,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRACRANIAL ANGIOPLASTY W/STENT,36000909,CDM,,,,Both,,,13000,3250,,13000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XRAY FLUORO EXAM OF G/COLON TUBE,36000910,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CISTERNAL/LATERAL C1 C2 PUNCTURE W/INJECTION,36000911,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BILIARY ENDOSCOPY VIS T TUBE, BIOPSY",36000912,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL,36000913,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL,36000914,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ HIP ARTHROGRAPHY W/O ANESTHESIA,36000915,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MANOMETRY URETEROSTOMY/INDW CATH,36000917,CDM,,,,Both,,,807,202,,807,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCHNG ABSC/CST DRG CATH RAD GID SPX,36000922,CDM,,,,Both,,,4067,1017,,4067,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL OF TRANS PACEMAKER ELECTRODE SIN,36000932,CDM,,,,Both,,,7828,1957,,7828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL OF TRANSVEN PACEMAKER ELECT DUAL,36000933,CDM,,,,Both,,,7828,1957,,7828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIPS ALL INCLUSIVE (PRIMARY),36000938,CDM,,,,Both,,,11610,2903,,11610,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE URETER STENT PERCUT,36000939,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS INTRAPERITONEAL CATHETER W/IMG GID,36000940,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLT 1/> LVR TUM PRQ RF,36000942,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BIOPSY, PANCREAS, PERC",36000944,CDM,,,,Both,,,2270,568,,2270,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY ABD/RETROPERI MASS PERC,36000946,CDM,,,,Both,,,2602,651,,2602,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT,36000947,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSURE INTESTINAL CUTANEOUS FISTULA,36000949,CDM,,,,Both,,,2029,507,,2029,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ABLATION,LUNG TUMOR,PERC  RADIO FREQ",36000950,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT PLMT XTRC VRT STENT S&I PRQ/OPEN 1ST VSL,36000951,CDM,,,,Both,,,6306,1577,,6306,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BONE CYST, ASPIRATION/INJECTION",36000953,CDM,,,,Both,,,1057,264,,1057,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DRAINAGE, BRAIN ABSCESS",36000954,CDM,,,,Both,,,2014,504,,2014,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE URINARY SYSTEM,36000955,CDM,,,,Both,,,2704,676,,2704,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE LUNGS AND PLEURA,36000956,CDM,,,,Both,,,1583,396,,1583,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL,36000960,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC RF ABLATE 1+ RENAL TUMOR RADIO FR,36000962,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/PERONEAL STENT EA ADDL,36000964,CDM,,,,Both,,,13000,3250,,13000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/PERONEAL STENT & ATHERECTOMY EA ADDL,36000965,CDM,,,,Both,,,14040,3510,,14040,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI,36000966,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEPH TUBE REMOVAL W/FLORO LT,36000967,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URETER STENT; CHANGE; PERC,36000968,CDM,,,,Both,,,2945,736,,2945,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URETER STENT; REMOVE; PERC,36000969,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URETER STENT; CHANGE EXT/INT,36000970,CDM,,,,Both,,,3787,947,,3787,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE,36000974,CDM,,,,Both,,,173,43,,173,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC SPINE, DISC, ASPIRATION",36000977,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INJECTION PROC CERVICAL OR THORACIC DISCOGRAM,EACH",36000980,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE,36000982,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATION BONE TUMOR RF PERCUTANEOUS CT GUIDANCE,36000983,CDM,,,,Both,,,12733,3183,,12733,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG,36000984,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RENAL BIOPSY PRQ TROCAR/NEEDLE,36000989,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY LIVER NEEDLE PERCUTANEOUS,36000990,CDM,,,,Both,,,2270,568,,2270,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY MUSCLE PERCUTANEOUS NEEDLE,36000992,CDM,,,,Both,,,2684,671,,2684,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THROMBECT,PERC CAROTID/SUBCLAV,NECK",36000995,CDM,,,,Both,,,3969,992,,3969,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASPIRATION AND/OR INJECTION THYROID CYST,36000996,CDM,,,,Both,,,1378,345,,1378,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THROMBECT,PERC,LT UPEXT, VIA ARM",36000997,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THROMBECT,PERC,LTRAD/ULNAR, VIA ARM",36000998,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDE,36000999,CDM,,,,Both,,,2471,618,,2471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THROMBECT, PERC, LT ILIAC/FEM POP",36001000,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THROMBECT, PERC, LT POP/TIBIO",36001001,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THROMBECT,VEIN,PERC,VC/ILIAC/FEM/POP",36001002,CDM,,,,Both,,,5491,1373,,5491,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THROMBECT,VEIN,PERC,SUBCLAV (NECK)",36001003,CDM,,,,Both,,,5491,1373,,5491,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THROMBECT,VEIN,PERC,SUBCLAVVIA ARM",36001004,CDM,,,,Both,,,5491,1373,,5491,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LUMBAR INJECTION, SUBARACHNOID",36001005,CDM,,,,Both,,,1261,315,,1261,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INJECT AIR OR CONTRAST,PERITONEAL CAVITY",36001006,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CISTERNAL/LATERAL C1 C2 PUNCTURE W/O INJ SPX,36001007,CDM,,,,Both,,,2439,610,,2439,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LARYNGOSCOPY, FLEXIBLE FIBEROPTIC, DIAG",36001014,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTO W/INSERT URETERAL STENT,36001015,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ SCLEROSING SOLUTION SINGLE VEIN,36001016,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ SCLEROSING SOLUT MULTI VEIN SAME LEG,36001017,CDM,,,,Both,,,801,200,,801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHANGE CYSTOSTOMY TUBE COMPLICATED,36001018,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRIM ART M-THROMBECT ADD-ON,36001019,CDM,,,,Both,,,5061,1265,,5061,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE BIOPSY NEEDLE/TROCAR,36001021,CDM,,,,Both,,,2420,605,,2420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY BONE TROCAR/NEEDLE DEEP,36001022,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE,36001023,CDM,,,,Both,,,10285,2571,,10285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ FOR VISUALIZATION OF ILEAL COND,36001025,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TIPS REVISION, (ALL INCLUSIVE)",36001026,CDM,,,,Both,,,12958,3240,,12958,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RELOCATE POCKET FOR DEFIB,36001027,CDM,,,,Both,,,3950,988,,3950,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMVL PAC CVDFB PLS GEN ONLY,36001028,CDM,,,,Both,,,7828,1957,,7828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BILENDOSCPY,DUCT,DILATWO STNT VIA T TU",36001030,CDM,,,,Both,,,5605,1401,,5605,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BILIARY NDSC PRQ T TUBE DILAT STRIX W/STENT,36001031,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATH PLMT,36001032,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC IVC FILTER PLACEMENT, INTRAVASCULAR",36001041,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LUMBAR FACET INJ. PROC., EA. LEVEL",36001043,CDM,,,,Both,,,1261,315,,1261,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION PROCEDURE LYMPHANGIOGRAPHY,36001045,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ FOR CORPORA CAVERNOSOGRAPHY,36001046,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FALLOPIAN TUBE CATHETER INTRO,36001047,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER PARAVER FCT JT W/US LUMB/SAC LVL 2,36001048,CDM,,,,Both,,,1004,251,,1004,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX PARAVERTBRL FCT JT W/US LUMB/SAC 3RD&> LVL,36001049,CDM,,,,Both,,,1004,251,,1004,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>,36001050,CDM,,,,Both,,,5586,1397,,5586,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ TUNNELED CTR VAD W/SUBQ PUMP,36001051,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ TUN VAD REQ 2 CATH 2 SITES W/O SUBQ PORT/PUMP,36001052,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ TUN VAD REQ 2 CATH 2 SITES W/SUBQ PORT,36001053,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INSJ PICC <5 YR, W/O PORT OR PUMP, W/O IMAGING GUIDANCE",36001054,CDM,,,,Both,,,2154,539,,2154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPLCMT CATH CTR VAD SUBQ PORT/PUMP,36001055,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CVC COMP REPLACE NON-TUN W/O PORT/PUMP SAME SITE,36001056,CDM,,,,Both,,,2858,715,,2858,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CVC COMP REPLACE TUN W/O PUMP/PORT SAME SITE,36001057,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CVC COMP REPLACE TUN W/PORT SAME SITE,36001058,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE COMPLETE PICC W/O PORT/PUMP SAME SITE W/GUIDANCE,36001059,CDM,,,,Both,,,2858,715,,2858,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE COMPLETE PICC W/PORT SAME SITE,36001060,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL TUN CTR VAD W/SUBQ PORT/PUMP CTR/PICC INSJ,36001061,CDM,,,,Both,,,2858,715,,2858,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS,36001062,CDM,,,,Both,,,7828,1957,,7828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN,36001063,CDM,,,,Both,,,2858,715,,2858,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDN,36001064,CDM,,,,Both,,,2858,715,,2858,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NERVE BLOCK ILIOING/ILIOHYPOGASTRIC,36001065,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LUMBAR PUNCTURE, DRAIN SPINAL FLUID",36001066,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTO/VCG INJECTION PROCEDURE,36001068,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BIOPSY, PLEURA, PERC",36001069,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BIOPSY, SPINAL CORD, PERC",36001070,CDM,,,,Both,,,2420,605,,2420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CVC/PICC REPAIR TUN/NON TUN W PORT/PUMP,36001071,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAW BLOOD OFF VENOUS DEVICE,36001075,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPOSITION GI FEEDING TUBE,36001077,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PORTAL VEIN CATHETERIZATION,PERCUTANEOUS",36001078,CDM,,,,Both,,,832,208,,832,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYELOGRAM INJ LUMBAR NOT C1-C2,36001079,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ NEUROLYTIC; EPIDURAL CERV/THORACIC,36001080,CDM,,,,Both,,,2439,610,,2439,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION SIALOGRAM,36001081,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION HYSTEROSALPINGOGRAM,36001082,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION URETHROGRAM,36001083,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX&PLMT CHAIN CONTRAST&/URETHROCSTOGRAPY,36001086,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TRANSVENOUS LEAD REMOVAL S OR D, ICD",36001087,CDM,,,,Both,,,7828,1957,,7828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INJ CYSTOURETHROGRAM, RETROGRADE",36001088,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REDO ENDOVAS VENA CAVA FILTER,36001089,CDM,,,,Both,,,5701,1425,,5701,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC,36001090,CDM,,,,Both,,,2749,687,,2749,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION SINUS TRACT DIAGNOSTIC,36001091,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE ENDOVAS VENA CAVA FILTER,36001092,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDO T ANEURYSM INVOLVING LSC,36001093,CDM,,,,Both,,,2716,679,,2716,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDO T ANEURYSM NOT INVOLVING LSC,36001095,CDM,,,,Both,,,2333,583,,2333,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL TUNNELED IP CATH,36001096,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY/NEEDLE BX EACH,36001097,CDM,,,,Both,,,5457,1364,,5457,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEG PRESS WOUND TX <=50 SQ CM W/DME,36001098,CDM,,,,Both,,,275,69,,275,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEG PRESS WOUND TX >50 SQ CM W/DME,36001099,CDM,,,,Both,,,630,158,,630,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMPUTATE FING/TH SGL; W LOC ADV FLAP,36001100,CDM,,,,Both,,,10166,2542,,10166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UPGRADE PPACER SYSTEM SINGLE TO DUAL,36001101,CDM,,,,Both,,,18318,4580,,18318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR SINGLE LEADS TO SINGLE CHAMBER,36001102,CDM,,,,Both,,,6219,1555,,6219,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR 2 LEADS TO DUAL CHAMBER,36001103,CDM,,,,Both,,,6219,1555,,6219,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL OF PULSE GENERATOR,36001104,CDM,,,,Both,,,14373,3593,,14373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDO THORACIC EACH ADD'L,36001106,CDM,,,,Both,,,2299,575,,2299,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY LIVER WEDGE,36001107,CDM,,,,Both,,,5799,1450,,5799,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATHETER BIOPSY PROC,36001109,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC EMBOLIZATION,INTRA ART/INJ/BALLOON NEURO",36001110,CDM,,,,Both,,,14330,3583,,14330,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDO THORACIC REVISION,36001111,CDM,,,,Both,,,2299,575,,2299,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT/REPLACE P PACER WITH ATRIAL LEAD,36001113,CDM,,,,Both,,,18318,4580,,18318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT/REPLACE P PACER W VENTRICULAR LD,36001114,CDM,,,,Both,,,18318,4580,,18318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT/REPLACE PPM WITH ATR & VENT LDS,36001116,CDM,,,,Both,,,18318,4580,,18318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS LV LEAD AT TIME OF INS W PPM OR ICD,36001120,CDM,,,,Both,,,18015,4504,,18015,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPASS,36001125,CDM,,,,Both,,,2019,505,,2019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TREAT LUNG LINING CHEMICALLY,36001126,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE DUOD/JEJ TUBE PERC,36001127,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CECOSTOMY TUBE PERC,36001128,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHANGE G TUBE TO G J TUBE,36001129,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FIX G/COLON TUBE W/DEVICE,36001130,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHANGE STENT VIA TRANSURETH,36001131,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST ARTHROGRAM INJECTION,36001132,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW ARTHROGRAM INJECTION,36001133,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER ARTHROGRAM INJECTION,36001134,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION ANKLE ARTHROGRAPHY,36001135,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ HIP ARTHROGRAPHY W/ANESTHESIA,36001137,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DESTROY CERV/THOR FACET JNT, SINGLE",36001138,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTROY CERV/THORACIC FACET INJ ADDL,36001139,CDM,,,,Both,,,838,210,,838,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DESTROY LUMB/SAC FACET JNT, SINGLE",36001140,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTROY LUMBAR/SAC FACET INJ ADDL,36001141,CDM,,,,Both,,,838,210,,838,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPOS PREVIOUSLY IMPLANTED TRANS PACEMAKERCING,36001143,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SEC PRQ TRANSLUMINAL THROMBECTOMY NONCORONARY,36001145,CDM,,,,Both,,,4601,1150,,4601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RELOCATION POCKET PACEMAKER,36001146,CDM,,,,Both,,,3950,988,,3950,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABSC CYST CONSTRAST INJ,36001147,CDM,,,,Both,,,1154,289,,1154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ TUNNELED CVC W/O PORT OR PUMP YR RT,36001148,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ TUNNELED CVC W/O PORT OR PUMP YR LT,36001149,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHGE URTR TUBE/STNT VIA ILEAL CON RT,36001154,CDM,,,,Both,,,3154,789,,3154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHGE URTR TUBE/STNT VIA ILEAL CON LT,36001155,CDM,,,,Both,,,3154,789,,3154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHGE URTR TUBE/STNT VIA ILEAL CON BI,36001156,CDM,,,,Both,,,3154,789,,3154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  1,36001181,CDM,,,,Both,,,4417,1104,,4417,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  2,36001182,CDM,,,,Both,,,5910,1478,,5910,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  3,36001183,CDM,,,,Both,,,7212,1803,,7212,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  4,36001184,CDM,,,,Both,,,8581,2145,,8581,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  5,36001185,CDM,,,,Both,,,9551,2388,,9551,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  6,36001186,CDM,,,,Both,,,11572,2893,,11572,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  7,36001187,CDM,,,,Both,,,12931,3233,,12931,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  8,36001188,CDM,,,,Both,,,14361,3590,,14361,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  9,36001189,CDM,,,,Both,,,16716,4179,,16716,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL 10,36001190,CDM,,,,Both,,,22437,5609,,22437,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELECTIVE LASER TRABECULOPLASTY - SELECTA,36001191,CDM,,,,Both,,,823,206,,823,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANGIOGRAPHY CERVICO CEREBRAL ARCH,36001192,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RETRIEVAL OF INTRAVASCULAR FOREIGN BODY,36001194,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH CAROTID/INOM INTRACRANIAL-LT,36001201,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH CAROTID INOM/INTRACRANIAL-RT,36001202,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH INT. CAROTID - LT,36001203,CDM,,,,Both,,,9926,2482,,9926,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH INT. CAROTID - RT,36001204,CDM,,,,Both,,,10919,2730,,10919,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH SUBCLAVE/INOM ARTERY - LT,36001205,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH SUBCLAVE /INOM ARTERY - RT,36001206,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH VERT ARTERY - LT,36001207,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH  VERT ARTERY - RT,36001208,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH EXTERNAL CAROTID ARTERY - LT,36001209,CDM,,,,Both,,,2556,639,,2556,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH EXTERNAL CAROTID ARTERY - RT,36001210,CDM,,,,Both,,,2556,639,,2556,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH INTRACRANIAL ARTERY - LT,36001211,CDM,,,,Both,,,5964,1491,,5964,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH INTRACRANIAL ARTERY - RT,36001212,CDM,,,,Both,,,5964,1491,,5964,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP W/ PRESSURE MEASURE ODDI,36001215,CDM,,,,Both,,,5409,1352,,5409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARACENT ANT EYE W/REMOVAL OF VITREOUS,36001216,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACENTESIS-ASPIR W IMAGE GUIDANCE,36001217,CDM,,,,Both,,,3831,958,,3831,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DX BRONCHOSCOPE/BRUSH,36001224,CDM,,,,Both,,,2776,694,,2776,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATH THROMBO INF EITHER NEXT DAY,36001226,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATH THROMBO INF EITHER STOP/REMOVE,36001227,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTRACRANIAL CAROTID/INOMINATE BILAT,36001228,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LYSE CHEST FIBRIN INIT DAY,36001235,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATH THROMBO INF ART INITIAL S&I,36001239,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATH THROMBO INF VEN INITIAL S&I,36001240,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH CAR/INOM INTRACRAN BILAT,36001259,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH INT. CARTOID - BILAT,36001260,CDM,,,,Both,,,15632,3908,,15632,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH SUBCLAVE/INOM ART- BI-LAT,36001261,CDM,,,,Both,,,7576,1894,,7576,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH VERT. ARTERY - BI-LAT,36001262,CDM,,,,Both,,,12520,3130,,12520,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH CAROTID INOM ART EXTRACRAN LT,36001268,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH CAROTID INOM ART EXTRACRAN RT,36001269,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOSCOPIC PANCREATOSCOPY,36001282,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRID MUSC/FASIA EA ADDL 20SQ CM OR <,36001283,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PUNCT ASP ABCESS HEMATOMA BULLA/CYST,36001284,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D PILONIDAL CYST COMPLICATED,36001285,CDM,,,,Both,,,1951,488,,1951,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LARYNGOSCOPE W/VC INJ,36001287,CDM,,,,Both,,,1328,332,,1328,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HYSTERECTOMY,36001288,CDM,,,,Both,,,8008,2002,,8008,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLADDER REPAIR,36001289,CDM,,,,Both,,,1672,418,,1672,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TREAT FETAL DEMISE,36001290,CDM,,,,Both,,,3463,866,,3463,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE LENS MATERIAL; EXTRACAP 1+ STGS (YAG),36001293,CDM,,,,Both,,,10678,2670,,10678,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  1 INCREMENT,36001294,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  2  INCREMENT,36001295,CDM,,,,Both,,,87,22,,87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  3  INCREMENT,36001296,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  4  INCREMENT,36001297,CDM,,,,Both,,,125,31,,125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  5  INCREMENT,36001298,CDM,,,,Both,,,138,35,,138,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  6  INCREMENT,36001299,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  7  INCREMENT,36001300,CDM,,,,Both,,,170,43,,170,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  8  INCREMENT,36001301,CDM,,,,Both,,,174,44,,174,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL  9  INCREMENT,36001302,CDM,,,,Both,,,183,46,,183,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O.R. PROC LEVEL 10  INCREMENT,36001303,CDM,,,,Both,,,247,62,,247,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UMBILICAL ARTERY CATHETERIZATION NEWBORN,36001304,CDM,,,,Both,,,1000,250,,1000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS PM PULSE GEN ONLY W/EXIST SNG LEAD,36001305,CDM,,,,Both,,,14373,3593,,14373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS PM PULSE GEN ONLY W/EXIST DUAL LDS,36001306,CDM,,,,Both,,,18318,4580,,18318,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DISCISSION 2ND CATARACT YAG LASER,36001307,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROPHYLAXIS RETINA DETACH PHOTOCOAG,36001308,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IRIDOTOMY/IRIDECTOMY BY LASER,36001310,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LASER SURGERY SEVER VITREOUS STRANDS,36001312,CDM,,,,Both,,,1240,310,,1240,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RF BONE ABLATION W/O CT GUIDANCE,36001315,CDM,,,,Both,,,11035,2759,,11035,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX EXT RETINOPATHY PRETERM INFANT,36001316,CDM,,,,Both,,,1586,397,,1586,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL W/SUBMUCOSAL INJ,36001317,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ SACRAL AUGMT BILAT INJ(S),36001318,CDM,,,,Both,,,11035,2759,,11035,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT CATH PLEURA W/O IMAGE,36001319,CDM,,,,Both,,,3303,826,,3303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT CATH PLEURA W/ IMAGE,36001320,CDM,,,,Both,,,2154,539,,2154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRAVITREAL INJECTION PHARM,36001321,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNNA BOOT BILATERAL,36001322,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY W/TUMOR EXCISE,36001323,CDM,,,,Both,,,5457,1364,,5457,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE ABD PERITONEUM,36001325,CDM,,,,Both,,,3662,916,,3662,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX POSTOP HIP DISLOC W ANESTH,36001326,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GUIDE CATHET FLUID DRAINAGE,36001327,CDM,,,,Both,,,1410,353,,1410,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BX BREAST 1ST LESION STRTCTC,36001328,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BX BREAST ADD LESION STRTCTC,36001329,CDM,,,,Both,,,1085,271,,1085,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BX BREAST 1ST LESION US IMAG,36001330,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BX BREAST ADD LESION US IMAG,36001331,CDM,,,,Both,,,1085,271,,1085,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BX BREAST 1ST LESION MR IMAG,36001332,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BX BREAST ADD LESION MR IMAG,36001333,CDM,,,,Both,,,1085,271,,1085,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEVICE BREAST 1ST IMAG,36001334,CDM,,,,Both,,,953,238,,953,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEVICE BREAST EA IMAG,36001335,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEV BREAST 1ST STRTCTC,36001336,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEV BREAST ADD STRTCTC,36001337,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEV BREAST 1ST US IMAG,36001338,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEV BREAST ADD US IMAG,36001339,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEV BREAST 1ST MR GUIDE,36001340,CDM,,,,Both,,,953,238,,953,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEV BREAST ADD MR GUIDE,36001341,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN/PERQ PLACE STENT 1ST,36001342,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN/PERQ PLACE STENT EA ADD,36001343,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN/PERQ PLACE STENT SAME,36001344,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN/PERQ PLACE STENT EA ADD,36001345,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASC EMBOLIZE/OCCLUDE VENOUS,36001346,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASC EMBOLIZE/OCCLUDE ARTERY,36001347,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASC EMBOLIZE/OCCLUDE ORGAN,36001348,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASC EMBOLIZE/OCCLUDE BLEED,36001349,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMAGE CATH FLUID COLXN VISC,36001350,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMAGE CATH FLUID PERI/RETRO,36001351,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABD/PELVIS/LOW EXT ART 2ND BIL,36001352,CDM,,,,Both,,,2537,634,,2537,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABD/PELVIS/LOW EXT ART 3RD BIL,36001353,CDM,,,,Both,,,2663,666,,2663,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMBOLIZATION EXTRACRANIAL HEAD OR NECK,36001354,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ SCIATIC NERVE SINGLE; INCL IMAGING GUID,36001355,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILIAC REVASC W/STENT BIL,36001356,CDM,,,,Both,,,29640,7410,,29640,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACENTESIS ASPIR W IMAGE GUIDANCE BIL,36001357,CDM,,,,Both,,,5748,1437,,5748,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT CATH PLEURA W/O IMAGE BIL,36001358,CDM,,,,Both,,,3303,826,,3303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENOUS MECH THROMBECTOMY,36001359,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT CATH PLEUA W/IMAGE BIL,36001360,CDM,,,,Both,,,3035,759,,3035,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACENTESIS ASPIRATION W/O IMG GUIDAN BIL,36001361,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LYSE CHEST FIBRIN SUBQ DAY,36001362,CDM,,,,Both,,,828,207,,828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIGATE FALLOP TUBE ABD OR VAG UNI/BIL,36001363,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE HEMIC OR LYMPHATIC,36001365,CDM,,,,Both,,,1275,319,,1275,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BILIARY ENDO PERQ DX W/SPECI,36001367,CDM,,,,Both,,,5605,1401,,5605,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENOUS M-THROMBECTOMY ADD-ON,36001368,CDM,,,,Both,,,11101,2775,,11101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEMORAL N BLOCK SGL; INCL IMAGING GUID,36001369,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH PUDENDAL NERVE,36001375,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY SALIVARY GLAND NEEDLE,36001376,CDM,,,,Both,,,1388,347,,1388,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCLEROTHERAPY THERAPY,36001377,CDM,,,,Both,,,300,75,,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEPH TUBE REMOVED W/FLORO RT,36001378,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEPH TUBE REMOVED W/FLORO BIL,36001379,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PULMONARY ARTERY EMBOL W CPB,36001380,CDM,,,,Both,,,3926,982,,3926,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY W/MARKERS,36001381,CDM,,,,Both,,,10259,2565,,10259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NAVIGATIONAL BRONCHOSCOPY,36001382,CDM,,,,Both,,,1711,428,,1711,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN/INJ MAJOR JNT/BURSA BIL,36001384,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTOURETHROSCOPY,36001385,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH LUMB/THOR (SYMPATHETIC),36001386,CDM,,,,Both,,,1818,455,,1818,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY W/US NEEDLE BX,36001387,CDM,,,,Both,,,3303,826,,3303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE PANCREAS,36001388,CDM,,,,Both,,,1378,345,,1378,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SGL NBI BRACHIAL PLEXUS INCL IMAGING GUID,36001389,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT PLACEMT RETRO CAROTID,36001390,CDM,,,,Both,,,5344,1336,,5344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT PLMT XTRC VRT STENT S&I PRQ/OPEN EA ADL VSL,36001391,CDM,,,,Both,,,11309,2827,,11309,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOVASC TEMP B VESSEL OCCL,36001392,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRACRANIAL ANGIOPLASTY,36001393,CDM,,,,Both,,,12503,3126,,12503,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILATE IC VASOSPASM INIT,36001394,CDM,,,,Both,,,11309,2827,,11309,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILATE IC VASOSPASM ADD-ON SAME VASC TERRITORY,36001395,CDM,,,,Both,,,8189,2047,,8189,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILATE IC VASOSPASM ADD-ON DIFFERENT VASC TERRITORY,36001396,CDM,,,,Both,,,11309,2827,,11309,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTR W NEUROLYTIC; INTERCOSTAL NRV,36001397,CDM,,,,Both,,,1529,382,,1529,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS/REP SUBQ DEFIBRILLATOR,36001398,CDM,,,,Both,,,57869,14467,,57869,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROPHYSIOLOGY EVALUATION,36001399,CDM,,,,Both,,,1702,426,,1702,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ CERVICOTHORACIC INJECTION,36001400,CDM,,,,Both,,,11101,2775,,11101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ LUMBOSACRAL INJECTION,36001401,CDM,,,,Both,,,11101,2775,,11101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ CERVICOTHORACIC  OR LUMBOSACRAL INJ EA ADD,36001402,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ VERTEBRAL AUGMENTATION THORACIC,36001403,CDM,,,,Both,,,11854,2964,,11854,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ VERTEBRAL AUGMENTATION LUMBAR,36001404,CDM,,,,Both,,,11854,2964,,11854,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ VERTEBRAL AUGMENTATION THORACIC/LUMBAR EA ADD,36001405,CDM,,,,Both,,,11854,2964,,11854,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ SACRAL AUGMT UNILAT INJ,36001406,CDM,,,,Both,,,11035,2759,,11035,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSE RECTOVAGINAL FISTULA VAGINAL,36001408,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ SUBQ IMPLTBL DFB ELCTRD,36001409,CDM,,,,Both,,,14373,3593,,14373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL OF SUBQ DEFIBRULLATOR ELECTRODE,36001410,CDM,,,,Both,,,6067,1517,,6067,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPOS PREV IMPLTBL SUBQ DFB,36001411,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY/LUNG BX ADDL,36001412,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE LIVER,36001413,CDM,,,,Both,,,1397,349,,1397,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYELOGRAPHY LUMBAR INJECTION CERVICAL,36001414,CDM,,,,Both,,,6349,1587,,6349,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYELOGRAPHY LUMBAR INJECTION THORACIC,36001415,CDM,,,,Both,,,6349,1587,,6349,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYELOGRAPHY LUMBAR INJECTION LUMBOSACRAL,36001416,CDM,,,,Both,,,6349,1587,,6349,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEST TUBE INSERTION BIL,36001417,CDM,,,,Both,,,2669,667,,2669,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY DILATE/FX REPR,36001418,CDM,,,,Both,,,5457,1364,,5457,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY DILATE W/STENT,36001419,CDM,,,,Both,,,10259,2565,,10259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY BRONCH STENTS INITIAL,36001420,CDM,,,,Both,,,10259,2565,,10259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY REVISE STENT,36001421,CDM,,,,Both,,,10259,2565,,10259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY TREAT BLOCKAGE,36001422,CDM,,,,Both,,,5457,1364,,5457,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER ARTHROGRAM INJECTION BIL,36001425,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT VAD LEFT HEART ARTERY ACCESS,36001426,CDM,,,,Both,,,20624,5156,,20624,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN/INJ MAJOR JOINT/BURSA W/US,36001427,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENOUS SELECTIVE ORGAN BLOOD SAMPLING,36001428,CDM,,,,Both,,,2081,520,,2081,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPR 1ST INGUN HRNA AGE 5 YRS/>INCAR/STRANG,36001429,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL FLUID DRAINAGE W US,36001431,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPISIOTOMY OR VAGINAL REPAIR BY OTHER THAN ATTEND,36001432,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CERCLAGE CERVIX PREGNANT ABDOMINAL,36001433,CDM,,,,Both,,,4319,1080,,4319,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HYSTERORRHAPHY OF RUPTURED UTERUS,36001434,CDM,,,,Both,,,4319,1080,,4319,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CESAREAN DELIV AFTER ATTEMP VAG DELIV,36001435,CDM,,,,Both,,,9779,2445,,9779,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN/INJ MAJOR JOINT/BURSA W/US BIL,36001441,CDM,,,,Both,,,780,195,,780,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NONSELECT CATH RT HEART/MAIN PULMON ART,36001442,CDM,,,,Both,,,1047,262,,1047,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL BIL,36001444,CDM,,,,Both,,,1088,272,,1088,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL BIL,36001445,CDM,,,,Both,,,1088,272,,1088,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILIAC PTA INITIAL BIL,36001448,CDM,,,,Both,,,12823,3206,,12823,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATE BONE TUMOR(S) PERQ,36001453,CDM,,,,Both,,,10066,2517,,10066,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NONSELECT CATH TRANSLUMBAR AORTA,36001454,CDM,,,,Both,,,1487,372,,1487,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ ABLTJ LVR CRYOABLATION,36001455,CDM,,,,Both,,,11101,2775,,11101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT TUN IP CATH W/PORT,36001456,CDM,,,,Both,,,9845,2461,,9845,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATH RENAL SYMP DENERV UNI,36001457,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATH RENAL SYMP DENERV BILAT,36001458,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATION BONE TUMOR RF PERCUTANEOUS CT GUID BIL,36001459,CDM,,,,Both,,,11035,2759,,11035,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE BIL,36001460,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELECT CATH PLACE VEN SYS 2ND ORD FAM BIL,36001463,CDM,,,,Both,,,1700,425,,1700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRIM PRQ TRLUML MCHNL THRMBC 1ST VSL BIL,36001464,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENOUS MECH THROMBECTOMY  BIL,36001465,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENOUS M-THROMBECTOMY ADD-ON BIL,36001466,CDM,,,,Both,,,11101,2775,,11101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEM/POP PTA BIL,36001469,CDM,,,,Both,,,11102,2776,,11102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEM/POP ATHERECTOMY BIL,36001470,CDM,,,,Both,,,19438,4860,,19438,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEM/POP STENT BIL,36001471,CDM,,,,Both,,,19438,4860,,19438,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL BIL,36001472,CDM,,,,Both,,,30360,7590,,30360,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/PERONEAL STENT INITIAL BIL,36001473,CDM,,,,Both,,,31200,7800,,31200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIB/PERONEAL STENT & ATHERECTOMY INITIAL BIL,36001474,CDM,,,,Both,,,34118,8530,,34118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN/PERQ PLACE STENT 1ST BIL,36001479,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN/PERQ PLACE STENT SAME BIL,36001481,CDM,,,,Both,,,17696,4424,,17696,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URETER STENT CHANGE PERC BIL,36001483,CDM,,,,Both,,,4418,1105,,4418,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE URETER STENT PERCUT BIL,36001484,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URETER STENT CHANGE EXT/INT BIL,36001485,CDM,,,,Both,,,3787,947,,3787,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL BIL,36001486,CDM,,,,Both,,,1920,480,,1920,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LUMBAR TRANSFORAM EPIDRL INJ SNGL BIL,36001487,CDM,,,,Both,,,1920,480,,1920,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL BIL,36001488,CDM,,,,Both,,,4561,1140,,4561,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL BIL,36001489,CDM,,,,Both,,,1088,272,,1088,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL BIL,36001490,CDM,,,,Both,,,4561,1140,,4561,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL BIL,36001491,CDM,,,,Both,,,1088,272,,1088,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MG LIVER HEMORRHAGE COMPLEX SUTURE,36001492,CDM,,,,Both,,,2688,672,,2688,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CREATE SHUNT VENTRIC-ATR JUGUL AURICL,36001493,CDM,,,,Both,,,1960,490,,1960,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEUROENDOSCOPY ADD-ON,36001494,CDM,,,,Both,,,1613,403,,1613,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY/NEEDLE BX ADDL,36001495,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LARYNGOSCOPY FLEX/RIGID W STROBOSCOPY,36001498,CDM,,,,Both,,,853,213,,853,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TT NDL WIRE/DILATOR/STENT FOR O2 TX,36001499,CDM,,,,Both,,,3041,760,,3041,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LARYNGOSCOPY FLEX WITH BX,36001500,CDM,,,,Both,,,2363,591,,2363,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LARYNGOSCOPY FLEX W REM LESION,36001501,CDM,,,,Both,,,5457,1364,,5457,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCH W/BALLOON OCCLUSION,36001502,CDM,,,,Both,,,10259,2565,,10259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIAG BRONCHOSCOPE/CATHETER,36001503,CDM,,,,Both,,,2292,573,,2292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY CLEAR AIRWAYS,36001504,CDM,,,,Both,,,2292,573,,2292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOSCOPY RECLEAR AIRWAY,36001505,CDM,,,,Both,,,1979,495,,1979,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY DIAGNOSTIC,36001506,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY WBX SAC,36001507,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/BX MED SPACE,36001508,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/BX INFILTRATE,36001509,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/BX NODULE,36001510,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/BX PLEURA,36001511,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATION LUNG TUMOR PERC  RADIO FREQ BIL,36001512,CDM,,,,Both,,,15364,3841,,15364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOP ULTRASOUND EXAM,36001513,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/PLEURODESIS,36001514,CDM,,,,Both,,,10519,2630,,10519,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/PLEURODESIS BIL,36001515,CDM,,,,Both,,,15248,3812,,15248,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY REMOVE CORTEX,36001516,CDM,,,,Both,,,10519,2630,,10519,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY REMOVE CORTEX BIL,36001517,CDM,,,,Both,,,10519,2630,,10519,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY REM TOTL CORTEX,36001518,CDM,,,,Both,,,20986,5247,,20986,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY REM TOTL CORTEX BIL,36001519,CDM,,,,Both,,,41972,10493,,41972,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY REMOV FB/FIBRIN,36001520,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY CONTRL BLEEDING,36001521,CDM,,,,Both,,,985,246,,985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY CONTRL BLEEDING BIL,36001522,CDM,,,,Both,,,1970,493,,1970,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY RESECT BULLAE,36001523,CDM,,,,Both,,,13906,3477,,13906,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY RESECT BULLAE BIL,36001524,CDM,,,,Both,,,27812,6953,,27812,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/MEDIAST EXC,36001525,CDM,,,,Both,,,4437,1109,,4437,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/LOBECTOMY,36001526,CDM,,,,Both,,,11682,2921,,11682,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/ TH NRV EXC,36001527,CDM,,,,Both,,,12352,3088,,12352,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/ TH NRV EXC BIL,36001528,CDM,,,,Both,,,24705,6176,,24705,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/WEDGE RESECT,36001529,CDM,,,,Both,,,6557,1639,,6557,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/W RESECT ADDL,36001530,CDM,,,,Both,,,2926,732,,2926,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY REMOVE SEGMENT,36001531,CDM,,,,Both,,,3816,954,,3816,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY W/THYMUS RESECT,36001532,CDM,,,,Both,,,11306,2827,,11306,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACOSCOPY LYMPH NODE EXC,36001533,CDM,,,,Both,,,6496,1624,,6496,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOTAL LUNG LAVAGE (UNILATERAL),36001534,CDM,,,,Both,,,1482,371,,1482,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOTAL LUNG LAVAGE (BILATERAL),36001535,CDM,,,,Both,,,2964,741,,2964,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCDURE PELVIS OR HIP JOINT,36001536,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RENAL ENDO THRU ESTAB N/P OSTOMY,36001537,CDM,,,,Both,,,7773,1943,,7773,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRACHEOBRONCHIAL CATH ASP W/ FIBERSCOPE,36001538,CDM,,,,Both,,,2086,522,,2086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ NEUROLYTIC EPIDURAL LUMB/CAUDAL,36001539,CDM,,,,Both,,,1535,384,,1535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTR W NEUROLYT TRIGEM NRV INF ALV BR,36001540,CDM,,,,Both,,,1535,384,,1535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TAP BLOCK BIL BY INJECTION,36001544,CDM,,,,Both,,,2184,546,,2184,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS INSJ PRPH CANNULA PRQ,36001545,CDM,,,,Both,,,11875,2969,,11875,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEUROL AG DESTR SH PLEXUS,36001546,CDM,,,,Both,,,1535,384,,1535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE STOMACH,36001547,CDM,,,,Both,,,1792,448,,1792,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIGATION MAJOR ARTERY EXTREMITY,36001548,CDM,,,,Both,,,3496,874,,3496,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY HALO CRANIAL,36001549,CDM,,,,Both,,,5151,1288,,5151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS INITIATION VENOUS,36001550,CDM,,,,Both,,,2786,697,,2786,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS INITIATION ARTERY,36001551,CDM,,,,Both,,,3065,766,,3065,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS DAILY MGMT VENOUS,36001552,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS DAILY MGMT ARTERY,36001553,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS INSJ PRPH CANNULA OPEN,36001554,CDM,,,,Both,,,7408,1852,,7408,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS INSJ CTR CANNULA STERNO/THORA,36001555,CDM,,,,Both,,,7408,1852,,7408,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS REPOS PERPH CNULA PRQ,36001556,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS REPOS PERPH CNULA OPEN,36001557,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS REPOS CTR CNULA STERNA/THORA,36001558,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS RMVL PRPH CANNULA PRQ,36001559,CDM,,,,Both,,,2027,507,,2027,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM IAB ASSIST DEVICE PERCUTANEOUS,36001560,CDM,,,,Both,,,13673,3418,,13673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS IAB ASSIST DEVICE THRU FEM ART OPEN,36001561,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM IAB ASSIST DEVICE  REPAIR FEM ART W  W/O GRAFT,36001562,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERT VAD EC BIV,36001563,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM VAD EC SGL V,36001564,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM VAD EC BIV,36001565,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS RMVL PRPH CANNULA OPEN,36001566,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECMO/ECLS RMVL CTR CANNULA STERNO/THORA,36001567,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE VAD LEFT HEART DIFFERENT SESSION,36001568,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPOSITION VAD RIGHT OR LEFT HEART DIFF SESSION,36001569,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASP VITREOUS SUBRETIN OR CHOROID FLUID,36001570,CDM,,,,Both,,,3259,815,,3259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE AORTIC VALVE PERQ FEM APRCH,36001571,CDM,,,,Both,,,8609,2152,,8609,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE AORTIC VALVE OPEN FEM APRCH,36001572,CDM,,,,Both,,,8609,2152,,8609,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE AORTIC VALVE OPEN AXILLARY APRCH,36001573,CDM,,,,Both,,,8609,2152,,8609,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE AORTIC VALVE OPEN ILIAC APRCH,36001574,CDM,,,,Both,,,8609,2152,,8609,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE AORTIC VALVE TRANSAORTIC APRCH,36001575,CDM,,,,Both,,,8609,2152,,8609,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATH TRANSAPICAL REPLACE AORTIC VALVE,36001576,CDM,,,,Both,,,8609,2152,,8609,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APRCH,36001577,CDM,,,,Both,,,3151,788,,3151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH,36001578,CDM,,,,Both,,,3151,788,,3151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPLACE AORTIC VALVE W/BYP CNTRL ART/VENOUS APRCH,36001579,CDM,,,,Both,,,3151,788,,3151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ HIP ARTHROGRAPHY W/O ANESTHESIA BIL,36001580,CDM,,,,Both,,,1589,397,,1589,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH OTHR PERIPHERAL NRV BIL,36001582,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH LUMB/THOR (SYMPATHETIC) BIL,36001584,CDM,,,,Both,,,2650,663,,2650,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DESTROY CERV/THOR FACET JNT, SINGLE BIL",36001585,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTROY CERV/THORACIC FACET INJ ADDL BIL,36001586,CDM,,,,Both,,,2095,524,,2095,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DESTROY LUMB/SAC FACET JNT, SINGLE BIL",36001587,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTROY LUMBAR/SAC FACET INJ ADDL BIL,36001588,CDM,,,,Both,,,1257,314,,1257,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VALVULOPLASTY AORTIC VALVE SIMPLE,36001589,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VALVULOPLASTY AORTIC VALVE COMPLEX,36001590,CDM,,,,Both,,,3686,922,,3686,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRO CATH DIALYSIS CIRCUIT,36001591,CDM,,,,Both,,,2154,539,,2154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRO CATH DIALYSIS CIRCUIT W/BALLN ANGIOPLASTY,36001592,CDM,,,,Both,,,10462,2616,,10462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRO CATH DIALYSIS CIRCUIT W/INTRAVAS STENT,36001593,CDM,,,,Both,,,17893,4473,,17893,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THRMBC/NFS DIALYSIS CIRCUIT,36001594,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THRMBC/NFS DIALYSIS CIRCUIT W/BALLN ANGIOPLASTY,36001595,CDM,,,,Both,,,17893,4473,,17893,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THRMBC/NFS DIALYSIS CIRCUIT W/INTRAVAS STENT,36001596,CDM,,,,Both,,,28294,7074,,28294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BALO ANGIOP CTR DIALYSIS SEG,36001597,CDM,,,,Both,,,5148,1287,,5148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT PLMT CTR DIALYSIS SEG,36001598,CDM,,,,Both,,,5148,1287,,5148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIALYSIS CIRCUIT EMBOLJ,36001599,CDM,,,,Both,,,5148,1287,,5148,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NDSC DCMPRN 1 NTRSPC LUMBAR,36001600,CDM,,,,Both,,,11035,2759,,11035,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NDSC DCMPRN 1 NTRSPC LUMBAR BIL,36001601,CDM,,,,Both,,,19161,4790,,19161,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC IMPL NS ELECTRODE ARRAY EPIDURAL,36001604,CDM,,,,Both,,,10860,2715,,10860,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ TRANSCATH SEPTAL REDUXN,36001605,CDM,,,,Both,,,17535,4384,,17535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE TONGUE FLOOR MOUTH,36001606,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLPOSCOPY OF VULVA,36001607,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY SHORT ARM APLINT FOREARM HAND STATIC BIL,36001608,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATE PULM TUMOR PERQ CRYBL,36001609,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATE PULM TUMOR PERQ CRYBL BIL,36001610,CDM,,,,Both,,,16118,4030,,16118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVASC RPR A-AO NDGFT,36001611,CDM,,,,Both,,,3826,957,,3826,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVASC RPR A-AO NDGFT RPT,36001612,CDM,,,,Both,,,5610,1403,,5610,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVASC RPR A-UNILAC NDGFT,36001613,CDM,,,,Both,,,11113,2778,,11113,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVASC RPR A-UNILAC NDGFT RPT,36001614,CDM,,,,Both,,,18033,4508,,18033,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVAC RPR A-BIILIAC NDGFT,36001615,CDM,,,,Both,,,5896,1474,,5896,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVASC RPR A-BIILIAC RPT,36001616,CDM,,,,Both,,,6620,1655,,6620,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVASC RPR ILIO-ILIAC NDGFT,36001617,CDM,,,,Both,,,5805,1451,,5805,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVASC RPR ILIO-ILIAC RPT,36001618,CDM,,,,Both,,,6505,1626,,6505,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT XTN PROSTH EVASC RPR,36001619,CDM,,,,Both,,,4235,1059,,4235,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DLYD PLMT XTN PROSTH 1ST VSL,36001620,CDM,,,,Both,,,4235,1059,,4235,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DLYD PLMT XTN PROSTH EA ADDL,36001621,CDM,,,,Both,,,1553,388,,1553,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DX BONE MARROW BX & ASPIR,36001622,CDM,,,,Both,,,4177,1044,,4177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DX BONE MARROW BX & ASPIR BIL,36001623,CDM,,,,Both,,,4840,1210,,4840,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT DLVR ENHNCD FIXJ DEV,36001630,CDM,,,,Both,,,3362,841,,3362,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ ACCESS & CLSR FEM ART,36001631,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPN FEM ART EXPOS CNDT CRTJ,36001632,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TMVI PERCUTANEOUS APPROACH,36001634,CDM,,,,Both,,,3362,841,,3362,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TMVI TRANSTHORACIC EXPOSURE,36001635,CDM,,,,Both,,,3362,841,,3362,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMPLANT TCAT PULM VLV PERQ,36001636,CDM,,,,Both,,,3151,788,,3151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR TCAT MITRAL VALVE INITIAL,36001637,CDM,,,,Both,,,21274,5319,,21274,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR TCAT MITRAL VALVE ADDITIONAL,36001638,CDM,,,,Both,,,7908,1977,,7908,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC ASPIRATION SPINAL CORD CYST,36001639,CDM,,,,Both,,,1261,315,,1261,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH AXILLARY NERVE INCL IMAGING GUID,36001640,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH AXILLARY NERVE BIL INCL IMAGING GUID,36001641,CDM,,,,Both,,,1810,453,,1810,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTR W NEUROLYTIC; OTHER PERIPH NRV,36001642,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMPUTATE FOOT TRANSMETATARSAL,36001643,CDM,,,,Both,,,4750,1188,,4750,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR DETACHED RETINA,36001644,CDM,,,,Both,,,13618,3405,,13618,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FNA BX W/US GDN 1ST LES,36001646,CDM,,,,Both,,,2056,514,,2056,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FNA BX W/US GDN EA ADDL LES,36001647,CDM,,,,Both,,,1028,257,,1028,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FNA BX W/FLUOR GDN 1ST LES,36001648,CDM,,,,Both,,,1028,257,,1028,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FNA BX W/FLUOR GDN EA ADDL LES,36001649,CDM,,,,Both,,,1028,257,,1028,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FNA BX W/CT GDN 1ST LES,36001650,CDM,,,,Both,,,1028,257,,1028,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FNA BX W/CT GDN EA ADDL LES,36001651,CDM,,,,Both,,,1028,257,,1028,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FNA BX W/MR GDN 1ST LES,36001652,CDM,,,,Both,,,1028,257,,1028,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FNA BX W/MR GDN EA ADDL LES,36001653,CDM,,,,Both,,,1028,257,,1028,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TANGNTL BX SKIN SINGLE LES,36001654,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TANGNTL BX SKIN EA SEP/ADDL LES,36001655,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PUNCH BX SKIN SINGLE LESION,36001656,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PUNCH BX SKIN EA SEP/ADDL LES,36001657,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INCAL BX SKN SINGLE LES,36001658,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INCAL BX SKN EA SEP/ADDL LES,36001659,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX CNTRST KNE ARTHG/CT/MRI,36001660,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILAT XST TRC NDURLGC PX,36001661,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILAT XST TRC NDURLGC PX BIL,36001662,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILAT XST TRC NEW ACCESS RCS,36001663,CDM,,,,Both,,,5191,1298,,5191,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILAT XST TRC NEW ACCESS RCS BIL,36001664,CDM,,,,Both,,,7787,1947,,7787,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ PICC >5 YR W/O PORT OR PUMP W/IMAGING GUIDANCE W/S&I,36001665,CDM,,,,Both,,,6352,1588,,6352,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTR W NEUROLYTIC CELIAC PLEXUS,36001666,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSURE OF GASTROCOLIC FISTULA,36001667,CDM,,,,Both,,,5881,1470,,5881,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTOURETHROSCOPY WITH URETERAL CATH,36001668,CDM,,,,Both,,,3857,964,,3857,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE ILIAC ART OCCLUS DEVICE,36001669,CDM,,,,Both,,,809,202,,809,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ PICC <5 YR W/O PORT OR PUMP W/IMAGING GUIDANCE W/S&I,36001670,CDM,,,,Both,,,1372,343,,1372,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DX LMBR SPI PNXR W/FLUOR/CT,36001671,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THER SPI PNXR CSF FLUOR/CT,36001672,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DSTRJ NULYT AGT GNCLR NRV,36001673,CDM,,,,Both,,,3850,963,,3850,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE DENTOALVEOLAR STRUCT,36001674,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEM/POP STENT & ATHERECTOMY BILAT,36001675,CDM,,,,Both,,,53546,13387,,53546,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SLIT PREPUCE DORSAL OR LAT; NOT NEWBORN,36001676,CDM,,,,Both,,,3967,992,,3967,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSURE OF GASTROSTOMY SURGICAL,36001677,CDM,,,,Both,,,6716,1679,,6716,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE VAGINAL FOREIGN BODY,36001678,CDM,,,,Both,,,5594,1399,,5594,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE CATH EXTERNAL CAROTID ARTERY - BIL,36001679,CDM,,,,Both,,,3567,892,,3567,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSPLANT W/WO CARDIECTOMY,36001680,CDM,,,,Both,,,101807,25452,,101807,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INCISION OF LINGUAL FRENUM (FRENOTOMY),36001681,CDM,,,,Both,,,3030,758,,3030,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AV ANASTOMOSIS OPEN; DIRECT ANY SITE,36001683,CDM,,,,Both,,,6469,1617,,6469,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL BILATERAL,36001684,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX EXT RETINOPOTHY PRETERM INFANT BIL,36001685,CDM,,,,Both,,,2379,595,,2379,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONTROL OF NOSEBLEED BILATERAL,36001686,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEMORAL NERVE BLOCK BIL INCL IMAGING GUID,36001687,CDM,,,,Both,,,1074,269,,1074,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TREAT ECTOPIC PREGNANCY,36001688,CDM,,,,Both,,,11617,2904,,11617,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED NECK/CHEST SURGERY PROCEDURE,36001689,CDM,,,,Both,,,486,122,,486,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE BIOPSY LIVER ADD ON,36001690,CDM,,,,Both,,,2270,568,,2270,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH PUDENDAL NERVE BILAT,36001692,CDM,,,,Both,,,1257,314,,1257,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LAPAROSCOPIC CHOLECYSTECTOMY,36001693,CDM,,,,Both,,,11617,2904,,11617,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RENAL ENDOSCOPY THRU EST. NEPH WITH BIOPSY,36001694,CDM,,,,Both,,,18948,4737,,18948,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ BILAT,36001695,CDM,,,,Both,,,6156,1539,,6156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LARYNGOSCOPY W/FB REMOVAL,36001696,CDM,,,,Both,,,3625,906,,3625,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRQ AV FSTL CRT UXTR SEP ACS,36001697,CDM,,,,Both,,,38303,9576,,38303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR OF STERNUM SEPARATION,36001699,CDM,,,,Both,,,16212,4053,,16212,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX MISSED ABORTION FIRST TRIMESTER SURGICAL,36001700,CDM,,,,Both,,,6411,1603,,6411,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP,36001702,CDM,,,,Both,,,14750,3688,,14750,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTRUCTION RECTAL TUMOR,36001703,CDM,,,,Both,,,6065,1516,,6065,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATARACT STUDY,36001704,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION OF ANAL LESION(S),36001705,CDM,,,,Both,,,6115,1529,,6115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LAM FACETC/FRMT ARTHRD LUM 1,36001706,CDM,,,,Both,,,4600,1150,,4600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASC EMB/OCC W/PRS CATH,36001708,CDM,,,,Both,,,38187,9547,,38187,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES,36001709,CDM,,,,Both,,,7049,1762,,7049,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRODUCTION NEEDLE/INTRACATHETER VEIN RT,36100001,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BONE MARROW ASP,36100007,CDM,,,,Both,,,2420,605,,2420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABD/PELVIS/LOW EXT ART 2ND RT,36100010,CDM,,,,Both,,,1691,423,,1691,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABD/PELVIS/LOW EXT ART 3RD RT,36100013,CDM,,,,Both,,,1864,466,,1864,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECT PERC ANEURYSM EXTREMITY (THROMBIN,36100018,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BONE MARROW, BIOPSY",36100019,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELECT CATH SEGMENTAL ART PULM RT,36100021,CDM,,,,Both,,,1102,276,,1102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH PLACEMENT ABD-ADD'L 2ND OR 3RD RT,36100022,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PUNCT ASP BRST RT,36100023,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PUNCT ASP BRST CYST EA ADDL LT,36100025,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAMMARY DUCT INJ SINGLE BILATERAL,36100026,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SVC/IVC CATH INTRO,36100029,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC AORTA, INTRO OF CATHETER",36100030,CDM,,,,Both,,,1478,370,,1478,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SENTINEL NODE INJ RADIOACTIVE TRACER,36100031,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS CATH REN ART 2ND + BILAT,36100033,CDM,,,,Both,,,6048,1512,,6048,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PUNCT ASP BRST LT,36100034,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PUNCT ASP BRST CYST EA ADDL RT,36100037,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAMMARY DUCT INJ LT,36100038,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAMMARY DUCT INJ RT,36100039,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRODUCTION NEEDLE/INTRACATHETER VEIN LT,36100058,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENO CONTRAST/INJ PROC RT,36100059,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENO CONTRAST/INJ PROC BILAT,36100060,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENO CONTRAST/INJ PROC LT,36100062,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELECT CATH PLACE VEN SYS 1ST ORD FAM BILAT,36100070,CDM,,,,Both,,,1632,408,,1632,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELECT CATH PLACE VEN SYS 1ST ORD FAM RT,36100071,CDM,,,,Both,,,1088,272,,1088,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELECT CATH PLACE VEN SYS 1ST ORD FAM LT,36100072,CDM,,,,Both,,,1088,272,,1088,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELECT CATH PLACE VEN SYS 2ND ORD FAM RT,36100073,CDM,,,,Both,,,1134,284,,1134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PULMON SEL CATH PLACE BIL,36100075,CDM,,,,Both,,,1636,409,,1636,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PULMON SEL CATH PLACE LT,36100076,CDM,,,,Both,,,1091,273,,1091,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELECT CATH SEGMENTAL ART PULM LT,36100078,CDM,,,,Both,,,1102,276,,1102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELECT CATH SEGMENTAL ART PULM BILAT,36100079,CDM,,,,Both,,,1654,414,,1654,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTREMITY ART INTRO NEEDLE/CAT RT,36100080,CDM,,,,Both,,,1700,425,,1700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTREMITY ART INTRO NEEDLE/CAT LT,36100081,CDM,,,,Both,,,1700,425,,1700,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THORAC, SELCATH PL, ART 1ST RT",36100084,CDM,,,,Both,,,3432,858,,3432,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THORAC, SELCATH PL, ART 1ST LT",36100085,CDM,,,,Both,,,3354,839,,3354,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THORAC, SELCATH PL, ART 2ND LT",36100090,CDM,,,,Both,,,3380,845,,3380,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THORAC, SELCATH PL, ART 2ND RT",36100091,CDM,,,,Both,,,3718,930,,3718,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THORAC, SELCATH PL, ART 3RD RT",36100096,CDM,,,,Both,,,3640,910,,3640,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC THORAC, SELCATH PL, ART 3RD LT",36100097,CDM,,,,Both,,,3640,910,,3640,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CA;ART;EA ADD 2ND/3RD RT,36100101,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CA;ART;EA ADD 2ND/3RD LT,36100102,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH PLACE ABD/PELV/LOW EXT ART 1ST ORDER LT,36100108,CDM,,,,Both,,,1691,423,,1691,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH PLACE ABD/PELV/LOW EXT ART 1ST ORDER RT,36100109,CDM,,,,Both,,,1691,423,,1691,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABD/PELVIS/LOW EXT ART 2ND LT,36100114,CDM,,,,Both,,,1691,423,,1691,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABD/PELVIS/LOW EXT ART 3RD LT,36100120,CDM,,,,Both,,,1864,466,,1864,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH PLACEMENT ABD-ADD'L 2ND OR 3RD LT,36100125,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS CATH REN ART 1ST UNILAT LT,36100128,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS CATH REN ART 1ST UNILAT RT,36100129,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS CATH REN ART 1ST BILAT,36100133,CDM,,,,Both,,,5747,1437,,5747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS CATH REN ART 2ND + UNILAT LT,36100135,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS CATH REN ART 2ND + UNILAT RT,36100136,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SENTINEL NODE INJ RADIOACTIVE TRACER BIL,36100137,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PULMON SEL CATH PLACE RT,36100141,CDM,,,,Both,,,1200,300,,1200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATH PL ABD/PELV/LOW EXT ART 1ST OR BILAT,36100142,CDM,,,,Both,,,2415,604,,2415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE BREAST,36100145,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL IMPLANT DEEP,36100146,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTR W NEUROLYT TRIGEM NRV W/RAD GUIDE,36100147,CDM,,,,Both,,,3188,797,,3188,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE LARYNX,36100148,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE NERVOUS SYSTEM,36100149,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE DRUG IMPLANT,36100150,CDM,,,,Both,,,772,193,,772,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LARGSC W/THER INJECTION,36100152,CDM,,,,Both,,,6917,1729,,6917,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABRASION SINGLE LESION,36100153,CDM,,,,Both,,,390,98,,390,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTRUCT PREMALG LESION,36100155,CDM,,,,Both,,,390,98,,390,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DESTRUCT PREMALG LES 2-14,36100156,CDM,,,,Both,,,781,195,,781,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ CARPAL TUNNEL THERAPEUTIC,36100158,CDM,,,,Both,,,876,219,,876,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE SACRUM PRESSURE SORE,36100159,CDM,,,,Both,,,5351,1338,,5351,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMODENERV SALIV GLANDS,36100160,CDM,,,,Both,,,606,152,,606,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GENERAL ANESTHESIA BASE,37000001,CDM,,,,Both,,,853,213,,853,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GENERAL INCREMENTS,37000002,CDM,,,,Both,,,30,8,,30,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAC BASE,37000003,CDM,,,,Both,,,610,153,,610,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAC INCREMENTS,37000004,CDM,,,,Both,,,22,6,,22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HOSP MANAGE CONT DRUG ADMIN,37000005,CDM,,,,Both,,,260,65,,260,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MOD SED SAME PHYS/QHP <5 YRS INITIAL 15 MIN,37000006,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MOD SED SAME PHYS/QHP 5/>YRS INITIAL 15 MIN,37000007,CDM,,,,Both,,,292,73,,292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MOD SED SAME PHYS/QHP EA ADDL 15 MIN,37000008,CDM,,,,Both,,,292,73,,292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MOD SED OTH PHYS/QHP <5 YRS INITIAL 15 MIN,37000009,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MOD SED OTH PHYS/QHP 5/>YRS INITIAL 15 MIN,37000010,CDM,,,,Both,,,292,73,,292,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MOD SED OTHER PHYS/QHP EA  ADDL 15 MIN,37000011,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MOD SEDAT ENDO SERIVCE > 5 YRS INIT 15 MIN,37000012,CDM,,,,Both,,,265,66,,265,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NITROUS OXIDE,37000013,CDM,,,,Both,,,69,17,,69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRYOPRECIPITATE,39000001,CDM,,,,Both,,,141,35,,141,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FRESH FROZEN PLASMA,39000002,CDM,,,,Both,,,146,37,,146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RED CELLS,39000003,CDM,,,,Both,,,391,98,,391,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RED CELLS, AUTOLOGOUS",39000004,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RED CELLS, DEGLYCEROLIZED",39000005,CDM,,,,Both,,,796,199,,796,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RED CELLS, LEUKODEPLETED",39000006,CDM,,,,Both,,,530,133,,530,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHOLE BLOOD,39000007,CDM,,,,Both,,,502,126,,502,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPLIT BLOOD PRODUCT,39000008,CDM,,,,Both,,,226,57,,226,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PLATELETS, LKD PHERESIS",39000009,CDM,,,,Both,,,1757,439,,1757,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PLATELETS, PHERESIS, LEUKOCYTE RED, IRRA",39000010,CDM,,,,Both,,,2145,536,,2145,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RED BLOOD CELLS, LEUKOCYTE RED, IRRA",39000011,CDM,,,,Both,,,920,230,,920,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRYO POOR PLASMA,39000012,CDM,,,,Both,,,209,52,,209,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHORT DRAW PLATELET PHERESIS,39000013,CDM,,,,Both,,,1731,433,,1731,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 24 HOUR PLASMA,39000014,CDM,,,,Both,,,109,27,,109,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RED CELL LEUKODEPLETED,39000018,CDM,,,,Both,,,332,83,,332,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLATELET CONCENTRATE,39000020,CDM,,,,Both,,,254,64,,254,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC AUTOLOGOUS LKD RED CELLS, WASHED",39000023,CDM,,,,Both,,,701,175,,701,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PLATELETS, PHERESIS",39000025,CDM,,,,Both,,,1731,433,,1731,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AUTOLOGOUS PLATELET PHERESIS,39000026,CDM,,,,Both,,,1731,433,,1731,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RED BLOOD CELLS, IRRADIATED",39000029,CDM,,,,Both,,,486,122,,486,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC GRANULOCYTES, PHERESIS",39000030,CDM,,,,Both,,,2904,726,,2904,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC AUTOLOGOUS LKD RED CELLS, DEGLYC",39000031,CDM,,,,Both,,,478,120,,478,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLATELETS PHERESIS PATHOGEN REDUCED EACH UNIT,39000033,CDM,,,,Both,,,1864,466,,1864,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PATHOGEN TEST FOR PLATELETS,39000034,CDM,,,,Both,,,135,34,,135,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIQUID PLASMA,39000035,CDM,,,,Both,,,269,67,,269,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PLATELETS, HLA-M, L/R, UNIT",39000036,CDM,,,,Both,,,1450,363,,1450,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSFUSION INTRAUTERINE FETAL,39100001,CDM,,,,Both,,,3348,837,,3348,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BLOOD TRANSFUSION ADMIN DAILY,39100002,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DX MAMMO W/CAD IF PERFORMED BILAT,40100004,CDM,,,,Both,,,940,235,,940,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DX MAMMO W/CAD IF PERFORMED UNILAT LT,40100005,CDM,,,,Both,,,538,135,,538,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DX MAMMO W/CAD IF PERFORMED UNILAT RT,40100006,CDM,,,,Both,,,538,135,,538,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BREAST TOMOSYNTHESIS UNI LT,40100013,CDM,,,,Both,,,283,71,,283,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BREAST TOMOSYNTHESIS UNI RT,40100014,CDM,,,,Both,,,283,71,,283,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BREAST TOMOSYNTHESIS BIL,40100015,CDM,,,,Both,,,375,94,,375,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROSTATE ULTRASOUND,40200001,CDM,,,,Both,,,371,93,,371,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL BIOPHYSICAL PROFILE,40200002,CDM,,,,Both,,,390,98,,390,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC US GUIDE NEEDLE;BX,ASP",40200004,CDM,,,,Both,,,509,127,,509,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC U/S GUIDE; ENDOMYOCARDIAL BX,40200005,CDM,,,,Both,,,2260,565,,2260,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ART PSEUDOANEURYSM COMPRESS REPAIR,40200006,CDM,,,,Both,,,463,116,,463,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABDOMINAL US LIMITED,40200007,CDM,,,,Both,,,236,59,,236,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US CHEST,40200008,CDM,,,,Both,,,576,144,,576,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US HEAD/THYROID &/OR NECK,40200009,CDM,,,,Both,,,583,146,,583,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ULTRASOUND, RETROPERITONEAL, LIMITED",40200010,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEONATAL HEAD ECHO,40200012,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPHYSICAL PROFILE WO NON STRESS TEST,40200013,CDM,,,,Both,,,371,93,,371,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABDOMINAL US COMPLETE,40200014,CDM,,,,Both,,,1442,361,,1442,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASCULAR ACCESS  US GUIDANCE(M59),40200015,CDM,,,,Both,,,548,137,,548,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPINAL CANAL/CONTENTS,40200016,CDM,,,,Both,,,515,129,,515,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC HIP, INFANT, W PHYSICIAN MANIPULATION",40200017,CDM,,,,Both,,,409,102,,409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCROTUM ULTRASOUND,40200018,CDM,,,,Both,,,669,167,,669,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RENAL TRANSPLANT (WITH DOPPLER),40200019,CDM,,,,Both,,,1579,395,,1579,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSVAGINAL NON OBSTETRICAL,40200020,CDM,,,,Both,,,632,158,,632,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RETROPERITONEAL ECHOGRAPHY,COMPLETE",40200021,CDM,,,,Both,,,936,234,,936,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US EXAM PELVIC LIMITED,40200022,CDM,,,,Both,,,452,113,,452,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PREG,>14 WKS, FET/MAT EVAL, 1 GEST",40200023,CDM,,,,Both,,,371,93,,371,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PREG,>14 WKS, FET/MAT EVAL, ADD'L GEST",40200024,CDM,,,,Both,,,243,61,,243,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PREG LIMITED, 1 OR MORE FETUSES",40200025,CDM,,,,Both,,,487,122,,487,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PELVIC ULTRASOUND NON OBSTETRICAL,40200027,CDM,,,,Both,,,648,162,,648,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMNIOCENTESIS BY US GUIDANCE,40200028,CDM,,,,Both,,,463,116,,463,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRAOPERATIVE ULTRASOUND OR,40200029,CDM,,,,Both,,,606,152,,606,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PREG, FOLLOW UP/RE EVAL, PER FETUS",40200031,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC US GUIDE, VISC. TISSUE ABLAT.(59)",40200034,CDM,,,,Both,,,463,116,,463,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PREG,<14 WKS, FET/MAT EVAL, 1 GEST",40200035,CDM,,,,Both,,,371,93,,371,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PREG,<14 WKS, FET/MAT EVAL, ADD'L GEST",40200036,CDM,,,,Both,,,243,61,,243,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PREG, COMPLETE, 1 GESTATION",40200037,CDM,,,,Both,,,542,136,,542,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PREG COMPLETE, EA, ADD'L GESTATION",40200038,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TRANSVAGINAL, OBSTETRICAL",40200039,CDM,,,,Both,,,601,150,,601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC HIP, INFANT, WO PHYSICIAN MANIPULATION",40200040,CDM,,,,Both,,,371,93,,371,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED ULTRASOUND,40200042,CDM,,,,Both,,,371,93,,371,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROSTATE VOLUME STUDY,40200043,CDM,,,,Both,,,327,82,,327,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTREMITY LIMITED RT,40200044,CDM,,,,Both,,,403,101,,403,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTREMITY LIMITED LT,40200045,CDM,,,,Both,,,403,101,,403,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US BREAST COMPLETE LT,40200046,CDM,,,,Both,,,275,69,,275,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US BREAST COMPLETE RT,40200047,CDM,,,,Both,,,275,69,,275,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US BREAST COMPLETE BIL,40200048,CDM,,,,Both,,,284,71,,284,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US BREAST LIMITED LT,40200049,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US BREAST LIMITED RT,40200050,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US BREAST LIMITED BIL,40200051,CDM,,,,Both,,,258,65,,258,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIVER ELASTOGRAPHY,40200052,CDM,,,,Both,,,253,63,,253,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UMBILICAL ARTERY ECHO,40200054,CDM,,,,Both,,,215,54,,215,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DX OPHTHAL B-SCAN US,40200055,CDM,,,,Both,,,213,53,,213,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL MIDL CEREBRAL ARTERY ECHO,40200056,CDM,,,,Both,,,207,52,,207,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US ABDL AORTA SCREEN AAA,40200057,CDM,,,,Both,,,207,52,,207,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTREMITY LIMITED,40200058,CDM,,,,Both,,,403,101,,403,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US TRGT DYN MBUBB 1ST LES,40200059,CDM,,,,Both,,,358,90,,358,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US TRGT DYN MBUBB EA ADDL LES,40200060,CDM,,,,Both,,,358,90,,358,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC USE PARENCHYMA,40200061,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC USE 1ST TARGET LESION,40200062,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC USE EA ADDL TARGET LESION,40200063,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC US COMPL JOINT R-T W/IMG,40200064,CDM,,,,Both,,,249,62,,249,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUP-SCAN HEMO COMPL BI STD,40200065,CDM,,,,Both,,,522,131,,522,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUP-SCAN HEMO COMPL UNI STD,40200066,CDM,,,,Both,,,251,63,,251,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OB 4D ULTRASOUND,40200067,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCRN MAMMO W/CAD IF PERFORMED BILAT,40300003,CDM,,,,Both,,,423,106,,423,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCREEN BREAST TOMOSYNTHESIS BIL,40300004,CDM,,,,Both,,,224,56,,224,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PET,MYOCARDVIABILITY AFTER NON CONSPEC",40400001,CDM,,,,Both,,,4051,1013,,4051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOCARDIAL PET PERF SNG STRESS OR REST,40400002,CDM,,,,Both,,,4051,1013,,4051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOCARDIAL PET MULTI STRESS AND REST,40400003,CDM,,,,Both,,,4051,1013,,4051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRAIN PET METABOLIC EVAL,40400004,CDM,,,,Both,,,4051,1013,,4051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PET IMAGE, LTD AREA",40400005,CDM,,,,Both,,,4051,1013,,4051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PET IMAGE, SKULL THIGH",40400006,CDM,,,,Both,,,4051,1013,,4051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PET IMAGE, FULL BODY",40400007,CDM,,,,Both,,,4051,1013,,4051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PET IMAGING CT FOR ATTENUATION LIMITED AREA,40400008,CDM,,,,Both,,,3409,852,,3409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,40400009,CDM,,,,Both,,,4051,1013,,4051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PET IMAGING FOR CT ATTENUATION WHOLE BODY,40400010,CDM,,,,Both,,,9731,2433,,9731,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PET/CT-LIMITED STUDY,40400011,CDM,,,,Both,,,4051,1013,,4051,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECHO 3D RECON,40900000,CDM,,,,Both,,,55,14,,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENTILATION ASSIST & MGMT INPATIENT 1ST DAY,41000001,CDM,,,,Both,,,1995,499,,1995,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CPAP VENTILATION CPAP INITIATION&MGMT,41000002,CDM,,,,Both,,,331,83,,331,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DAY,41000003,CDM,,,,Both,,,1861,465,,1861,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ,41000004,CDM,,,,Both,,,173,43,,173,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL,41000005,CDM,,,,Both,,,264,66,,264,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR,41000006,CDM,,,,Both,,,442,111,,442,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONTINUOUS INHALATION TREATMENT 1ST HR,41000007,CDM,,,,Both,,,195,49,,195,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONTINUOUS INHALATION TREATMENT EA ADDL HR,41000008,CDM,,,,Both,,,139,35,,139,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPMTRY W/VC EXPIRATORY FLO +MXML VOL VNTJ,41000009,CDM,,,,Both,,,298,75,,298,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VITAL CAPACITY TOTAL SEPARATE PROCEDURE,41000010,CDM,,,,Both,,,214,54,,214,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IPPB,41000011,CDM,,,,Both,,,335,84,,335,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AEROSOL PENTAMIDEN FOR P. CARINII,41000013,CDM,,,,Both,,,309,77,,309,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MECHANICAL CHEST WALL OSCILL,41000014,CDM,,,,Both,,,331,83,,331,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP FCN THERAPY PER 15 MIN,41000015,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESP FCN/STRENGTH 2/> INDIV,41000016,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEWBORN RESUSCITATION,41000017,CDM,,,,Both,,,1201,300,,1201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RT NEWBORN TRANSPORT PER HOUR,41000018,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERAPEUTIC PROCD STRG ENDURANCE EA 15 MIN,41000019,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HBO THERAPY PER SESSION,41300002,CDM,,,,Both,,,817,204,,817,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WORK HARDEN/ CONDITIONING INITIAL 2 HRS,42000001,CDM,,,,Both,,,238,60,,238,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PT TRACTION MECHANICAL,42000002,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROSTHETIC TRAINING  EA 15 MIN INITIAL PT,42000003,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ULTRAVIOLET,42000007,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTRICAL STIM UNATTENDED/NON WOUND,42000010,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WORK HARDEN/ CONDITIONING EA ADD HR,42000011,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GAIT TRAINING THERAPY EA 15 MINS,42000013,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHEELCHAIR MANAGEMENT  EA 15 MIN,42000040,CDM,,,,Both,,,284,71,,284,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTRIC STIM MANUAL EA 15 MIN,42000041,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLUIDO THERAPY/WHIRLPOOL,42000042,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MANUAL THERAPY  1/> REGIONS EA 15 MIN,42000043,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERAPEUTIC PROCEDURES  EA 15 MIN EXERCISES,42000044,CDM,,,,Both,,,250,63,,250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMMUNITY RE-INTEGRATION TRAINING EA 15 MIN,42000045,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THER ACTV DIR PT CONTACT BY PROVIDER EA 15 MIN,42000046,CDM,,,,Both,,,157,39,,157,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERAPEUTIC PROC GROUP 2/> INDIVIDUALS,42000047,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEG PRESS WOUND THER I <OR=50 SQCM,42000048,CDM,,,,Both,,,275,69,,275,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEG PRESS WOUND THER II >50 SQCM,42000049,CDM,,,,Both,,,583,146,,583,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASOPNEUMATIC DEVICE APPLICATION,42000050,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARAFFIN BATH,42000051,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ULTRASOUND EA 15 MIN,42000052,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IONTOPHORESIS EA 15 MIN,42000053,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEUROMUSCULAR RE-EDUCATION EA 15 MIN,42000054,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MASSAGE EA 15 MIN,42000055,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELF CARE/HOME MANG TRAINING EA 15 MIN,42000056,CDM,,,,Both,,,181,45,,181,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ORTHOTIC FITTING & TRAINING EA 15 MIN INITIAL PT,42000058,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHYSICAL PERFORM/TEST W/REPORT EA 15 MIN,42000059,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IP THERAPEUTIC PROCEDURES  EA 15 MIN EXERCISES,42000060,CDM,,,,Both,,,226,57,,226,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IP SELF CARE/HOME MANG TRAINING EA 15 MIN,42000061,CDM,,,,Both,,,181,45,,181,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IP THER ACTV DIR PT CONTACT BY PROVIDER EA 15 MIN,42000062,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRIDEMENT OPEN WOUND 20 SQ CM/<,42000063,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,42000064,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL DEVITAL TISS NSLCTV DBRDMT W/O ANES 1 SESS,42000065,CDM,,,,Both,,,303,76,,303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PT OR MANIP FOR MAINT,42000066,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN,42000067,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEAM CONF W/O PAT BY HC PRO 30+ MINS PT,42000068,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CANALITH REPOSITIONING PROC PT PER DAY,42000069,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HOT OR COLD PACKS THERAPY 1+ AREAS,42000071,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INFRARED THERAPY 1+ AREAS,42000072,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BFB TRAINING 1ST 15 MIN,42000074,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BFB TRAINING EA ADDL 15 MIN,42000075,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PT DEVEL TST PHYS/QHP 1ST HR,42000080,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PT EVAL LOW COMPLEX,42400001,CDM,,,,Both,,,250,63,,250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PT EVAL MOD COMPLEX,42400002,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PT EVAL HIGH COMPLEX,42400003,CDM,,,,Both,,,471,118,,471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PT RE-EVAL EST PLAN CARE,42400004,CDM,,,,Both,,,235,59,,235,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL DEVITAL TISS NSLCTV DBRDMT W/O ANES 1 SESS,43000001,CDM,,,,Both,,,303,76,,303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WHEELCHAIR MANAGEMENT  EA 15 MIN,43000002,CDM,,,,Both,,,284,71,,284,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTRIC STIM MANUAL EA 15 MIN,43000003,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLUIDO THERAPY/WHIRLPOOL,43000005,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MANUAL THERAPY  1/> REGIONS EA 15 MIN,43000006,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERAP PROC  EA 15  MIN EXER,43000008,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMMUNITY RE-INTEGRATION TRAINING EA 15 MIN,43000010,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THER ACTV DIR PT CONTACT BY PROVIDER EA 15 MIN,43000011,CDM,,,,Both,,,250,63,,250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THERAPEUTIC PROC GROUP 2/> INDIVIDUALS,43000012,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEG PRESS WOUND THER I <OR=50 SQCM,43000013,CDM,,,,Both,,,275,69,,275,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEG PRESS WOUND THER II >50 SQCM,43000014,CDM,,,,Both,,,586,147,,586,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VASOPNEUMATIC DEVICE APPLICATION,43000015,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PARAFFIN BATH,43000016,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ULTRASOUND EA 15 MIN,43000017,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IONTOPHORESIS EA 15 MIN,43000018,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ORTHOTIC FITTING & TRAINING EA 15 MIN INITIAL OT,43000020,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHYSICAL PERFORM/TEST W/REPORT EA 15 MIN,43000021,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEUROMUSCULAR RE-EDUCATION EA 15 MIN,43000023,CDM,,,,Both,,,155,39,,155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MASSAGE EA 15 MIN,43000024,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SELF CARE/HOME MANG TRAINING EA 15 MIN,43000025,CDM,,,,Both,,,250,63,,250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IP SELF CARE/HOME MANG TRAINING EA 15 MIN,43000028,CDM,,,,Both,,,181,45,,181,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IP THER ACTV DIR PT CONTACT BY PROVIDER EA 15 MIN,43000029,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COGNITIVE PERFORMANCE TESTING,43000060,CDM,,,,Both,,,621,155,,621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WORK HARDENING I,43000061,CDM,,,,Both,,,238,60,,238,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WORK HARDENING II,43000062,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTRICAL STIM UNATTENDED/NON WOUND,43000063,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROSTHETIC TRAINING  EA 15 MIN INITIAL OT,43000066,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ORTHC/PROSTC MGMT SBSQ ENC OT EA 15 MIN,43000068,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT OR MANIP FOR MAINT,43000069,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEAM CONF W/O PAT BY HC PRO 30+ MINS OT,43000070,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CANALITH REPOSITIONING PROC OT PER DAY,43000071,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT THER IVNTJ 1ST 15 MIN,43000072,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT THER IVNTJ EA ADDL 15 MIN,43000073,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT SENSORY INTEGRATION EA 15 MIN,43000077,CDM,,,,Both,,,143,36,,143,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT DEVEL TST PHYS/QHP 1ST HR,43000078,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT TRACTION MECHANICAL,43000079,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT EVAL LOW COMPLEX,43400001,CDM,,,,Both,,,235,59,,235,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT EVAL MOD COMPLEX,43400002,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT EVAL HIGH COMPLEX,43400003,CDM,,,,Both,,,471,118,,471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OT RE-EVAL EST PLAN CARE,43400004,CDM,,,,Both,,,235,59,,235,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MODIFICATION OF A&A DEVICE,44000001,CDM,,,,Both,,,177,44,,177,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TX SPEECH, LANG, VOICE & AUDITORY PROC",44000002,CDM,,,,Both,,,404,101,,404,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPEECH COGNITIVE PERFORMANCE TESTING,44000003,CDM,,,,Both,,,621,155,,621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVAL ORAL & PHARYNEGEAL SWALLOW,44000004,CDM,,,,Both,,,332,83,,332,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TX SPEECH, LANG, VOICE & AUDITORY GROUP",44000005,CDM,,,,Both,,,161,40,,161,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SWALLOW TX AND/OR ORAL FUNCTION,44000006,CDM,,,,Both,,,276,69,,276,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEECH,44000007,CDM,,,,Both,,,168,42,,168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SP DEVELOPMENTAL TESTING LIMITED,44000008,CDM,,,,Both,,,666,167,,666,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BEHAVRAL QUALIT ANALYS VOICE,44000016,CDM,,,,Both,,,202,51,,202,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEAM CONF W/O PAT BY HC PRO 30+ MINS SLP,44000017,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEVEL TST PHYS/QHP 1ST HR,44000018,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEVEL TST PHYS/QHP EA ADDL 30 MIN,44000019,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ST THER IVNTJ 1ST 15 MIN,44000020,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ST THER IVNTJ EA ADDL 15 MIN,44000021,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ST SENSORY INTEGRATION EA 15 MIN,44000025,CDM,,,,Both,,,143,36,,143,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEES SWALLOW EVALUATION,44400002,CDM,,,,Both,,,420,105,,420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ASSESSMENT OF APHASIA/PER HR,44400003,CDM,,,,Both,,,666,167,,666,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SWALLOW EVAL WITH VIDEO,44400004,CDM,,,,Both,,,357,89,,357,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVAL FOR RX OF ALT COMM DEVICE EA ADD'L 30 MIN,44400005,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVAL FOR RX OF ALT COMMUNICATION DEVICE 1ST HR,44400006,CDM,,,,Both,,,297,74,,297,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVALUATION OF SPEECH FLUENCY,44400025,CDM,,,,Both,,,245,61,,245,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVALUATE SPEECH PRODUCTION,44400026,CDM,,,,Both,,,198,50,,198,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPEECH SOUND LANG COMPREHEN,44400027,CDM,,,,Both,,,434,109,,434,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMERGENCY DEPT VISIT LEVEL 1,45000001,CDM,,,,Both,,,1616,404,,1616,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMERGENCY DEPT VISIT LEVEL 2,45000002,CDM,,,,Both,,,2338,585,,2338,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMERGENCY DEPT VISIT LEVEL 3,45000003,CDM,,,,Both,,,2783,696,,2783,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMERGENCY DEPT VISIT LEVEL 4,45000004,CDM,,,,Both,,,3033,758,,3033,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMERGENCY DEPT VISIT LEVEL 5,45000005,CDM,,,,Both,,,3739,935,,3739,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CRITICAL CARE INITIAL 30-74 MIN,45000006,CDM,,,,Both,,,4181,1045,,4181,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PCP ENROLLMENT FEE,45000013,CDM,,,,Both,,,34,9,,34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEDICAID SCREENING,45000015,CDM,,,,Both,,,54,14,,54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX KNEE DISL/W ANESTHESIA,45000016,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THORACENTESIS ASPIRATION W/O IMG GUIDANC,45000018,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABD PARACENTESIS W/IMAGING,45000019,CDM,,,,Both,,,2471,618,,2471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX SHLDR DISL W MANIP; W ANESTH,45000020,CDM,,,,Both,,,2169,542,,2169,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D PILONIDAL CYST COMPLI,45000021,CDM,,,,Both,,,1951,488,,1951,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX CL ELBOW DISLOC W ANESTH,45000022,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX MCP DISLOC W MANIP & ANESTH,45000025,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX TRAUMA HIP DISLOC W ANESTH,45000026,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX IP JOINT DISL; W ANESTH,45000027,CDM,,,,Both,,,1733,433,,1733,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NERVE BLOCK INJ PLANTAR DIGIT,45000028,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED MUSCULOSKELETAL SYSTEM OP,45000029,CDM,,,,Both,,,2475,619,,2475,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTO W DIL OF URETHRAL STRICTURE,45000030,CDM,,,,Both,,,4285,1071,,4285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FORESKIN MANIPULATION,45000031,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX MTP JNT DISLOC W ANESTH,45000032,CDM,,,,Both,,,2134,534,,2134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE IMPACTED EAR WAX IRRIG/LAVAGE UNI,45000034,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE IMPACTED EAR WAX IRRIG/LAVAGE BIL,45000035,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN EXTERNAL AUDITORY CANAL ABSCESS,45000036,CDM,,,,Both,,,1029,257,,1029,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE IMPACTED EAR WAX W/INSTRUMENT BIL,45000037,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TREAT FINGER DISLOCATION,45000039,CDM,,,,Both,,,6638,1660,,6638,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,45000451,CDM,,,,Both,,,393,98,,393,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED IV INFUSION HYDRATION EACH ADDITIONAL HOUR,45000452,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED IV INFUSION THERAPY/PROPH /DX 1ST TO 1 HR,45000453,CDM,,,,Both,,,476,119,,476,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED IV INFUSION THERAPY PROPH/DX EA HOUR,45000454,CDM,,,,Both,,,164,41,,164,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED IV INFUSION THER PROPH ADDL SEQ TO 1 HR,45000455,CDM,,,,Both,,,206,52,,206,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED IV NFS THERAPY PROPHY/DX CONCURRENT NFS,45000456,CDM,,,,Both,,,498,125,,498,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED THERAPEUTIC PROPHY/DX INJECTION SUBQ/IM,45000457,CDM,,,,Both,,,172,43,,172,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,45000458,CDM,,,,Both,,,364,91,,364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,45000459,CDM,,,,Both,,,153,38,,153,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC,45000460,CDM,,,,Both,,,126,32,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED UNLISTED THER./PROPHYLACTIC/DIAG. INJ.,45000461,CDM,,,,Both,,,194,49,,194,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN TX DISTAL PHALANG FRACT EA,45000462,CDM,,,,Both,,,10166,2542,,10166,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE HUMERUS OR ELBOW,45000463,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC I&D ABSC/CYST TONGUE FOM LINGUAL,45000464,CDM,,,,Both,,,812,203,,812,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TREAT TOE FRACTURE,45000465,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE ANUS,45000466,CDM,,,,Both,,,1385,346,,1385,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MASTOTOMY W EXPL DEEP,45000467,CDM,,,,Both,,,3070,768,,3070,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CANTHOTOMY,45000468,CDM,,,,Both,,,3123,781,,3123,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEV 1 HOSP TYPE B ED VISIT,45000469,CDM,,,,Both,,,364,91,,364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEV 2 HOSP TYPE B ED VISIT,45000470,CDM,,,,Both,,,594,149,,594,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEV 3 HOSP TYPE B ED VISIT,45000471,CDM,,,,Both,,,835,209,,835,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEV 4 HOSP TYPE B ED VISIT,45000472,CDM,,,,Both,,,1564,391,,1564,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEV 5 HOSP TYPE B ED VISIT,45000473,CDM,,,,Both,,,1920,480,,1920,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REP ACQ/TRAUM AV FISTULA EXTREMITIES,45000474,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE PHARYNX ADENOIDS,45000475,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CORPORA CAVERNOSA-GLANS PENIS FISTULIZ,45000476,CDM,,,,Both,,,9747,2437,,9747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE MALE GENITAL SYSTEM,45000477,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMPUTATE FINGER/THUMB SGL W DIR CLOSE,45000478,CDM,,,,Both,,,4950,1238,,4950,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC SKTL FIX D PHALANG FX FINGER/THUMB,45000479,CDM,,,,Both,,,4750,1188,,4750,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CORRECT RECTAL PROLAPSE PERINEAL,45000480,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CL TX PATELLAR DISLOCATION WITH ANESTH,45000481,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLC,45000482,CDM,,,,Both,,,12637,3159,,12637,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ CORPORA CAVERNOSA W PHARM AGENTS,45000483,CDM,,,,Both,,,775,194,,775,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REP T/M EXTENSOR FA/W - 1' EA,45000484,CDM,,,,Both,,,6040,1510,,6040,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
TX SPONTAN HIP DISLOC W ANESTH,45000485,CDM,,,,Both,,,6130,1533,,6130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDO INJ OF IMPLANT MATERIAL,45000486,CDM,,,,Both,,,6760,1690,,6760,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE ANT SEG OF EYE,45000487,CDM,,,,Both,,,4528,1132,,4528,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE FEMALE GENITAL SYS,45000488,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN TX BIMALLEOLAR ANKLE FRACTURE,45000489,CDM,,,,Both,,,13396,3349,,13396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR INCOMPL CIRCUMCISION,45000490,CDM,,,,Both,,,3968,992,,3968,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED CRANIOFACIAL & MAXILLOFACIAL OP,45000491,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTO/URETERO W/LITHOTRIPSY,45000492,CDM,,,,Both,,,10678,2670,,10678,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPEN TX TRIMALLEOLAR ANKLE FX WO FIX PST LIP,45000493,CDM,,,,Both,,,14030,3508,,14030,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIL URETH STRICT SOUND; MALE INITIAL,45000494,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE RECTUM,45000496,CDM,,,,Both,,,1884,471,,1884,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPR AA HRN 1ST < 3 NCR/STRN,45000497,CDM,,,,Both,,,11820,2955,,11820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PX FOREARM/WRIST,45000498,CDM,,,,Both,,,462,116,,462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE FEMUR/KNEE,45000499,CDM,,,,Both,,,470,118,,470,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ED THER/PROPH/DIAG INJ IA,45000500,CDM,,,,Both,,,468,117,,468,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,46000002,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRNCDILAT RSPSE SPMTRY PRE&POSTBRNCDILAT ADMN,46000004,CDM,,,,Both,,,575,144,,575,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL,46000006,CDM,,,,Both,,,222,56,,222,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRAPULMONARY SURFACTANT ADMINISTRATION,46000008,CDM,,,,Both,,,465,116,,465,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PULMONARY SERVICE/PROCEDURE,46000009,CDM,,,,Both,,,246,62,,246,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,46000010,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INO PER HOUR,46000011,CDM,,,,Both,,,632,158,,632,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,46000013,CDM,,,,Both,,,541,135,,541,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,46000014,CDM,,,,Both,,,173,43,,173,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PULMONARY STRESS TESTING COMPLEX,46000015,CDM,,,,Both,,,486,122,,486,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RESPIRATORY FLOW VOLUME LOOP,46000016,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INHALATION TREAT INITAL OR SUBSEQUENT,46000017,CDM,,,,Both,,,300,75,,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CAR SEAT/BED TEST INFANT TO 12MTHS 60 MINUTES,46000018,CDM,,,,Both,,,153,38,,153,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CAR SEAT/BED TEST INFANT TO 12MTHS EA ADDL 30 MIN,46000020,CDM,,,,Both,,,149,37,,149,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAST W/REPORT,46000022,CDM,,,,Both,,,420,105,,420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HAST W/OXYGEN TITRATE,46000023,CDM,,,,Both,,,598,150,,598,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC C0 DIFFUSE CAPACITY,46000024,CDM,,,,Both,,,125,31,,125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXHALED NITRIC OXIDE MEAS,46000025,CDM,,,,Both,,,92,23,,92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INHALATION TREAT INITIAL OR SUBSEQUENT (OP),46000099,CDM,,,,Both,,,300,75,,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PULMONARY STRESS TESTING (6 MIN WALK TEST),46000101,CDM,,,,Both,,,189,47,,189,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVIEW PATIENT SPIROMETRY,46000103,CDM,,,,Both,,,160,40,,160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OXYGEN UPTAKE REST INDIRECT,46000105,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXERCISE TST BRNCSPSM WO ECG,46000106,CDM,,,,Both,,,126,32,,126,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CPX TESTING - SELF PAY,46000107,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPONTANEOUS NYSTAGMUS W/GAZE,47000001,CDM,,,,Both,,,42,11,,42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,47100001,CDM,,,,Both,,,667,167,,667,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PURE TONE AUDIOMETRY AIR ONLY,47100003,CDM,,,,Both,,,173,43,,173,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACOUSTIC REFLEX THRESHOLD,47100004,CDM,,,,Both,,,305,76,,305,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ,47100005,CDM,,,,Both,,,305,76,,305,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PURE TONE AUDIOMETRY AIR & BONE,47100006,CDM,,,,Both,,,214,54,,214,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPEECH AUDIOMETRY THRESHOLD,47100007,CDM,,,,Both,,,154,39,,154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ,47100008,CDM,,,,Both,,,154,39,,154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TYMPANOMETRY,47100009,CDM,,,,Both,,,154,39,,154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,47100010,CDM,,,,Both,,,588,147,,588,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OSCILLATING TRACKING TEST W/RECORDING,47100011,CDM,,,,Both,,,588,147,,588,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COMPUTERIZED DYNAMIC POSTUROGRAPY,47100013,CDM,,,,Both,,,588,147,,588,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AUD EVOKED POTEN SCREEN W/BROADBAND STIMULI AUTO ANALYSIS,47100016,CDM,,,,Both,,,776,194,,776,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AUD EVOKED POTEN HEAR STATUS DETERM BROADBAND STIM W/INTERP,47100017,CDM,,,,Both,,,302,76,,302,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AEP THRSHLD EST MLT FREQ I&R,47100018,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AEP NEURODIAGNOSTIC I&R,47100019,CDM,,,,Both,,,592,148,,592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING,48000001,CDM,,,,Both,,,2714,679,,2714,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TTE CONGENITAL W/O CONTRAST FOLLOW UP,48000003,CDM,,,,Both,,,1004,251,,1004,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV DOPPLER INITIAL VESSEL,48000004,CDM,,,,Both,,,963,241,,963,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV DOPPLER EA ADDTL VESSEL,48000005,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EP EVALUATION W/O INDUCTION OF ARRHYTHIM,48000006,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TTE W/DOPPLER, COMPLETE",48000007,CDM,,,,Both,,,1762,441,,1762,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRESS TTE COMPLETE W/O CONTRAST,48000009,CDM,,,,Both,,,1296,324,,1296,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECHO COLOR FLOW,48000010,CDM,,,,Both,,,88,22,,88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVAL. HEART DEVICE LEAD TEST,48000011,CDM,,,,Both,,,2279,570,,2279,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EP EVALUATION GENERATOR TEST,48000012,CDM,,,,Both,,,2929,732,,2929,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ,48000013,CDM,,,,Both,,,1924,481,,1924,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THROMBOLYSIS CORONARY; INTRAVEN INFUSION,48000014,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DOPPLER ECHO W/SPECT DISPLAY,48000015,CDM,,,,Both,,,1511,378,,1511,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARD DOPPLER F/U OR LIMITED,48000017,CDM,,,,Both,,,1108,277,,1108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRESS ECHO TREADMILL W/O CONTRAST,48000018,CDM,,,,Both,,,913,228,,913,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSESOPHAGEAL ECHO W/O CONTRAST,48000020,CDM,,,,Both,,,2369,592,,2369,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TTE CONGENITAL W/O CONTRAST COMPLETE,48000021,CDM,,,,Both,,,1577,394,,1577,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAPPING OF TACHYCARDIA SITE (S),48000023,CDM,,,,Both,,,5269,1317,,5269,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BASELINE EP W INDUCTION OF ARRHY,48000024,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRO/STIM/PACE AFTER IV DRUG INF,48000025,CDM,,,,Both,,,6774,1694,,6774,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOLLOWUP EP,48000026,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EP EVALUATION OF CARDIO VERTER DEF,48000027,CDM,,,,Both,,,3121,780,,3121,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANL CV/DEFIB W/O REPRO;SGL,48000028,CDM,,,,Both,,,418,105,,418,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARDIOASSIST EXTERNAL CPS,48000031,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BUNDLE OF HIS RECORDING,48000032,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRAATRIAL RECORDING,48000033,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RIGHT VENTRICULAR RECORDING,48000034,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRAATRIAL PACING,48000035,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRAVENTRICULAR PACING,48000036,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECHO MMODE REAL TIME W/O CONTRAST,48000038,CDM,,,,Both,,,1248,312,,1248,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECHOF/U OR LIMITED STUDY W/O CONT,48000040,CDM,,,,Both,,,1159,290,,1159,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MICROVOLT T-WAVE ASSESS,48000041,CDM,,,,Both,,,484,121,,484,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRGRMG DEV EVAL PM OR LDLS PM,48000042,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PM DEVICE PROG EVAL DUAL,48000043,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PM DEVICE PROG EVAL MULTI,48000044,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ICD DEVICE PROG EVAL 1 SNGL,48000045,CDM,,,,Both,,,76,19,,76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ICD DEVICE PROG EVAL DUAL,48000046,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ICD DEVICE PROG EVAL MULTI,48000047,CDM,,,,Both,,,97,24,,97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ICM DEVICE EVAL PER PT ENCOUNTER,48000048,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PM/ICD REMOTE TECH SERV =<90 DAYS,48000049,CDM,,,,Both,,,106,27,,106,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PM PHONE R-STRIP DEVICE EVAL = <90 DAYS,48000050,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PM/ICD REMOTE TECH SERV =<90 DAYS,48000060,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PM PHONE R-STRIP DEVICE EVAL = <90 DAYS,48000061,CDM,,,,Both,,,134,34,,134,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTERROG DEV EVAL SCRMS IP,48000063,CDM,,,,Both,,,141,35,,141,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTERROGATE SUBQ DEFIB,48000064,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PB VALVULOPLASTY AORTIC VALVE,48000065,CDM,,,,Both,,,17535,4384,,17535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ CLSR TCAT L ATR APNDGE,48000066,CDM,,,,Both,,,19547,4887,,19547,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRGRMG DEV EVAL IMPLTBL SYS,48000067,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WCD DEVICE INTERROGATE,48000068,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRGRMG DEV EVAL SCRMS IP,48000069,CDM,,,,Both,,,64,16,,64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ARRHYTHMIA INDUCTION,48000071,CDM,,,,Both,,,2212,553,,2212,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PB VALVULOPLASTY; PULMON VALVE,48000072,CDM,,,,Both,,,28902,7226,,28902,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED CARDIOVASCULAR PROCEDURE,48000075,CDM,,,,Both,,,665,166,,665,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC N-INVAS EST C FFR SW ALY CTA,48000076,CDM,,,,Both,,,2629,657,,2629,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COR ANGIO/VENT W/FFR,48000077,CDM,,,,Both,,,2129,532,,2129,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COR ANGIO/VENT W/DRUG ADMIN,48000078,CDM,,,,Both,,,2129,532,,2129,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC CLOSURE, VENTRICULAR DEFECT",48100004,CDM,,,,Both,,,44568,11142,,44568,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THROMBOLYSIS INTRACORANARY INFUSION,48100010,CDM,,,,Both,,,3443,861,,3443,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IVUS CORONARY V EA ADDLT,48100029,CDM,,,,Both,,,2504,626,,2504,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRACARDIAC ECHO,48100030,CDM,,,,Both,,,8786,2197,,8786,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILIAC ANGIO W CARD CATH,48100032,CDM,,,,Both,,,1288,322,,1288,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RIGHT HEART CATH,48100034,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LH W OR W/O LV,48100035,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&L W OR W/O LV,48100036,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COR W/O LH,48100037,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COR WO LH/IMA &/OR VBG,48100038,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RH W COR,48100039,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RH/COR IMA &/OR VGB /WO LH,48100040,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LH W OR WO LV/COR,48100041,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LH W COR/IMA &/OR VBG, W/WO LV",48100042,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&L W OR W/O LV/COR,48100043,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC R&L W/WO LV/COR/IMA &/OR VBG,48100044,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSSEPTAL PUNCTURE,48100045,CDM,,,,Both,,,5994,1499,,5994,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARM AGENT ADMINISTRATION W HEMO,48100046,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ CH CATH SEL CORONARY,48100050,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ CH CATH SEL AORTOCORON VENOUS/BYPASS,48100051,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ CH CATH SEL LT VENT/ATRIAL,48100052,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ CATH SEL RT VENT/ATRIAL,48100053,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ CATH SEL SUPRAVALVULAR,48100054,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ CATH NON SEL PULMONARY,48100055,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLOSURE OF ATRIAL DEFECT,48100056,CDM,,,,Both,,,44568,11142,,44568,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 3DIMENSIONAL MAPPING,48100063,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOMYOCARDIAL BIOPSY,48100065,CDM,,,,Both,,,14985,3746,,14985,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EP W/ IND;LA PACE & RECORDING,48100067,CDM,,,,Both,,,5990,1498,,5990,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EP W/ IND;LV PACE & RECORDING,48100068,CDM,,,,Both,,,5990,1498,,5990,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATION OF AV NODE FUNCTION,48100069,CDM,,,,Both,,,20569,5142,,20569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUT W/WO PHARMACY INTERVENT,48100072,CDM,,,,Both,,,933,233,,933,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRACORONARY ULTRASOUND,48100073,CDM,,,,Both,,,3052,763,,3052,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC TRANS CORONARY THROMB LC,48100074,CDM,,,,Both,,,4601,1150,,4601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC TRANS CORONARY THROMB RC,48100075,CDM,,,,Both,,,4601,1150,,4601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERC TRANS CORONARY THROMB LAD,48100076,CDM,,,,Both,,,4601,1150,,4601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PTCA SINGLE MAJOR ARTERY OR BRANCH,48100098,CDM,,,,Both,,,17535,4384,,17535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PTCA EACH ADD'L BRANCH,48100099,CDM,,,,Both,,,17535,4384,,17535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COR. ARTERECTOMY W/PTCA SINGLE MAJOR ART,48100100,CDM,,,,Both,,,28902,7226,,28902,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COR. ATHERECTOMY W/PTCA EACH ADD'L BRANC,48100101,CDM,,,,Both,,,10519,2630,,10519,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT W/PTCA SINGLE COR. ARTERY,48100102,CDM,,,,Both,,,28902,7226,,28902,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STENT W/PTCA EACH ADD'L COR. BRANCH,48100103,CDM,,,,Both,,,17535,4384,,17535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COR. ATHERECTOMY W/STENT AND PTCA SMCA,48100104,CDM,,,,Both,,,44568,11142,,44568,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COR. ATHERECTOMY W/STENT AND PTCA ADD'L,48100105,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC BYP GRAFT 1ST VESL,48100106,CDM,,,,Both,,,28902,7226,,28902,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC BYP GRAFT EACH ADD'L,48100107,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC ACUTE MI ANY VESSEL W/THROMB,48100108,CDM,,,,Both,,,28902,7226,,28902,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC REVASC CTO ANY BRANCH STENT, ATHER PTCA",48100109,CDM,,,,Both,,,28902,7226,,28902,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC REVASC CTO ADD'L BRCH STENT, ATHER, PTCA",48100110,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EP & ABLATE SVT ARRHYT,48100111,CDM,,,,Both,,,43115,10779,,43115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EP & ABLATE VENTRIC TACHY,48100112,CDM,,,,Both,,,43115,10779,,43115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ABLATE ARRHYTMIA - ADD ON,48100113,CDM,,,,Both,,,20569,5142,,20569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX ATRIAL FIB PUL VEIN ISOL,48100114,CDM,,,,Both,,,43115,10779,,43115,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TX ATRIAL FIB ADD'L,48100115,CDM,,,,Both,,,20569,5142,,20569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE DES STENT W/PTCA SINGLE VESSEL,48100117,CDM,,,,Both,,,31638,7910,,31638,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLACE DES STENT W/PTCA ADD'L VESSEL,48100118,CDM,,,,Both,,,17535,4384,,17535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ATHERECTOMY W/DES SINGLE VESSEL,48100119,CDM,,,,Both,,,44568,11142,,44568,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ATHERECTOMY W/DES/PTCA EACH ADD'L VESSEL,48100120,CDM,,,,Both,,,15819,3955,,15819,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BYPASS GRAFT DES ATHER PTCA SINGLE,48100121,CDM,,,,Both,,,33220,8305,,33220,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BYPASS GRAFT / DES/ ATHER/ PTCA ADD'L,48100122,CDM,,,,Both,,,17535,4384,,17535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVAS AMI/DES/ATHER/PTCA THROMB SINGLE,48100123,CDM,,,,Both,,,31638,7910,,31638,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVAS CTO DES/ATHER/PTCA SINGLE VESSEL,48100124,CDM,,,,Both,,,44568,11142,,44568,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVAS CTO DES/ATHER/PTCA ADD'L,48100125,CDM,,,,Both,,,15819,3955,,15819,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRLUML BALO ANGIOP 1ST ART,48100126,CDM,,,,Both,,,10462,2616,,10462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRLUML BALO ANGIOP 1ST ART BIL,48100127,CDM,,,,Both,,,17706,4427,,17706,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRLUML BALO ANGIOP ADDL ART,48100128,CDM,,,,Both,,,8854,2214,,8854,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRLUML BALO ANGIOP 1ST VEIN,48100130,CDM,,,,Both,,,9804,2451,,9804,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRLUML BALO ANGIOP 1ST VEIN BIL,48100131,CDM,,,,Both,,,17706,4427,,17706,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRLUML BALO ANGIOP ADDL VEIN,48100132,CDM,,,,Both,,,8854,2214,,8854,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ TRANSCATH CLS MITRAL,48100134,CDM,,,,Both,,,28294,7074,,28294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ TRANSCATH CLS AORTIC,48100135,CDM,,,,Both,,,28294,7074,,28294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ TRANSCATH CLOSURE EACH,48100136,CDM,,,,Both,,,27121,6780,,27121,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PB VALVULOPLASTY MITRAL VALVE,48100138,CDM,,,,Both,,,28902,7226,,28902,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXERCISE W/HEMODYNAMIC MEAS,48100139,CDM,,,,Both,,,850,213,,850,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOPSY WITH RHC,48100141,CDM,,,,Both,,,12403,3101,,12403,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT INSJ/RPL PERM LDLS PM,48100142,CDM,,,,Both,,,28294,7074,,28294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT RMVL PERM LDLS PM W/WO IMAGING,48100143,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSJ SUBQ CAR RHYTHM MNTR,48100144,CDM,,,,Both,,,14373,3593,,14373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL SUBQ CAR RHYTHM MNTR,48100145,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT IMPL WRLS P-ART PRS SNR,48100146,CDM,,,,Both,,,52041,13010,,52041,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERICARDIOCENTESIS W/IMAGING,48100147,CDM,,,,Both,,,7218,1805,,7218,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRCRD DRG 6YR+ W/O CGEN CAR,48100148,CDM,,,,Both,,,1765,441,,1765,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRCRD DRG 0-5YR OR W/ANOMLY,48100149,CDM,,,,Both,,,1765,441,,1765,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ PRCRD DRG INSJ CATH CT,48100150,CDM,,,,Both,,,1765,441,,1765,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM INTERROG DEV EVAL ICPMS,48100151,CDM,,,,Both,,,82,21,,82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REM INTERROG DEV EVAL SCRMS,48100152,CDM,,,,Both,,,82,21,,82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TAS CONGENITAL CARDIAC ANOMALIES ANY METHOD,48100153,CDM,,,,Both,,,6482,1621,,6482,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIS CREATION STENT PLACE CONGENITAL CARD ANOM 1ST SHUNT,48100154,CDM,,,,Both,,,6482,1621,,6482,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TIS CREATION STENT PLACE CONGENITAL CARD ANOM ADDL SHUNT,48100155,CDM,,,,Both,,,6482,1621,,6482,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOV PERQ VAD RIGHT HEART DIFFERENT SESSION,48100157,CDM,,,,Both,,,1843,461,,1843,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IRE ABLATION 1+TUMORS PER ORGAN PERQ,48100158,CDM,,,,Both,,,19653,4913,,19653,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL & REPLACE SUBSTERNAL IMPLANT DEFIB PULSE GEN,48100159,CDM,,,,Both,,,50834,12709,,50834,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOVAS VENOUS ARTLZ TIBIAL/PERONEAL VEIN,48100160,CDM,,,,Both,,,35442,8861,,35442,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC INTRAVASC LITHOTRIPSY,48100161,CDM,,,,Both,,,15388,3847,,15388,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC INTRA LITHOTRIP-STENT,48100162,CDM,,,,Both,,,28294,7074,,28294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC INTRA LITHOTRIP-ATHER,48100163,CDM,,,,Both,,,28294,7074,,28294,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC LITHOTRIP-STENT-ATHER,48100164,CDM,,,,Both,,,36271,9068,,36271,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT RMVL/DBLK ICAR MAS PERQ,48100165,CDM,,,,Both,,,11192,2798,,11192,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT PLMT&RMVL CEPD PERQ,48100167,CDM,,,,Both,,,8609,2152,,8609,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ P-ART REVSC 1 NM NT UNI,48100169,CDM,,,,Both,,,24070,6018,,24070,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ P-ART REVSC 1 NM NT BI,48100170,CDM,,,,Both,,,24070,6018,,24070,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ P-ART REVSC 1 ABNOR UNI,48100171,CDM,,,,Both,,,38950,9738,,38950,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ P-ART REVSC 1 ABNOR BI,48100172,CDM,,,,Both,,,24070,6018,,24070,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ P-ART REVSC EACH ADDL,48100173,CDM,,,,Both,,,24070,6018,,24070,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX CTH SLCT P-ART ANGRP UNI,48100174,CDM,,,,Both,,,344,86,,344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX CATH SLCT P-ART ANGRP BI,48100175,CDM,,,,Both,,,516,129,,516,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX CATH SLCT PULM VN ANGRPH,48100176,CDM,,,,Both,,,344,86,,344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX CATH SLCT P ANGRPH MAPCA,48100177,CDM,,,,Both,,,344,86,,344,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT L VENTR RSTRJ DEV IMPLT,48100178,CDM,,,,Both,,,12403,3101,,12403,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC LITHOTR-STENT TIB/PER,48100179,CDM,,,,Both,,,38303,9576,,38303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC LITHOTR-ATHER TIB/PER,48100180,CDM,,,,Both,,,38303,9576,,38303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INCISION OF HEART SAC,48100181,CDM,,,,Both,,,25624,6406,,25624,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ TRLUML CORONRY LITHOTRP,48100182,CDM,,,,Both,,,4601,1150,,4601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT INS 1CHMBR LDLS PM RA,48100183,CDM,,,,Both,,,42478,10620,,42478,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT RMV 1CHMBR LDLS PM RA,48100184,CDM,,,,Both,,,6949,1737,,6949,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT RMV&RPL1CHMB LDLS PM RA,48100185,CDM,,,,Both,,,42478,10620,,42478,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRGRMG EVL LDLS PM 1CHMBR IP,48100186,CDM,,,,Both,,,82,21,,82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL PG WCS LV BOTH COMPNT,48100187,CDM,,,,Both,,,8561,2140,,8561,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RLCJ PG WCS LV BATTERY ONLY,48100188,CDM,,,,Both,,,3976,994,,3976,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RLCJ PG WCS LV TRNSMTR ONLY,48100189,CDM,,,,Both,,,3976,994,,3976,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCAT INS 2CHMBR LDLS PM CMPL,48100190,CDM,,,,Both,,,42434,10609,,42434,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC INTRA LITHOTRIP-STENT BILATERAL,48100191,CDM,,,,Both,,,42441,10610,,42441,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRESS TEST TRACING ONLY,48200001,CDM,,,,Both,,,677,169,,677,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TTE W/CONTRAST CONGENITAL COMPLETE,48300002,CDM,,,,Both,,,1559,390,,1559,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TTE W/CONTRAST CONGENITAL FOLLOW UP,48300003,CDM,,,,Both,,,1096,274,,1096,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TTE W/DOPPLER COMPLETE W/CONTRAST,48300004,CDM,,,,Both,,,1510,378,,1510,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 2D TTE W/CONTRAST COMPLETE W/O DOP,48300005,CDM,,,,Both,,,1552,388,,1552,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 2D TTE W/CONTRAST FOL UP LIMITED STUDY,48300006,CDM,,,,Both,,,990,248,,990,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSESOPHAGEAL ECHO W/CONTRAST,48300007,CDM,,,,Both,,,2233,558,,2233,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEE CONGENITAL CARDIAC ANOMALIES W/CONT,48300008,CDM,,,,Both,,,1414,354,,1414,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEE MONITORING W/CONTRAST,48300009,CDM,,,,Both,,,1175,294,,1175,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRESS ECHO TREADMILL W/CONTRAST,48300010,CDM,,,,Both,,,2933,733,,2933,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STRESS TTE COMPLETE W/CONTRAST,48300011,CDM,,,,Both,,,2704,676,,2704,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECHO TRANSESOPHAGEAL (TEE),48300014,CDM,,,,Both,,,2415,604,,2415,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TEE CONGENITAL GLOBAL,48300015,CDM,,,,Both,,,1103,276,,1103,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOCRD STRAIN IMG SPCKL TRCK,48300016,CDM,,,,Both,,,62,16,,62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CAR ACOUS WAVFRM REC CAD RSK,48300017,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ECHO CAD FOR HF PRESERVED EF,48300018,CDM,,,,Both,,,250,63,,250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLINIC VISIT EST  LEVEL III,51000001,CDM,,,,Both,,,380,95,,380,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLINIC VISIT EST  LEVEL I,51000002,CDM,,,,Both,,,200,50,,200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLINIC VISIT EST  LEVEL IV,51000003,CDM,,,,Both,,,509,127,,509,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLINIC VISIT EST  LEVEL  V,51000004,CDM,,,,Both,,,536,134,,536,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLINIC VISIT NEW PATIENT LEVEL 2,51000006,CDM,,,,Both,,,310,78,,310,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLINIC VISIT NEW PATIENT LEVEL 3,51000007,CDM,,,,Both,,,382,96,,382,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLINIC VISIT NEW PATIENT LEVEL 4,51000008,CDM,,,,Both,,,569,142,,569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLINIC VISIT NEW PATIENT LEVEL 5,51000009,CDM,,,,Both,,,578,145,,578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLINIC VISIT EST  LEVEL II,51000010,CDM,,,,Both,,,280,70,,280,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DEMONSTRATION USE HOME INR MONITORING,51000011,CDM,,,,Both,,,277,69,,277,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI CHEST W/O CONTRAST,61000001,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ABDOMEN W/O CONTRAST,61000002,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI PELVIS W/O CONTRAST,61000003,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI TMJ(S),61000004,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BONE MARROW BLOOD SUPPLY,61000005,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA HEAD W/O CONTRAST,61000006,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA NECK W/O CONTRAST,61000007,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA CHEST W CONTRAST,61000008,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA PELVIS W/O CONTRAST,61000009,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA PELVIS W CONTRAST,61000010,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA ABDOMEN W CONTRAST,61000011,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA ABDOMEN W/O CONTRAST,61000012,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA CHEST W/O CONTRAST,61000013,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA CHEST W/WO CONTRAST,61000014,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA ABD. W/WO CONTRAST,61000015,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BREAST W/CONTRAST LT,61000016,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BREAST W/CONTRAST RT,61000017,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BREAST W/CONTRAST BILATERAL,61000018,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BREAST W/WO CONTRAST LT,61000021,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BREAST W/WO CONTRAST RT,61000022,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MRI GUIDANCE NEEDLE PLCMT, RAD S&I",61000023,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI FUNCTIONAL BRAIN,61000025,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI FUNCT BRAIN W DR NEURO TESTING,61000026,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BRAIN OPEN W/CONTRAST,61000027,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED MRI PROCEDURE,61000028,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARDIAC VELOCITY FLOW MAPPING,61000029,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MAGNETIC RESONANCE SPECTROSCOPY,61000030,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ABDOMEN W AND W/O CONTRAST,61000033,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BREAST BILATERAL W AND W/O CONTRAST,61000036,CDM,,,,Both,,,3169,792,,3169,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI PELVIS WITH CONTRAST,61000037,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA HEAD WITH CONTRAST,61000038,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA HEAD W AND W/O CONTRAST,61000039,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA NECK WITH CONTRAST,61000040,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA NECK W AND W/O CONTRAST,61000041,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ABDOMEN WITH CONTRAST,61000042,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI CHEST WITH CONTRAST,61000044,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI CHEST W AND W/O CONTRAST,61000045,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MRI ORBIT, FACE, NECK W & W/O CONTRAST",61000046,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI PELVIS W AND W/O CONTRAST,61000047,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/O CONTRAST UPPER EXTREMITY RT,61000153,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA WITH CONTRAST UPPER EXTREMITY RT,61000154,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/WO CONTRAST UPPER EXTREMITY RT,61000155,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/O CONTRAST UPPER EXTREMITY LT,61000159,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA WITH CONTRAST UPPER EXTREMITY LT,61000160,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/WO CONTRAST UPPER EXTREMITY LT,61000161,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/O CONTRAST LOWER EXTREMITY RT,61000174,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA LOW EXTREM W CONT BIL,61000175,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/O CONTRAST LOWER EXT BIL,61000182,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/O CONTRAST LOWER EXTREMITY LT,61000183,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/WO CONTRAST LOWER EXTREMITY RT,61000185,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/WO CONTRAST LOWER EXTREMITY LT,61000194,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA SPINAL CANAL W CONTRAST,61000196,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA SPINAL CANAL W/O CONTRAST,61000197,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA SPINAL CANAL W/WO CONTRAST,61000198,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI UPPER EXTR OTH THAN JT W/O CONTR RT,61000199,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI UPPER EXTR OTH THAN JT W/O CONTR LT,61000200,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI UPPER EXTREMITY OTH THAN JT W/CONTR RT,61000207,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI UPPER EXTREMITY OTH THAN JT W/CONTR LT,61000208,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI UPPER EXTREM OTHER THAN JT W/WO CONT LT,61000216,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI UPPER EXTREM OTHER THAN JT W/WO CONT RT,61000218,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT UPPER EXTREM W/O CONTRAST LT,61000224,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT UPPER EXTREM W/O CONTRAST RT,61000226,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT UPPER EXTREM W/CONTRAST LT,61000234,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT UPPER EXTREM W/CONTRAST RT,61000236,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT UPPER EXTREM W/WO CONTR LT,61000244,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT UPPER EXTREM W/WO CONTR RT,61000246,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI LOWER EXTREM OTH/THN JT W/O CONTR RT,61000253,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI LOWER EXTREM OTH/THN JT W/O CONTR LT,61000254,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI LOWER EXTREM OTH/THN JT W/CONTRAST RT,61000259,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI LOWER EXTREM OTH/THN JT W/CONTRAST LT,61000260,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI LOWER EXTREM OTH/THN JT W/WO CONTR RT,61000265,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI LOWER EXTREM OTH/THN JT W/WO CONTR LT,61000266,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT LOWER EXTREM W/O CONTRAST RT,61000271,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT LOWER EXTREM W/O CONTRAST LT,61000272,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT LOWER EXTREM W/O CONTRAST BILATERAL,61000273,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT LOWER EXTREM W/CONTRAST  RT,61000280,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT LOWER EXTREM W/CONTRAST  LT,61000281,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT LOWER EXTREM W/CONTRAST BILATERAL,61000282,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT LOWER EXTREM W/WO CONTRAST RT,61000289,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT LOWER EXTREM W/WO CONTRAST LT,61000290,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT LOWER EXTREM W/WO CONTRAST BILAT,61000291,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HANDS W & W/O CONTR.  BILAT,61000292,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HANDS W/O CONTR.  BILAT,61000293,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HANDS WITH CONTR.  BILAT,61000294,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEES W & W/O CONTR.  BILAT,61000295,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEES W/O CONTR.  BILAT,61000296,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC KNEES WITH CONTR.  BILAT,61000297,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER W & W/O CONTR.  BILAT,61000298,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI ANY JT UPPER EXTREM W/O CONTRAST BIL,61000299,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHOULDER WITH CONTR.  BILAT,61000300,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLES W/O CONTR.  BILAT,61000301,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLES WITH CONTR.  BILAT,61000302,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANKLES W & W/O CONTR.  BILAT,61000303,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BIOMET KNEE W/O CONTR.  BILAT,61000304,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRACHIAL PLEXUS W & W/O CONTR.  BILAT,61000305,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRACHIAL PLEXUS W/O CONTR.  BILAT,61000306,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRACHIAL PLEXUS WITH CONTR.  BILAT,61000307,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLAVICLES W  & W/O CONTR.  BILAT,61000308,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLAVICLES W/O CONTR.  BILAT,61000309,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CLAVICLES WITH CONTR.  BILAT,61000310,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW W & W/O CONTR.  BILAT,61000311,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW W/O CONTR.  BILAT,61000312,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELBOW WITH CONTR.  BILAT,61000313,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEET W & W/O CONTR.  BILAT,61000314,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEET W/O CONTR.  BILAT,61000315,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FEET WITH CONTR.  BILAT,61000316,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FINGERS W & W/O CONTR.  BILAT,61000317,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FINGERS W/O CONTR.  BILAT,61000318,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FINGERS WITH CONTR.  BILAT,61000319,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOREARM W & W/O CONTR.  BILAT,61000320,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOREARM W/O CONTR.  BILAT,61000321,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FOREARM WITH CONTR.  BILAT,61000322,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERI W & W/O CONTR.  BILAT,61000323,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERI W/O CONTR.  BILAT,61000324,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HUMERI WITH CONTR.  BILAT,61000325,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEG/CALF W &  W/O CONTR.  BILAT,61000326,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEG/CALF W/O CONTR.  BILAT,61000327,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEG/CALF WITH CONTR.  BILAT,61000328,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STERNOCLAVICULAR JNTS W & W/O CONTR.  BILAT,61000329,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STERNOCLAVICULAR JNTS W/O CONTR.  BILAT,61000330,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STERNOCLAVICULAR JNTS WITH CONTR.  BILAT,61000331,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THIGHS W & W/O CONTR.  BILAT,61000332,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THIGHS WITH CONTR  BILAT,61000333,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THIGHS W/O CONTR  BILAT,61000334,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOES W & W/O CONTR.  BILAT,61000335,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOES W/O CONTR.  BILAT,61000336,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TOES WITH CONTR.  BILAT,61000337,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST W & W/O CONTR.  BILAT,61000338,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST W/O CONTR.  BILAT,61000339,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WRIST WITH CONTR.  BILAT,61000340,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CAD BREAST MRI,61000341,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUAN MR ALYS TISS W/O MRI,61000342,CDM,,,,Both,,,2137,534,,2137,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QUAN MR ALYS TISS W/MRI,61000343,CDM,,,,Both,,,2146,537,,2146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QMRCP W/O DX MRI SM ANAT SES,61000344,CDM,,,,Both,,,2137,534,,2137,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QMRCP W/DX MRI SAME ANATOMY,61000345,CDM,,,,Both,,,2146,537,,2146,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BRAIN W/O CONTRAST,61100001,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BRAIN CONTRAST,61100002,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MRI ORBIT,FACE AND/OR NECK W/O CONTRAST",61100003,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BRAIN W&WO CONTRAST,61100004,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BRAIN W/O DYE,61100005,CDM,,,,Both,,,1201,300,,1201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI C SPINE W/O CONTRAST,61200001,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI C SPINE W/CONTRAST,61200002,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI THORACIC SPINE W/O CONTRAST,61200003,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI THORACIC SPINE W/CONTRAST,61200004,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI LUMBAR SPINE W/O CONTRAST,61200005,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI LUMBAR SPINE W/CONTRAST,61200006,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI CERVICAL SPINE W&WO CONTRAST,61200007,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI THORACIC SPINE W&WO CONTRAST,61200008,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI LUMBAR SPINE W&WO CONTRAST,61200009,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI CARDIAC MORPHOLOGY WO CONTRAST,61400001,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI CARDIAC MORPHOLOGY W/WO CONTRAST,61400002,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MRI ORBIT, FACE AND/OR NECK W CONTRAST",61400003,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI 3D RECON ON INDEP WORK STATION,61400004,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI 3D RECON,61400005,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MR ELASTOGRAPHY,61400006,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BREAST W/O CONTRAST UNILATERAL,61400007,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRI BREAST W/O CONTRAST BILATERAL,61400008,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRGFUS STRTCTC LES ABLTJ,61400009,CDM,,,,Both,,,29715,7429,,29715,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA LOW EXTREM W CONT LT,61800001,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA LOW EXTREM W CONT RT,61800002,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA W/WO CONTRAST LOWER EXTREMITY BIL,61800003,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MRA PELVIS W & WO CONTRAST,61800004,CDM,,,,Both,,,2234,559,,2234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INVESTIGATIONAL BIV,62400001,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INVESTIGATIONAL LV LEAD,62400002,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GATEWAY PTA BALLOON CATH ONLY CLINICAL INVEST,62400006,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WINGSPAN STENT SYSTEM W/GATEWAY PTA CATH,62400007,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM III SYSTEM CONTROLLER,62400008,CDM,,,,Both,,,21450,5363,,21450,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM III SEALED OUTFLOW GRAFT,62400009,CDM,,,,Both,,,18720,4680,,18720,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM III MODULAR CABLE,62400010,CDM,,,,Both,,,19306,4827,,19306,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM III TUNNELER,62400011,CDM,,,,Both,,,8386,2097,,8386,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM III MOBILE POWER UNIT W/AC POWER CABLE,62400012,CDM,,,,Both,,,31200,7800,,31200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HM III CATEGORY B IDE,62400013,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VALVE ACURATE NEO2,62400014,CDM,,,,Both,,,44800,11200,,44800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DELIVERY SYSTEM ACURATE NEO2 ,62400015,CDM,,,,Both,,,11200,2800,,11200,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRODUCER SHEATH ISLEEVE EXPANDABLE INTRODUCER SET,62400018,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 634 W/HCPCS,63400634,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 635 W/HCPCS,63500635,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AUTOLOGOUS CULTURED CHONDROCYTES(CARTICE,63600007,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DOBUTAMINE PER 250MG,63600046,CDM,,,,Both,,,102,26,,102,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RH IMMUNE GLOBULIN,63600050,CDM,,,,Both,,,191,48,,191,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9358,63600088,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS Q4112,63600100,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION OCTREOTIDE DEPOT IM 1MG,63600112,CDM,,,,Both,,,310,78,,310,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE,63600113,CDM,,,,Both,,,38,10,,38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,63600114,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GRAFIX PL PRIME 1.5 X 2 CM PER SQ CM PS13015,63600115,CDM,,,,Both,,,556,139,,556,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GRAFIX PL PRIME 2 X 3 CM PER SQ CM PS13023,63600116,CDM,,,,Both,,,348,87,,348,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS C9250,63600119,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC JCODES FOR BLOOD CLOTTING,63600124,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RIG-HT FOR IM/SQ,63600126,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SARSCOV2 VAC IM (PFIZER),63600127,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SARSCOV2 VAC IM (MODERNA),63600128,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC BAMLANIVIMAB AND ETESEVIMAB, 2100 MG (FOR COVID INFUSION)",63600129,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GRAFIX PL PRIME 16MM DISC,63600134,CDM,,,,Both,,,1238,310,,1238,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INJECTION, AMINOPHYLLINE, UP TO 250 MG",63600135,CDM,,,,Both,,,35,9,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LEQVIO INJECTION,63600136,CDM,,,,Both,,,14,4,,14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMVUTTRA INJECTION,63600137,CDM,,,,Both,,,9600,2400,,9600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVUSHIELD INJECTION,63600138,CDM,,,,Both,,,0.05,0.01,,0.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DTAP VACCINE < 7 YRS IM,63600139,CDM,,,,Both,,,130,33,,130,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MARIGEN, 16 MM, CIRCULAR 50200S16B0D",63600140,CDM,,,,Both,,,1036,259,,1036,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MARIGEN, 3X3.5 CM 50200S01B0D",63600142,CDM,,,,Both,,,1516,379,,1516,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MARIGEN EXPANSE 7X8, MESHED, PER SQ CM",63600149,CDM,,,,Both,,,5600,1400,,5600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC LECANEMAB-IRMB INJECTION, 1 MG    ",63600151,CDM,,,,Both,,,3,1,,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TUMESCENT LOCAL ANESTHETIC SOLUTION 516 ML BAG,63600152,CDM,,,,Both,,,82,21,,82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MARTRION 2X3  6 CM2 PAC06,63600153,CDM,,,,Both,,,2974,744,,2974,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INJECTION,ONABOTULINUMTOXINA",63600154,CDM,,,,Both,,,13,3,,13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIEFFECT 2X3 6SQ CM,63600155,CDM,,,,Both,,,3420,855,,3420,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUROSEMIDE INJECTION UP TO 20 MG,63600156,CDM,,,,Both,,,11,3,,11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEPARIN SODIUM INJECTION PER 10 UNITS,63600157,CDM,,,,Both,,,11,3,,11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION DENOSUMAB PROLIA 1MG,63600158,CDM,,,,Both,,,35,9,,35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC INJECTION, INCOBOTULINUMTOXINA, 1 UNIT",63600159,CDM,,,,Both,,,11,3,,11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 636,63600636,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARM REV 636 C CODES,63600700,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARMACY REV 637,63700637,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HOSPICE INPATIENT RESPITE,65500001,CDM,,,,Both,,,149,37,,149,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FS TRAUMA LVL 3 CRIT CARE 30 MIN OR MORE,68100001,CDM,,,,Both,,,4724,1181,,4724,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FS TRAUMA LVL 3 LESS THAN 30 MIN,68100002,CDM,,,,Both,,,4949,1237,,4949,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LR TRAUMA LVL 2 CRIT. CARE 30 MIN OR MORE,68200001,CDM,,,,Both,,,5716,1429,,5716,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LR TRAUMA LVL 2 LESS THAN 30 MIN,68200002,CDM,,,,Both,,,5444,1361,,5444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NLR TRAUMA LVL 3 CRIT. CARE 30 MIN OR MORE,68300001,CDM,,,,Both,,,5716,1429,,5716,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NLR TRAUMA LVL 3 LESS THAN 30 MIN,68300002,CDM,,,,Both,,,5444,1361,,5444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CW TRAUMA LVL 3 CRIT. CARE 30 MIN OR MORE,68300003,CDM,,,,Both,,,5716,1429,,5716,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CW TRAUMA LVL 3 LESS THAN 30 MIN,68300004,CDM,,,,Both,,,5444,1361,,5444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRAUMA LVL 4 CRIT. CARE 30 MIN OR MORE,68400001,CDM,,,,Both,,,5716,1429,,5716,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ST TRAUMA LVL 4 LESS THAN 30 MIN,68400004,CDM,,,,Both,,,5444,1361,,5444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MV TRAUMA LVL 4 LESS THAN 30 MIN,68400005,CDM,,,,Both,,,5444,1361,,5444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VB TRAUMA LVL 4 LESS THAN 30 MIN,68400006,CDM,,,,Both,,,4949,1237,,4949,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DC TRAUMA LVL 4 LESS THAN 30 MIN,68400007,CDM,,,,Both,,,5444,1361,,5444,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OB RECOVERY,71000002,CDM,,,,Both,,,782,196,,782,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 0-30 MIN RECOVER CHARGE,71000003,CDM,,,,Both,,,746,187,,746,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 31-60 MIN RECOVER CHARGE,71000004,CDM,,,,Both,,,1078,270,,1078,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 61-90 MIN RECOVER CHARGE,71000005,CDM,,,,Both,,,1472,368,,1472,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 91-120 MIN RECOVER CHARGE,71000006,CDM,,,,Both,,,1724,431,,1724,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 121-150 MIN RECOVER CHARGE,71000007,CDM,,,,Both,,,2156,539,,2156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 151-180 MIN RECOVER CHARGE,71000008,CDM,,,,Both,,,2588,647,,2588,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 181-210 MIN RECOVER CHARGE,71000009,CDM,,,,Both,,,3019,755,,3019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 211-240 MIN RECOVER CHARGE,71000010,CDM,,,,Both,,,3451,863,,3451,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 241 - 270 MIN RECOVER CHARGE,71000011,CDM,,,,Both,,,3883,971,,3883,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 271 - 300 MIN RECOVER CHARGE,71000012,CDM,,,,Both,,,4314,1079,,4314,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 301-330 MIN RECOVER CHARGE,71000013,CDM,,,,Both,,,4744,1186,,4744,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 331-360 MIN RECOVER CHARGE,71000014,CDM,,,,Both,,,5176,1294,,5176,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 361-390 MIN RECOVER CHARGE,71000015,CDM,,,,Both,,,5608,1402,,5608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC 391-420 MIN RECOVER CHARGE,71000016,CDM,,,,Both,,,6039,1510,,6039,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTENDED RECOVERY,71000017,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CURETTAGE POSTPARTUM,72000001,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VAGINAL DELIVERY ONLY,72000002,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DELIVERY PLACENTA SEPARATE PROCEDURE,72000003,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CESAREAN DELIVERY,72000004,CDM,,,,Both,,,7823,1956,,7823,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STOT/TOT HYSTERECTOMY AFTER CESAREN DELIVERY,72000005,CDM,,,,Both,,,8008,2002,,8008,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX,72000007,CDM,,,,Both,,,6566,1642,,6566,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL CONTRACTION STRESS TEST,72000008,CDM,,,,Both,,,1000,250,,1000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG,72000010,CDM,,,,Both,,,4196,1049,,4196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL MONITORING,72000011,CDM,,,,Both,,,1388,347,,1388,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL NON STRESS TEST,72000012,CDM,,,,Both,,,1155,289,,1155,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POSTPARTUM CARE ONLY SEPARATE PROCEDURE,72000014,CDM,,,,Both,,,882,221,,882,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 1,72000015,CDM,,,,Both,,,3655,914,,3655,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 2,72000016,CDM,,,,Both,,,4658,1165,,4658,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 3,72000017,CDM,,,,Both,,,5684,1421,,5684,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 4,72000018,CDM,,,,Both,,,7777,1944,,7777,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 5,72000019,CDM,,,,Both,,,7904,1976,,7904,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 6,72000020,CDM,,,,Both,,,9121,2280,,9121,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 7,72000021,CDM,,,,Both,,,10439,2610,,10439,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 8,72000022,CDM,,,,Both,,,11885,2971,,11885,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 9,72000023,CDM,,,,Both,,,13495,3374,,13495,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 10,72000024,CDM,,,,Both,,,15312,3828,,15312,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH RISK LDR W/O INDUCTION/AUGMENTATION & W EPI,72000025,CDM,,,,Both,,,10670,2668,,10670,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH RISK LDR W/INDUCTION/AUGMENTATION&W EPI,72000026,CDM,,,,Both,,,11472,2868,,11472,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LDR W/INDUCTION/AUGMENTATION & W/EPIDURAL,72000028,CDM,,,,Both,,,10607,2652,,10607,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LDR W/INDUCTION/AUGMENTATION & W/O EPIDURAL,72000029,CDM,,,,Both,,,9553,2388,,9553,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LDR W/O INDUCTION/AUGMENTATION & W/O EPIDURAL,72000030,CDM,,,,Both,,,7749,1937,,7749,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LUMBAR EPIDURAL INF/INTERMITTENT BOLUS,72000031,CDM,,,,Both,,,1279,320,,1279,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRIAL INDUCTION/LABOR,72000033,CDM,,,,Both,,,4136,1034,,4136,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMNIO INFUSION (VAGINAL),72000035,CDM,,,,Both,,,1388,347,,1388,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LDR W/O INDUCTION/AUGMENTATION & W/EPIDURAL,72000036,CDM,,,,Both,,,9589,2397,,9589,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TREAT FETAL DEMISE<22 WKS, NONSURGICAL",72000037,CDM,,,,Both,,,4183,1046,,4183,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 1 INCREMENT,72000038,CDM,,,,Both,,,43,11,,43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 2  INCREMENT,72000039,CDM,,,,Both,,,58,15,,58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 3  INCREMENT,72000040,CDM,,,,Both,,,70,18,,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 4  INCREMENT,72000041,CDM,,,,Both,,,86,22,,86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 5  INCREMENT,72000042,CDM,,,,Both,,,95,24,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 6  INCREMENT,72000043,CDM,,,,Both,,,108,27,,108,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 7  INCREMENT,72000044,CDM,,,,Both,,,118,30,,118,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 8  INCREMENT,72000045,CDM,,,,Both,,,131,33,,131,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 9  INCREMENT,72000046,CDM,,,,Both,,,144,36,,144,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LABOR & DELIVERY O.R. PROC LEVEL 10  INCREMENT,72000047,CDM,,,,Both,,,154,39,,154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOMECTOMY ABDOM METHOD 1-4 MYOMAS,72000048,CDM,,,,Both,,,7517,1879,,7517,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MYOMECTOMY ABDOM COMPLEX 5+ MYOMAS,72000049,CDM,,,,Both,,,8734,2184,,8734,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOMETRIAL BX WO CERVICAL DILATION,72000050,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CORDOCENTESIS (INTRAUTERINE),72000051,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL SCALP BLOOD SAMPLING,72000052,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL MONITORING DURING LABOR,72000053,CDM,,,,Both,,,364,91,,364,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VAG DELIVERY AFTER CEASARIAN,72000054,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FETAL INVAS PX W/US,72000055,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NIPPLE STIMULATION STRESS TEST,72000056,CDM,,,,Both,,,384,96,,384,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EPIDURAL INTRATHECAL CARE,72000057,CDM,,,,Both,,,156,39,,156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEWBORN CARE,72000058,CDM,,,,Both,,,3777,944,,3777,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IUPC APPLICATION,72000059,CDM,,,,Both,,,1388,347,,1388,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC JADA/BAKRI BALLOON PROCEDURE,72000060,CDM,,,,Both,,,1388,347,,1388,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH RISK LDR W/O INDUCTION/AUGMENTATION & W/O EPI,72000061,CDM,,,,Both,,,8831,2208,,8831,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HIGH RISK LDR W/INDUCTION/AUGMENTATION&W/O EPI,72000062,CDM,,,,Both,,,9788,2447,,9788,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ATTENDANCE AT DELIVERY,72000063,CDM,,,,Both,,,747,187,,747,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC RHYTHM STRIP ECG, 1-3 LEADS, TRACING ONLY",73000001,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EKG ROUTINE EKG W/LEAST 12 LDS TRCG ONLY W/O I&R,73000002,CDM,,,,Both,,,100,25,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XTRNL ECG < 48 HR RECORDING,73100001,CDM,,,,Both,,,353,88,,353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC XTRNL ECG SCANNING ANALYSIS REPORT,73100002,CDM,,,,Both,,,356,89,,356,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CARDIAC MONITOR UP TO 30 DAYS 24 HR ATTENDED MONITOR,73100003,CDM,,,,Both,,,356,89,,356,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVENT MONITOR CONNECTION ONLY,73100004,CDM,,,,Both,,,101,25,,101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTERNAL ECG REC>48HR<7D RECORDING,73100005,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXTERNAL ECG REC>7D<15D RECORDING,73100007,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,74000002,CDM,,,,Both,,,1281,320,,1281,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EEG NONINTRACRANIAL SURGERY,74000003,CDM,,,,Both,,,1560,390,,1560,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROENCEPHALOGRAM EXTND MNTR > 1 HR,74000004,CDM,,,,Both,,,2312,578,,2312,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUNCJAL CORT&SUBCORT MAPG ELTRDS 1 HR PHYS ATTN,74000006,CDM,,,,Both,,,1409,352,,1409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROCORTICOGRAM SURGERY SPX,74000008,CDM,,,,Both,,,10611,2653,,10611,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,74000009,CDM,,,,Both,,,1352,338,,1352,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,74000010,CDM,,,,Both,,,2312,578,,2312,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,74000011,CDM,,,,Both,,,1250,313,,1250,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,74000012,CDM,,,,Both,,,1313,328,,1313,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUNCJAL CORT&SUBCORT MAPG ELTRDS EA HR PHYS ATTN,74000014,CDM,,,,Both,,,596,149,,596,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROENCEPHALOGRAM EXTND MNTR 4160 MIN,74000015,CDM,,,,Both,,,2543,636,,2543,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EEG CONT REC W/VID EEG TECH,74000016,CDM,,,,Both,,,595,149,,595,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EEG W/O VID 2-12 HR UNMNTR,74000017,CDM,,,,Both,,,567,142,,567,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EEG WO VID 2-12HR INTMT MNTR,74000018,CDM,,,,Both,,,567,142,,567,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EEG W/O VID 2-12HR CONT MNTR,74000019,CDM,,,,Both,,,567,142,,567,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EEG WO VID EA 12-26HR UNMNTR,74000020,CDM,,,,Both,,,1087,272,,1087,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EEG W/O VID EA 12-26HR INTMT,74000021,CDM,,,,Both,,,1087,272,,1087,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EEG W/O VID EA 12-26HR CONT,74000022,CDM,,,,Both,,,1087,272,,1087,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VEEG BY TECH 2-12 HOURS UNMONITORED,74000023,CDM,,,,Both,,,567,142,,567,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VEEG BY TECH 2-12 HR INTERMITTENT MONITORING,74000024,CDM,,,,Both,,,567,142,,567,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORING,74000025,CDM,,,,Both,,,1087,272,,1087,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VEEG EA 12-26 HR UNMNTR,74000026,CDM,,,,Both,,,1169,292,,1169,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VEEG EA 12-26HR INTMT MNTR,74000027,CDM,,,,Both,,,1196,299,,1196,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VEEG EA 12-26HR CONT MNTR,74000028,CDM,,,,Both,,,2188,547,,2188,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD,75000001,CDM,,,,Both,,,8868,2217,,8868,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,75000003,CDM,,,,Both,,,748,187,,748,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,75000004,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,75000005,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHGL FUNCJ GESOP RFLX IMPD ELTRD PROLNG,75000006,CDM,,,,Both,,,1007,252,,1007,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,75000007,CDM,,,,Both,,,1924,481,,1924,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCRN COLONOSCOPY ON HI RISK PT,75000008,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILATE ESOPH UNGUIDED SND/BOUG,75000009,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY RIGID TRANSORAL BRUSH/WASH,75000010,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY RIGID TRANSORAL W/SUBMUC INJ,75000011,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY RIGID TRANSORAL BIOPSY SINGLE/MULTI,75000012,CDM,,,,Both,,,6673,1668,,6673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY RIGID TRANSORAL REM FOREIGN BODY,75000013,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DIL<30,75000014,CDM,,,,Both,,,6673,1668,,6673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY RIGID TRANSORAL GUIDEWIRE INSERT,75000015,CDM,,,,Both,,,6673,1668,,6673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSNASAL BRUSH/WASH,75000016,CDM,,,,Both,,,4417,1104,,4417,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSNASAL BIOPSY SINGLE/MULTI,75000017,CDM,,,,Both,,,4417,1104,,4417,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSORAL ENDO MUC RESECT,75000018,CDM,,,,Both,,,4417,1104,,4417,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSORAL STENT PLACE,75000019,CDM,,,,Both,,,10220,2555,,10220,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSORAL RETRO BALLN,75000020,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSORAL DILATE BALLN >30,75000021,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATE,75000022,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL BALLOON DIL ESOPH >30,75000023,CDM,,,,Both,,,6673,1668,,6673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL US TRANSMURAL INJ/MARK,75000024,CDM,,,,Both,,,6673,1668,,6673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL ENDO MUCOSAL RESECTION,75000025,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL ENDO STENT PLACE,75000026,CDM,,,,Both,,,10220,2555,,10220,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD FLEX TRANSORAL LESION ABLATION,75000027,CDM,,,,Both,,,6673,1668,,6673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP DUCT STENT PLACEMENT,75000028,CDM,,,,Both,,,10220,2555,,10220,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP REMOVE FORGN BODY DUCT,75000029,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP STENT EXCHANGE W/DILATE,75000030,CDM,,,,Both,,,10220,2555,,10220,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP EA DUCT/AMPULLA DILATE,75000031,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP LESION ABLATE W/DILATE,75000032,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPH EGD DILATION <30 MM,75000033,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD TUBE/CATH INSERTION,75000034,CDM,,,,Both,,,3303,826,,3303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC COLONOSCOPY VIA STOMA W/ABLATION OF TUMOR, POLYP, OR  LESION",75000035,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY VIA STOMA W/DIRECTED SUBMUCOSAL INJ ANY SUBSTANCE,75000036,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY VIA STOMA W/TRANSENDO US GUIDED FNA/BX,75000037,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY VIA STOMA W/DECOMPRESS INCLUDE PLACE OF TUBE,75000038,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY FLEXIBLE W/ABLATION OF TUMOR POLYP OR LESION,75000039,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY FLEX W/BAND LIGATION,75000040,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY FLEXIBLE W/ABLATION OF TUMOR POLYP OR LESION,75000041,CDM,,,,Both,,,6349,1587,,6349,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY FLEXIBLE W/ENDOSCOPIC STENT PLACEMENT,75000042,CDM,,,,Both,,,10220,2555,,10220,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PROCEDURE COLON,75000043,CDM,,,,Both,,,6673,1668,,6673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ANOSCOPY DX W/HRA, CHEM AGENT ENHANCE",75000044,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LAPAROSCOPY CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,75000045,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SM INT ENDO W ILEUM DX W/WO SPECI BRUSH/WASH,75000046,CDM,,,,Both,,,3303,826,,3303,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY W/DECOMPRESSION,75000047,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SM INTESTINE ENDO W REM T/P/L W SNARE,75000048,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SCREENING COLONOSCOPY,75000049,CDM,,,,Both,,,4195,1049,,4195,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GI TRACT CAPSULE ENDOSCOPY ESOPHAGUS THROUGH ILEUM,75000051,CDM,,,,Both,,,1600,400,,1600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY W/RESECTION,75000053,CDM,,,,Both,,,6349,1587,,6349,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLEX SIGM CANCER SCREENING,75000054,CDM,,,,Both,,,1391,348,,1391,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOSCOPIC US EXAM ESOPH,75000055,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD US FINE NEEDLE BX/ASP LIMITED,75000056,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD US FINE NEEDLE BX/ASP COMPLETE,75000057,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD OPTICAL ENDOMICROSCOPY,75000058,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD W/THRML TXMNT GERD,75000059,CDM,,,,Both,,,5409,1352,,5409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD US EXAM DUODENUM/JEJUNUM,75000060,CDM,,,,Both,,,5005,1251,,5005,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP W/OPTICAL ENDOMICROSCPY,75000061,CDM,,,,Both,,,1731,433,,1731,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY W/ENDOSCOPE US,75000062,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY THROUGH STOMA W/RESECTION,75000063,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT,75000064,CDM,,,,Both,,,8868,2217,,8868,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY STOMA W/BALOON DILATION,75000065,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY STOMA W/ENDOSCOPIC US,75000066,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY SUBMUCOUS NJX,75000067,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY W/ULTRASOUND,75000068,CDM,,,,Both,,,1805,451,,1805,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY W/US GUIDE BX,75000069,CDM,,,,Both,,,3101,775,,3101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY W/PLCMT STENT,75000070,CDM,,,,Both,,,8868,2217,,8868,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SIGMOIDOSCOPY W/RESECTION,75000071,CDM,,,,Both,,,6349,1587,,6349,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY W/ENDOSCOPIC FNB,75000072,CDM,,,,Both,,,3101,775,,3101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLONOSCOPY W/BAND LIGATION,75000073,CDM,,,,Both,,,6349,1587,,6349,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY FLEX REMOVE FB,75000074,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY LESION REMOVAL,75000075,CDM,,,,Both,,,3697,924,,3697,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY SNARE LES REMV,75000076,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LAPS ESOPHGL SPHNCTR AGMNTJ,75000077,CDM,,,,Both,,,15691,3923,,15691,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RMVL ESOPHGL SPHNCTR DEV,75000078,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ANOSCOPY W REM MULTI TUMORS POLYPS LESIONS,75000079,CDM,,,,Both,,,3978,995,,3978,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE FECAL IMPACT OR FB,75000080,CDM,,,,Both,,,1811,453,,1811,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ILEOSCOPY THRU STOMA W BX SGL/MULTI,75000081,CDM,,,,Both,,,1284,321,,1284,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMALL BOWEL ENDOSCOPY BR/WA,75000082,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY RIGID TRNSO,75000083,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPH SCOPE W/SUBMUCOUS INJ,75000084,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPH SCOPE W/SCLEROSIS INJ,75000085,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPH OPTICAL ENDOMICROSCOPY,75000086,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPH ENDOSCOPY DILATION,75000087,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHAGOSCOPY CONTROL BLEED,75000088,CDM,,,,Both,,,2488,622,,2488,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD ESOPHAGOGASTRC FNDOPLSTY,75000089,CDM,,,,Both,,,18104,4526,,18104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SMALL BOWEL ENDOSCOPY,75000090,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPLC GTUBE NO REVJ TRC,75000092,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RPLC GTUBE REVJ GSTRST TRC,75000093,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC G-ESOPH REFLUX W MUCOSAL PH,75000094,CDM,,,,Both,,,4422,1106,,4422,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PROCTOSIG RIGID WITH REMOVAL FB,75000095,CDM,,,,Both,,,4422,1106,,4422,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOSCOPY BOWEL POUCH/BIOP,75000096,CDM,,,,Both,,,1802,451,,1802,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVE EXT HEM GROUPS 2+,75000097,CDM,,,,Both,,,5614,1404,,5614,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSORAL LOWER ESOPHGL MYOTOMY,75000098,CDM,,,,Both,,,7002,1751,,7002,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EGD VOL ADJ BARIATRIC BALO,75000101,CDM,,,,Both,,,3949,987,,3949,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ERCP REMOVE FORGN BODY&ENDO,75000102,CDM,,,,Both,,,9462,2366,,9462,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ESOPHGL BALO DISTENSION DX STD W/PROVOCATION,75000103,CDM,,,,Both,,,1168,292,,1168,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLLECT BLOOD FROM CENTRAL OR PICC LINE,76100001,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ACNE SURGERY, MILIA, CYSTS",76100002,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APPLY MULTLAY COMPRS LWR LEG BIL,76100003,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC APP LC SKIN SUB <100 SQCM, 1ST 25 SQCM TRNK ARM LEG",76100004,CDM,,,,Both,,,810,203,,810,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC APP LC SKIN SUB <100 SQCM, EA ADD 25 SQCM TRNK ARM LEG",76100005,CDM,,,,Both,,,810,203,,810,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC APP LC SKIN SUB >100 SQCM, 1ST 100 SQCM TRNK ARM LEG",76100006,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC APP LC SKIN SUB >100 SQCM, EA ADD 100 SQCM TRNK ARM LEG",76100007,CDM,,,,Both,,,2711,678,,2711,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC APP LC SKIN SUB <100 SQCM, 1ST 25 SQCM HEAD HAND FEET",76100008,CDM,,,,Both,,,810,203,,810,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC APP LC SKIN SUB <100 SQCM, EA ADD 25 SQCM HEAD HAND FEET",76100009,CDM,,,,Both,,,810,203,,810,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC APP LC SKIN SUB >100 SQCM, 1ST 100 SQCM HEAD HAND FEET",76100010,CDM,,,,Both,,,810,203,,810,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC APP LC SKIN SUB >100 SQCM, EA ADD 100 SQCM HEAD HAND FEET",76100011,CDM,,,,Both,,,810,203,,810,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOVENOUS RF 1ST VEIN,76100012,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOVENOUS RF VEIN ADD-ON,76100013,CDM,,,,Both,,,3013,753,,3013,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LASER ABLTN EXT VEIN 1ST VEIN,76100014,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LASER ABLTN EXTR VEIN 2ND & >,76100015,CDM,,,,Both,,,3013,753,,3013,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC STAB PHLEB VEINS XTR 10-20,76100016,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHLEB VEINS - EXTREM 20+,76100017,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED VASC PROCEDURE,76100018,CDM,,,,Both,,,1450,363,,1450,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ GREATER OCCIPITAL NERVE,76100024,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHIAL VALVE INIT INSERT,76100025,CDM,,,,Both,,,10259,2565,,10259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHIAL VALVE ADDL INSERT,76100026,CDM,,,,Both,,,6917,1729,,6917,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHIAL VALVE REMOV INIT,76100027,CDM,,,,Both,,,7218,1805,,7218,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHIAL VALVE REMOV ADDL,76100028,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCH EBUS SAMPLNG 1/2 NODE,76100029,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCH EBUS SAMPLNG 3/> NODE,76100030,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCH EBUS IVNTJ PERPH LES,76100031,CDM,,,,Both,,,4143,1036,,4143,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT URETERAL STENT PRQ PRE EXISTING NEPHROSTOMY TRACT,76100034,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT URETERAL STENT PRQ PRE EXISTING NEPHROSTOMY TRACT BIL,76100035,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT URETERAL STENT PRQ NEW ACCESS W/O NEPHROSTOMY CATH,76100036,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT URETERAL STENT PRQ NEW ACCESS W/O NEPHROSTOMY CATH BIL,76100037,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT URETERAL STENT PRQ NEW ACCESS W/NEPHROSTOMY CATH,76100038,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT URETERAL STENT PRQ NEW ACCESS W/NEPHROSTOMY CATH BIL,76100039,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVASC PRLNG ADMN RX AGNT 1ST,76100040,CDM,,,,Both,,,1939,485,,1939,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVASC PRLNG ADMN RX AGNT ADD,76100041,CDM,,,,Both,,,1939,485,,1939,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT BILIARY DRAINAGE CATH INTERNAL-EXTERNAL,76100042,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONVERSION EXT BIL DRG CATH,76100043,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCHANGE BILIARY DRG CATH,76100044,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL BILIARY DRG CATH,76100045,CDM,,,,Both,,,1840,460,,1840,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL DUCT GLBLDR CALCULI,76100046,CDM,,,,Both,,,4569,1142,,4569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX PX NFROSGRM &/URTRGRM NEW ACCESS,76100047,CDM,,,,Both,,,4417,1104,,4417,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX PX NFROSGRM &/URTRGRM NEW ACCESS BIL,76100048,CDM,,,,Both,,,4417,1104,,4417,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX PX NFROSGRM &/URTRGRM EXISTING ACCESS,76100049,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX PX NFROSGRM &/URTRGRM EXISTING ACCESS BIL,76100050,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT NEPHROSTOMY CATHETER,76100051,CDM,,,,Both,,,7218,1805,,7218,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT NEPHROSTOMY CATHETER BIL,76100052,CDM,,,,Both,,,7218,1805,,7218,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT NEPHROURETERAL CATHETER,76100053,CDM,,,,Both,,,7218,1805,,7218,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT NEPHROURETERAL CATHETER BIL,76100054,CDM,,,,Both,,,7218,1805,,7218,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONVERT NEPHROSTOMY CATHETER,76100055,CDM,,,,Both,,,4417,1104,,4417,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CONVERT NEPHROSTOMY CATHETER BIL,76100056,CDM,,,,Both,,,4567,1142,,4567,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCHANGE NEPHROSTOMY CATH,76100057,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCHANGE NEPHROSTOMY CATH BIL,76100058,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOLUMINAL BX URTR RNL PLVS,76100059,CDM,,,,Both,,,1812,453,,1812,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC URETERAL EMBOLIZATION/OCCL,76100061,CDM,,,,Both,,,1812,453,,1812,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BALLOON DILATE URTRL STRIX,76100063,CDM,,,,Both,,,1812,453,,1812,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ ART M-THROMBECT &/NFS BIL,76100065,CDM,,,,Both,,,12673,3168,,12673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ ART M-THROMBECT &/NFS,76100066,CDM,,,,Both,,,6337,1584,,6337,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PVB THORACIC SINGLE INJ SITE,76100067,CDM,,,,Both,,,1092,273,,1092,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PVB THORACIC SINGLE INJ SITE BIL,76100068,CDM,,,,Both,,,2185,546,,2185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PVB THORACIC 2 OR MORE INJ SITE,76100069,CDM,,,,Both,,,2185,546,,2185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PVB THORACIC CONT INFUSION,76100071,CDM,,,,Both,,,1092,273,,1092,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PVB THORACIC CONT INFUSION BIL,76100072,CDM,,,,Both,,,2185,546,,2185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION FOR CHOLANGIOGRAM EXISTING ACCESS,76100073,CDM,,,,Both,,,5227,1307,,5227,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION FOR CHOLANGIOGRAM NEW ACCESS,76100074,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PLMT BILIARY DRAINAGE CATH EXTERNAL,76100075,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRVASC US NONCORONARY 1ST,76100076,CDM,,,,Both,,,4366,1092,,4366,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTRVASC US NONCORONARY ADDL,76100077,CDM,,,,Both,,,3969,992,,3969,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH SUPRASCAPULAR NERVE,76100078,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOLUMINAL BX BILIARY TREE,76100079,CDM,,,,Both,,,4569,1142,,4569,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHOPL EXC STENOS & ANASTOM,76100081,CDM,,,,Both,,,2028,507,,2028,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ PLMT BILE DUCT STENT EXISTING ACCESS,76100082,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ PLMT BILE DUCT STENT NEW ACCESS W/PLACE SEP DRAIN CATH,76100083,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMAGE CATH FLUID TRNS/VGNL,76100084,CDM,,,,Both,,,4608,1152,,4608,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCH THERMOPLSTY 1 LOBE,76100085,CDM,,,,Both,,,10259,2565,,10259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCH THERMOPLSTY 2/> LOBES,76100086,CDM,,,,Both,,,10259,2565,,10259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CATHETERIZATION WITH BRONCHIAL BRUSH BX,76100087,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MANOMETRY NEPH/PYELO INDW CATH,76100088,CDM,,,,Both,,,3045,761,,3045,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHARYNGOSTOMY,76100089,CDM,,,,Both,,,2072,518,,2072,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DILATE BILIARY DUCT/AMPULLA,76100090,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ PLMT BILE DUCT STENT NEW ACCESS,76100093,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATH THROMBO INF ART INITIAL S&I BIL,76100094,CDM,,,,Both,,,14171,3543,,14171,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TRANSCATH THROMBO INF VEN INITIAL S&I BIL,76100095,CDM,,,,Both,,,6086,1522,,6086,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ HYPOGAS PLXS,76100096,CDM,,,,Both,,,2320,580,,2320,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEG PRESS WOUND TX <=50 SQ CM NON DME,76100097,CDM,,,,Both,,,530,133,,530,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEG PRESS WOUND TX >50 SQ CM NON DME,76100098,CDM,,,,Both,,,530,133,,530,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEV SOFT TISS 1ST LESION W/IMAGE,76100099,CDM,,,,Both,,,989,247,,989,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ DEV SOFT TISS ADD LESION W/IMAGE,76100100,CDM,,,,Both,,,989,247,,989,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOVENOUS MCHNCHEM 1ST VEIN,76100101,CDM,,,,Both,,,6353,1588,,6353,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOVENOUS MCHNCHEM ADD-ON,76100102,CDM,,,,Both,,,4332,1083,,4332,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX INTERLAMINAR CRV/THRC W/O IMAG GUID,76100104,CDM,,,,Both,,,2328,582,,2328,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX INTERLAMINAR CRV/THRC W/IMAG GUID,76100105,CDM,,,,Both,,,2328,582,,2328,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX INTERLAMINAR LMBR/SAC W/O IMAG GUID,76100106,CDM,,,,Both,,,2328,582,,2328,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX INTERLAMINAR LMBR/SAC W/IMAG GUID,76100107,CDM,,,,Both,,,2328,582,,2328,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX INTERLAMINAR CRV/THRC W/O IMAG GUID,76100108,CDM,,,,Both,,,2578,645,,2578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX INTERLAMINAR CRV/THRC W/IMAG GUID,76100109,CDM,,,,Both,,,2578,645,,2578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX INTERLAMINAR LMBR/SAC W/O IMAG GUID,76100110,CDM,,,,Both,,,2578,645,,2578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX INTERLAMINAR LMBR/SAC W/IMAG GUID,76100111,CDM,,,,Both,,,2578,645,,2578,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH STELLATE GANGLION,76100112,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED CARDIAC SURGERY,76100113,CDM,,,,Both,,,1255,314,,1255,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LARGSC W/LASER DSTRJ LES,76100114,CDM,,,,Both,,,7218,1805,,7218,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ GREATER OCCIPITAL NERVE BIL,76100115,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DRAIN/INJ INTER JOINT/BURSA W/US,76100116,CDM,,,,Both,,,1373,343,,1373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX NONCMPND SCLRSNT 1 VEIN,76100117,CDM,,,,Both,,,9601,2400,,9601,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX NONCMPND SCLRSNT MLT VN,76100118,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOVEN THER CHEM ADHES 1ST,76100119,CDM,,,,Both,,,9859,2465,,9859,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ENDOVEN THER CHEM ADHES SBSQ,76100120,CDM,,,,Both,,,7657,1914,,7657,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC THER APHERESIS PLASMA PHERESIS ICU ONE ON ONE CARE,76100121,CDM,,,,Both,,,3034,759,,3034,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PERQ LAMOT/LAM CRV/THRC,76100122,CDM,,,,Both,,,11035,2759,,11035,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS MARK THOR FOR RT PERQ,76100123,CDM,,,,Both,,,6396,1599,,6396,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISION OF LINGUAL FRENUM (FRENECTOMY),76100124,CDM,,,,Both,,,2072,518,,2072,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PAL & UAC,76100125,CDM,,,,Both,,,1475,369,,1475,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX SCLRSNT SPIDER VEINS,76100127,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC MICROWAVE BRONCH, 3D, EBUS",76100129,CDM,,,,Both,,,14634,3659,,14634,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX AA&/STRD NRV NRVTG SI JT,76100130,CDM,,,,Both,,,1400,350,,1400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX AA&/STRD NRV NRVTG SI JT BIL,76100131,CDM,,,,Both,,,2100,525,,2100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX AA&/STRD GNCLR NRV BRNCH,76100132,CDM,,,,Both,,,1400,350,,1400,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RF ABLTJ NRV NRVTG SI JT,76100133,CDM,,,,Both,,,7828,1957,,7828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RF ABLTJ NRV NRVTG SI JT BIL,76100134,CDM,,,,Both,,,7828,1957,,7828,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC APHERESIS WBC,76100135,CDM,,,,Both,,,2964,741,,2964,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ALVEOLOPLASTY EACH QUADRANT,76100136,CDM,,,,Both,,,5866,1467,,5866,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IRE ABLTJ 1+TUM ORGAN PERQ,76100137,CDM,,,,Both,,,15691,3923,,15691,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJ ANESTH STELLATE GANGLION BIL,76100138,CDM,,,,Both,,,1800,450,,1800,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CORE NDL BX LUNG/MEDIASTINUM PERQ W/IMG,76100139,CDM,,,,Both,,,3151,788,,3151,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REPAIR OF HAMMERTOE,76100140,CDM,,,,Both,,,6391,1598,,6391,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INCISION OF TOE TENDON,76100141,CDM,,,,Both,,,3144,786,,3144,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIABETES IP/OBS TRAIN PER 90 MINS,76100142,CDM,,,,Both,,,486,122,,486,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC RAPID DESENSITIZATION,76100143,CDM,,,,Both,,,621,155,,621,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NJX AA&/STRD GNCLR NRV BRNCH BILATERAL,76100144,CDM,,,,Both,,,2100,525,,2100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CYSTOSCOPY CHEMODENERVATION,76100145,CDM,,,,Both,,,6673,1668,,6673,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INJECTION SPHENOPALATINE GANGLION,76100146,CDM,,,,Both,,,600,150,,600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INS MARK ABD/PEL FOR RT PERQ,76100147,CDM,,,,Both,,,2900,725,,2900,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REVASC LITHOTRIP TIBI/PERONE,76100148,CDM,,,,Both,,,23061,5765,,23061,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EXCISE ANAL EXT TAG/PAPILLA,76100149,CDM,,,,Both,,,2456,614,,2456,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCH LAVAGE W/EBUS,76100150,CDM,,,,Both,,,9201,2300,,9201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REMOVAL CERCLAGE SUTURE WITHOUT ANESTHESIA ,76100151,CDM,,,,Both,,,380,95,,380,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT,76100152,CDM,,,,Both,,,693,173,,693,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INSTLL RX AGNT INTO RNAL TUBE,76100153,CDM,,,,Both,,,534,134,,534,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE,76100154,CDM,,,,Both,,,645,161,,645,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS ADMIT DATE PER HOUR,76200001,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS DIRECT ADMIT,76200002,CDM,,,,Both,,,1534,384,,1534,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT - RADIOLOGY,76200003,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT - G.I,76200004,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT - CARDIOLOGY,76200005,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT - RESPIRATORY,76200006,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT - SURGICAL TIME,76200007,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 30000-31899,76200009,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 32035-32540,76200010,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 32550-32701,76200011,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 32800-32999,76200012,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 33010-39599,76200013,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 40490-49999,76200014,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 70010-77086,76200015,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 77261-77799,76200016,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 78012-79999,76200017,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93015-93018,76200018,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93571-93572,76200019,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93880-93895,76200020,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93922 - 93998,76200021,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93965,76200022,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 95812-95830,76200023,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT THERAPY,76200024,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 96362-96368,76200025,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 30000-31899 ADDTL,76200026,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 32035-32540 ADDTL,76200027,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 32550-32701 ADDTL,76200028,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 32800-32999 ADDTL,76200029,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 33010-39599 ADDTL,76200030,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 40490-49999 ADDTL,76200031,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 70010-77086 ADDTL,76200032,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 77261-77799 ADDTL,76200033,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 78012-79999 ADDTL,76200034,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93015-93018 ADDTL,76200035,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93571-93572 ADDTL,76200036,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93880-93895 ADDTL,76200037,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 96360-96368 ADDTL,76200038,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93965 ADDTL,76200039,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93922 - 93998 ADDTL,76200040,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 95812-95830 ADDTL,76200041,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT THERAPY ADDTL,76200042,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT SOFT-CODED PROCEDURE,76200043,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93451 - 93462,76200044,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93451-93462 ADDTL,76200045,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 90935 - 90947,76200046,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 90935 - 90947 ADDTL,76200047,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93015 - 93018,76200048,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93015 - 93018 ADDTL,76200049,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93303 - 93355,76200050,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93303 - 93355 ADDTL,76200051,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93660 - 93662,76200052,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93660 - 93662 ADDTL,76200053,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93451 - 93462,76200054,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93451 - 93462 ADDTL,76200055,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 94640 TO 94645,76200056,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 94640 TO 94645 ADDTL,76200057,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93005,76200058,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OBS CARVE-OUT 93005 ADDTL,76200059,CDM,,,,Both,,,285,71,,285,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENTIVE BREASTFEEDING COUNSEL 15MIN,77000001,CDM,,,,Both,,,72,18,,72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENTIVE BREASTFEEDING COUNSEL 30MIN,77000002,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENTIVE BREASTFEEDING COUNSEL 45MIN,77000003,CDM,,,,Both,,,222,56,,222,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENTIVE BREASTFEEDING COUNSEL 60MIN,77000004,CDM,,,,Both,,,296,74,,296,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENT BREASTFEED TELEHLTH COUNSEL 15MIN,77000005,CDM,,,,Both,,,72,18,,72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENT BREASTFEED TELEHLTH COUNSEL 30MIN,77000006,CDM,,,,Both,,,150,38,,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENT BREASTFEED TELEHLTH COUNSEL 45MIN,77000007,CDM,,,,Both,,,222,56,,222,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PREVENT BREASTFEED TELEHLTH COUNSEL 60MIN,77000008,CDM,,,,Both,,,296,74,,296,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PNEUMONIA VACCINE ADMIN,77100002,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INFLUENZA VACCINE ADMIN,77100003,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE,77100004,CDM,,,,Both,,,95,24,,95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE,77100005,CDM,,,,Both,,,84,21,,84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ADMINISTRATION HEPATITIS B VACCINE,77100006,CDM,,,,Both,,,71,18,,71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEP B STATE FUNDED VACCINE ADMIN 1ST DOSE,77100007,CDM,,,,Both,,,19.54,5,,19.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEP B STATE FUNDED VACCINE ADMIN ADDL,77100008,CDM,,,,Both,,,19.54,5,,19.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION OR INJECTION CASIRIVI AND IMDEVI,77100014,CDM,,,,Both,,,1125,281,,1125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION BAMLAN AND ETESEV,77100015,CDM,,,,Both,,,1125,281,,1125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION SOTROVIMAB,77100019,CDM,,,,Both,,,1125,281,,1125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION TOCILIZU 1ST DOSE,77100020,CDM,,,,Both,,,1125,281,,1125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IV INFUSION TOCILIZU 2ND DOSE,77100021,CDM,,,,Both,,,1125,281,,1125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EVUSHELD INJECTION ADMIN AND MONITORING,77100023,CDM,,,,Both,,,376,94,,376,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BEBTELOVIMAB INJECTION ADMIN AND MONITORING,77100024,CDM,,,,Both,,,876,219,,876,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ADMN SARSCOV2 VACC 1 DOSE,77100026,CDM,,,,Both,,,238,60,,238,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LITHOTRIPSY XTRCORP SHOCK WAVE,79000001,CDM,,,,Both,,,11101,2775,,11101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DONOR NEPHRECTOMY OPEN LIVING DONOR,81100001,CDM,,,,Both,,,96704,24176,,96704,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL,81200001,CDM,,,,Both,,,71684,17921,,71684,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEART ACQUISITION,81200002,CDM,,,,Both,,,129659,32415,,129659,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HCPCS V2785,81200003,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC AMNOITIC MEMBRANE,81900001,CDM,,,,Both,,,1565,391,,1565,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMODIALYSIS REPEAT EVAL,82000001,CDM,,,,Both,,,1312,328,,1312,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMODIALYSIS ONE EVALUATION,82100001,CDM,,,,Both,,,1154,289,,1154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMODIALYSIS ONE EVAL ICU ONE ON ONE CARE,82900000,CDM,,,,Both,,,1154,289,,1154,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNSCHED/EMERG DIALYSIS ESRD PT,82900001,CDM,,,,Both,,,1077,269,,1077,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEMODIALYSIS ONE EVALUATION ONE ON ONE CARE SELECT,82900002,CDM,,,,Both,,,3365,841,,3365,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMERG DIALYSIS ESRD PT ONE ON ONE CARE SELECT,82900003,CDM,,,,Both,,,3592,898,,3592,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS EVAL,83000001,CDM,,,,Both,,,930,233,,930,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY,90000001,CDM,,,,Both,,,256,64,,256,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED PSYCHIATRIC SERVICE/PROCEDURE,90000003,CDM,,,,Both,,,275,69,,275,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYCH DIAGNOSTIC EVALUATION,90000004,CDM,,,,Both,,,205,51,,205,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ELECTROCONVULSIVE THERAPY,90100001,CDM,,,,Both,,,996,249,,996,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ACTIVITY THERAPY,90400001,CDM,,,,Both,,,267,67,,267,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYTX PT&/FAMILY 30 MINUTES,91400006,CDM,,,,Both,,,223,56,,223,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYTX PT&/FAMILY 45 MINUTES,91400007,CDM,,,,Both,,,205,51,,205,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYTX PT&/FAMILY 60 MINUTES,91400008,CDM,,,,Both,,,211,53,,211,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYTX COMPLEX INTERACTIVE,91400020,CDM,,,,Both,,,0.01,0.01,,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYCHOTHERAPY W/PATIENT 30 MINUTES,91400021,CDM,,,,Both,,,330,83,,330,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN,91400022,CDM,,,,Both,,,190,48,,190,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN,91400023,CDM,,,,Both,,,241,60,,241,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN,91400024,CDM,,,,Both,,,388,97,,388,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES,91400025,CDM,,,,Both,,,186,47,,186,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYTX W PT 45 MINUTES,91400026,CDM,,,,Both,,,330,83,,330,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PSYTX W PT 60 MINUTES,91400027,CDM,,,,Both,,,330,83,,330,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC GROUP THERAPY NOT MULTI-FAMILY,91500002,CDM,,,,Both,,,401,100,,401,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FAMILY THERAPY WO PT,91600001,CDM,,,,Both,,,485,121,,485,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FAMILY THERAPY W PT,91600002,CDM,,,,Both,,,485,121,,485,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MULTI-FAMILY GROUP THERAPY,91600003,CDM,,,,Both,,,401,100,,401,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN,91600006,CDM,,,,Both,,,61,15,,61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN,91600007,CDM,,,,Both,,,156,39,,156,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN,91600008,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15,91600009,CDM,,,,Both,,,68,17,,68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HLTH BHV ASSMT/REASSESSMENT,91800007,CDM,,,,Both,,,185,46,,185,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN,91800008,CDM,,,,Both,,,176,44,,176,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN,91800009,CDM,,,,Both,,,125,31,,125,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,92000001,CDM,,,,Both,,,2312,578,,2312,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POLYSM SLEEP STAGING 4/> ADDL PARAM W/CPAP TX,92000003,CDM,,,,Both,,,3993,998,,3993,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC POLYSOMNOGRAPHY SLEEP STAGING 4/> ADDL PARAM,92000004,CDM,,,,Both,,,3599,900,,3599,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL,92000006,CDM,,,,Both,,,3525,881,,3525,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,92000007,CDM,,,,Both,,,208,52,,208,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TENSILON TEST,92000008,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,92000009,CDM,,,,Both,,,208,52,,208,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,92000010,CDM,,,,Both,,,234,59,,234,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,92000011,CDM,,,,Both,,,259,65,,259,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHORT LATENCY SOMATOSENS EP STD LWR LIMBS,92000012,CDM,,,,Both,,,781,195,,781,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SHORT LATENCY SOMATOSENS EP STD UPR LIMBS,92000013,CDM,,,,Both,,,781,195,,781,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,92000014,CDM,,,,Both,,,596,149,,596,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,92000015,CDM,,,,Both,,,596,149,,596,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,92000016,CDM,,,,Both,,,596,149,,596,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,92000017,CDM,,,,Both,,,1503,376,,1503,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,92000018,CDM,,,,Both,,,1503,376,,1503,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SEP ANY/ALL PERIPH NV UPPER & LWR LIMBS,92000019,CDM,,,,Both,,,748,187,,748,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TC MOTOR - UPPER & LOWER LIMBS,92000020,CDM,,,,Both,,,1409,352,,1409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IONM IN OPERATING ROOM 15 MIN,92000021,CDM,,,,Both,,,229,57,,229,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC ART PRESSURE WAVEFORM ANALYS,92000022,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCD VASOREACTIVITY STUDY,92000023,CDM,,,,Both,,,543,136,,543,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TCD EMBOLI DETECT W/O INJ,92000024,CDM,,,,Both,,,565,141,,565,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEAR IFR 2IMG MIBMN GLND I&R,92000025,CDM,,,,Both,,,99,25,,99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IONM REMOTE/>1 PT OR PER HR,92000026,CDM,,,,Both,,,933,233,,933,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HOME SLEEP TEST/TYPE 2 PORTA,92000027,CDM,,,,Both,,,1698,425,,1698,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HOME SLEEP TEST/TYPE 3 PORTA,92000028,CDM,,,,Both,,,1698,425,,1698,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SLEEP STUDY UNATT&RESP EFFT,92000029,CDM,,,,Both,,,301,75,,301,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SLEEP STUDY ATTENDED,92000030,CDM,,,,Both,,,1007,252,,1007,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC UNLISTED NONINVAS VASC DX STUDY PROC,92000031,CDM,,,,Both,,,51,13,,51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC BRONCHIAL ALLERGY TESTS,92000032,CDM,,,,Both,,,1113,278,,1113,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMG RTA DETCJ/MNTR DS STAFF,92000033,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IMG RTA DETC/MNTR DS PHY/QHP,92000034,CDM,,,,Both,,,77,19,,77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC FLUORESCEIN ANGRPH UNI/BI,92000035,CDM,,,,Both,,,635,159,,635,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,92100001,CDM,,,,Both,,,1114,279,,1114,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NONINVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,92100002,CDM,,,,Both,,,470,118,,470,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NONINVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,92100003,CDM,,,,Both,,,734,184,,734,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VASC(DUP ABD/PELVIC ORG, COMP)",92100004,CDM,,,,Both,,,889,222,,889,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TRANSCRANIAL DOPPLER, HEAD, COMPLETE",92100005,CDM,,,,Both,,,1313,328,,1313,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC PENILE DUPLEX DOPPLER US, COMPLETE",92100006,CDM,,,,Both,,,644,161,,644,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ARTERIAL DOP.,ARM,LTD/UNILAT IMAGING",92100007,CDM,,,,Both,,,607,152,,607,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ART.DOP.,LEG,BILAT.,W PRESS/TREADMILL",92100008,CDM,,,,Both,,,471,118,,471,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ART.DOP.,LEG, BILAT/IMAGING",92100009,CDM,,,,Both,,,760,190,,760,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ART DOP. LEG,UNI/LIMITED IMA",92100010,CDM,,,,Both,,,565,141,,565,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUPSCAN XTR VEINS COMP BILATERAL STUDY,92100011,CDM,,,,Both,,,430,108,,430,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VERTEBRAL ARTERY, UNI/LIMITED",92100013,CDM,,,,Both,,,622,156,,622,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC TRANSCRANIAL DOPPLER, HEAD, LIMITED",92100014,CDM,,,,Both,,,751,188,,751,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC ART.DOP.,ARM COMPLETE,BILAT.,IMAGING",92100015,CDM,,,,Both,,,707,177,,707,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DUP,AO/IVC/ILIACS,GRAFT,COMP",92100016,CDM,,,,Both,,,644,161,,644,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC VASC.(DUP ABD/PELVIC ORG, LTD)",92100017,CDM,,,,Both,,,577,144,,577,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DUP,AO/IVC/ILIACS,GRAFT,LTD",92100018,CDM,,,,Both,,,565,141,,565,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"HC DOPPLER,DIALYSIS SHUNT EVALUATION",92100019,CDM,,,,Both,,,643,161,,643,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC INTERROGATION VAD IN PRSON W/PHYSICIAN ANALYSIS,92100020,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUPSCAN XTR VEINS UNILATERAL/LIMITED STUDY RT,92100021,CDM,,,,Both,,,802,201,,802,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUPSCAN XTR VEINS UNILATERAL/LIMITED STUDY LT,92100022,CDM,,,,Both,,,802,201,,802,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUPLEX FLOW PENILE FUP/LIMIT,92100023,CDM,,,,Both,,,287,72,,287,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PENILE PLETHYSMOGRAPHY,92100024,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DUPSCAN XTR VEINS UNILATERAL/LIMITED STUDY,92100025,CDM,,,,Both,,,802,201,,802,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,92200003,CDM,,,,Both,,,239,60,,239,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,92200004,CDM,,,,Both,,,427,107,,427,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,92200005,CDM,,,,Both,,,596,149,,596,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,92200006,CDM,,,,Both,,,774,194,,774,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,92200007,CDM,,,,Both,,,274,69,,274,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC VISUAL EP TSTG CNS CHECKERBOARD/FLASH,92200008,CDM,,,,Both,,,596,149,,596,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,92200010,CDM,,,,Both,,,596,149,,596,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,92200011,CDM,,,,Both,,,820,205,,820,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,92200012,CDM,,,,Both,,,239,60,,239,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NERVE CONDUCTION STUDIES; 1-2 STUDIES,92200013,CDM,,,,Both,,,228,57,,228,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NERVE CONDUCTION STUDIES; 3-4 STUDIES,92200014,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NERVE CONDUCTION STUDIES; 5-6 STUDIES,92200015,CDM,,,,Both,,,405,101,,405,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NERVE CONDUCTION STUDIES; 7-8 STUDIES,92200016,CDM,,,,Both,,,652,163,,652,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NERVE CONDUCTION STUDIES; 9-10 STUDIES,92200017,CDM,,,,Both,,,903,226,,903,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NERVE CONDUCTION STUDIES; 11-12 STUDIES,92200018,CDM,,,,Both,,,993,248,,993,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NERVE CONDUCTION STUDIES; 13 OR MORE,92200019,CDM,,,,Both,,,1084,271,,1084,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMG EACH EXTREMITY - LIMITED,92200020,CDM,,,,Both,,,203,51,,203,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC EMG EACH EXTREMITY - COMPLETE,92200021,CDM,,,,Both,,,308,77,,308,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NEEDLE EMG ANAL/URETHRAL SPHINCTER,92200023,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MUSCLE TEST LARYNX,92200024,CDM,,,,Both,,,178,45,,178,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MUSCLE TEST HEMIDIAPHRAGM,92200025,CDM,,,,Both,,,214,54,,214,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC NDL EMG SINGLE FIBER,92200026,CDM,,,,Both,,,233,58,,233,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MUSC TST DONE W/N TST NONEXT,92200027,CDM,,,,Both,,,104,26,,104,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN,94000001,CDM,,,,Both,,,725,181,,725,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST,94000002,CDM,,,,Both,,,85,21,,85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PHOTOTHERAPY DAILY,94000004,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC HYPOTHERMIA ILL NEONATE,94000005,CDM,,,,Both,,,232,58,,232,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QHP OP PULM RHB W/O MNTR,94000006,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC QHP OP PULM RHB W/MNTR,94000007,CDM,,,,Both,,,128,32,,128,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TR INDIV TREATMENT 1 (15 MIN),94100004,CDM,,,,Both,,,120,30,,120,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC TR GROUP TREATMENT 1 (15 MIN),94100008,CDM,,,,Both,,,60,15,,60,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIABETES GRP TRAIN PER 30 MINS,94200001,CDM,,,,Both,,,350,88,,350,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SYMPTOMATIC SMOKE/TOBACCO COUNSEL 4-10MIN,94200004,CDM,,,,Both,,,119,30,,119,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC SYMPTOMATIC SMOKE/TOBACCO COUNSEL>10MIN,94200005,CDM,,,,Both,,,201,50,,201,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIABETES OP SELFMANG TRAIN INDIV PER 30 MIN,94200006,CDM,,,,Both,,,350,88,,350,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MENTAL HEALTH EDUC TRAINING 45 MIN OR MORE,94200007,CDM,,,,Both,,,764,191,,764,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MIN,94200008,CDM,,,,Both,,,67,17,,67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 MIN,94200009,CDM,,,,Both,,,52,13,,52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MEDICAL NUTRITION THERAPY GRP2/> INDIV EA 30 MIN,94200010,CDM,,,,Both,,,27,7,,27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MNT REASSESSMENT 15 MIN CHG IN DX,94200011,CDM,,,,Both,,,57,14,,57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MNT REASSESSMENT GROUP 30 MIN CHG IN DX,94200012,CDM,,,,Both,,,27,7,,27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC MODERATE COMPLEXITY LACTATION CONSULT,94200015,CDM,,,,Both,,,123,31,,123,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC LACTATION CLASS,94200016,CDM,,,,Both,,,162,41,,162,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIABETES IP/OBS TRAIN PER 30 MINS,94200017,CDM,,,,Both,,,152,38,,152,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC DIABETES IP/OBS TRAIN PER 60 MINS,94200018,CDM,,,,Both,,,319,80,,319,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OUTPATIENT CARDIAC REHAB W/O CONT EKG MONITOR,94300001,CDM,,,,Both,,,648,162,,648,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC OUTPATIENT CARDIAC REHAB W/CONT EKG MONITORING,94300002,CDM,,,,Both,,,896,224,,896,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PAD REHAB PER SESSION,94300003,CDM,,,,Both,,,100,25,,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HC PRO INTERP EKG,98500009,CDM,,,,Both,,,25,6,,25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,